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Latest blog from our CEO: Human rights are at stake in Scotland’s social care.

Human rights are at stake in Scotland’s social care.

On Thursday last week within the beautiful setting provided by Clydesdale Bank’s Banking Hall in Glasgow Scottish Care held its first Care Lecture. I hope it will become an annual opportunity to hear a guest speaker explore an issue of the day relevant to the care and support of older people.

We were honoured to have Judith Robertson, Chair of the Scottish Human Rights Commission as our lecturer. She spoke to the theme of “Human rights in social care.’ The full text of her address with added analysis will be available in our second Care Cameo to be published in a few weeks time.  Needless to say it was both challenging and thought provoking and centred upon a strong critique of both the UK and Scottish Governments failures to properly embed human rights in social policy.

I will leave further comment on Ms Robertson’s analysis for another time but what I want to focus on today is a wider issue of the prevalence of human rights in contemporary public and policy discourse. This is a markedly different position to where rights were in public discourse even some five years ago and in no small part is down to the work of the SHRC and its National Action Plan for Human Rights (SNAP).But there is always a concern that the rhetoric and pervasiveness of the use of the language of rights isn’t followed through in the realities of their adherence and at what is happening at the care face. That is probably a concern which is beginning to have validity. So briefly I want to explore where rights are engaged and may be facing challenge.

The Guardian newspaper this week  had a helpful article which explored some of the challenges faced by social workers in the assessment of clients in an environment where middle and senior managers are faced with hard decisions around austerity. They have utilised a human rights based approach to highlight where there is a restriction or diminution in these rights. I have personally been highly critical of the systems which are currently operating around Self-directed Support and which seem antithetical to the exercising of a human rights based approach. However as Carlyn Miller  has shown in her recent report it is absolutely possible to use human rights to support stretched social workers to adhere to the values and principles at the heart of good social work. In that regard we need to support a hard-pressed group of workers to resist the compromises of the system which serve to limit the rights of older Scots.

However, it is perhaps in the area of procurement and commissioning that we feel a particular sharpness and restriction of rights. The statistics around Self-directed Support and the limitation of informed decision-making and exercising of choice by older people speaks to me at best of poor training and inadequate advocacy and at worse of blatant age discrimination. But they also speak to a system which is disproportionately unbalanced. How can one person/organisation be assessor, commissioner and provider and still remain transparent and equal? Certainly not in that Scottish IJB which recently declared that it wants 70% of social care provision to be provided by one provider (itself) – I wonder if they have told the older people of their communities that that is their extent of choice?

At other areas of social care in Scotland there is a deficiency of rights –

  •           where electronic call monitoring systems are being used by local authorities to monitor homecare contracts but result in the demeaning of a workforce by effectively treating them as human automaton in a trustless Big Brother approach;
  •           where there is a failure to properly resource providers to adequately train and support staff in our communities and care homes who are delivering the majority of palliative and end of life care;
  •           where the levels of regulation and registration are such that the same is expected of an individual with 3 weeks training as a care worker as of someone who has had 3 years preparation for the role of a nurse for social worker;
  •           where the inadequacy of resourcing is resulting in thousands of older Scots being prevented from being given sufficient finance to allow them to remain as part of their communities;
  •           where an appropriate focus on dementia is used to mask the lack of recognition for the other mental health needs of older Scots.

And I could go on. The rhetoric and talk of rights is cheap and casual, the exercising and implementing of rights are costly and hard. It is the latter we need to engage in or we will continue to use the language of sound bite. We sometimes imagine the abuse and limiting of human rights as out there, somewhere distant from where we are and the now, the truth is that human rights are on the line right now and right here as we deliver social care in Scotland. 

Dr Donald Macaskill

@DrDMacaskill

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Guest Post from Care at Home Development Officer, Julie Fraser

Kick the Sides off the Box!

I think when I came into this world; one of the first words out of my mouth was “why?”  Quickly followed by “how, what, when, where, and again why”.  You can feel for my poor mother!  I questioned everything about the world… why are things done that way, how does that work, what is the point in doing that, who benefits from doing things this way….and most importantly why do we give our compliance without questioning any of it?

And well, a few decades down the line, that hasn’t changed much… I still “won’t tow the line” as my mother delicately describes me to others! 

Over a year into this Scottish Care Development Officer role and I have found the perfect fit for my ever questioning mind.  North and West Highland covers a huge geographical area (if I remember correctly Highland area covers around a third of the whole of Scotland) however, this offers unique challenges in terms of devising and developing care services over such vast and mainly rural terrain.

A high reliance on traditional NHS care at home delivery and a lack of any available service in some areas, the scale of the challenge is great.  But the timing of this drive to improve and increase care services could not have been better.  With a focus on community empowerment, with Self Directed Support legislation changing the way we think about delivering services and with an increasing ageing population and a government focus on the care of the future- we are in an environment of possibility.  A blank canvas if you like- with the paint, paint brushes and subject all waiting to create “a masterpiece”!

So we can Kick the sides off the box.  More and more there is a drive towards new innovative services, new models of delivery, moving away from “what we have always had”.  As said above, let’s not think outside the box, let’s kick the sides of the box away and think like there never was a box!

Let’s not work from what we have, but work from what we need and how we build it.  When a service user recently told me she could not plan a holiday like any other person would plan a holiday, I asked her why not?

And yes she has a disability, and yes she has a motorised wheel chair, and yes she needs support to eat, drink, move, all of those things.  And yes the team around her want to keep her safe and secure and for no harm to come to her…. But she has always wanted to visit Rome.  So we are working through all the reasons why it might not be possible, and are finding ways to make it possible- because that is what is important to her.  Making the same choices anyone else would make, and weighing up the options and putting in place the supports that are needed to achieve that. 

We have to break down that box where we put people for our own peace of mind!  Our thinking should focus on what is possible, regardless of what has come before and what hurdles might be there in our road.  Anything is possible!

In Highland we have taken this opportunity to rethink things and have run with it.  We have some very innovative stuff happening and this seems to be contagious and is growing.  Communities are becoming more empowered, and as the pioneering examples show fruition, others build in confidence to embrace the opportunities that our forward thinking commissioners have offered.

We are exploring a large variety of new and different ways of delivering care.  When you live in a rural and remote area, you are forced to think outside the box, as the box was designed by someone in a city and it never really fitted anyway! 

In Highland we have care homes adding variations to their businesses by expanding into care at home delivery, day care centres looking to develop into care at home, small micro enterprises working within their own local communities across Highland, co-productive, collaborative relationships with the NHS, an overnight service that operates between 3 local providers and we are exploring how to develop 24 hour services in rural and remote areas – perhaps a joint venture between care at home providers and an emergency service. 

Anything really is possible when you kick the sides off the box!

Another element of the current climate that I am passionate about is Person Centred Service Delivery.  Coming from a background of person centred counselling at a time when nothing was considered more dangerous than to let people make their own decisions- it is mildly odd but thoroughly refreshing to now be in a world where we are strive to develop person centred services.  Understanding the term and the basis from which it comes, rather than just using the latest “buzz” word, is our next and biggest challenge. 

When we achieve that, we truly will have kicked the sides right off the box!

Julie Fraser, Care at Home Development Officer North & West Highland

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Latest blog from our CEO: Sex discrimination at the heart of social care in Scotland

Sex discrimination at the heart of social care in Scotland

Overheard whilst visiting friends: young 5 year old boy says to mum who is struggling to get the DVD player to work, “We will need to get dad. It’s men’s work!” The stony glare from his mother highlighted for me the way in which our children’s view of the world and the roles we play in it can be so greatly influenced by gender attitudes. Brought up 5 decades ago on one level society seemed to be giving me a clear message, namely that men did the hard physical work and women did jobs such as nursing and care. Despite advances on so many fronts I’m less and less convinced that things have changed in terms of our stereotyping of roles or that we have undertaken the serious and hard work needed to address gender segregation in society. So its not surprising a 5 year old in 2017 is still demonstrating attitudes of 50 years before.

At the end of last week the media reported the result of a historic equal pay case that could potentially cost Glasgow City Council hundreds of millions of pounds. For 12 years lawyers representing more than 6000 mainly female workers fought against the city administration which had graded jobs dominated by men, such as gravediggers and refuse collectors, above those largely done by women, such as home carers and cleaners. Last week three judges at the Court of Session quashed an earlier employment tribunal ruling that the grading system met equal pay laws.

Dependent upon a settlement the ruling has huge fiscal implications for Glasgow City Council but what it also displays is the insidious acceptable face of sex discrimination that has infected the treatment of care staff over the years.

Is it acceptable in Glasgow or elsewhere that predominantly male roles, such as gravediggers or refuse collectors, however valued a role they play, are rewarded so much more than mainly female care staff?

Why is it that we value the work of those who care so little? The fact that we are paying ‘only’ the Scottish Living Wage and struggling to even achieve that – communicates its own message of limited value and respect, as does the term ‘un-skilled.’ Yet the reality couldn’t be further from the truth. Today our care staff are engaged in multi-skilled, complex, clinical care and support – and still we reward them less than those who dispose of our detritus. It’s not surprising then that staff say they are made to feel ‘worthless.’

It seems to me that the whole of society continues to demean and devalue care. Our local authorities and Integrated Joint Boards are no doubt somewhere in Scotland as I write this issuing a tender or contract whose poor restrictive terms will make it inevitable that a care provider will have no alternative but to offer staff low terms and conditions. And probably the same authority will hypocritically laud itself as a Living Wage Employer – that is to its own staff!

Added to that when you eventually do get a contract the chances are that electronic contract monitoring will make staff feel as if Big Brother is watching them every step of their day! There is a simple truth that fair contracts and commissioning lead to fair work practice.

The Tribunal ruling against Glasgow City has helped to shine a light on discriminatory practice. With a workforce which is predominantly comprised of women at some 86% I am absolutely certain that the unequal treatment, poor terms and remuneration, intrusive work monitoring and lack of trust, are in part the result of systemic sex discrimination in social care in Scotland. Would any sector or profession dominated by men have to endure such unequal treatment and abuse?

Care is a female role so clearly not as important or worthy of reward as manual masculine labour is. That’s the message we are communicating and not just to 5 year old boys. It’s time to start challenging the status of care and stop having to scrimp and robustly negotiate for financial crumbs to provide quality services and offer decent conditions for workers.

It’s just a pity that in Scotland’s social care system expensive legal cases have become the route to achieving equality and dignity for our female workforce and by extension for the thousands they care for.

Donald Macaskill (Dr)

@DrDMacaskill

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Guest Post from Local Integration Lead, Anne Austin

Argyll and Bute is a beautiful part of the country but vast and as far as possible we divide the travel and meetings between us, with Susan Spicer covering MAKI (Mid-Argyll, Kintyre & Islay) and OLI (Oban, Lorne & the Isles) and me covering Bute & Cowal and Helensburgh & Lomond.

We are fortunate that we are familiar with the geography and how to cover the area as effectively as possible. We have established positive relationships with Independent providers, Third Sector and Health & Social Care Partners (HSCPs).

We continue to attend locality planning groups monthly and have a seat at strategic steering groups and planning meetings.

We have had a busy and productive time in Argyll and Bute over the past few months since we last blogged.

As well as the planned quarterly meetings of the Care Home Network and the Care at Home Forums we have hosted three Development Days for providers:

1. Monitoring and Improving the Quality of Care in Care Homes “Quality Outcomes: Improving Care Together” 24 April 2017

Quality in Care Homes Poster final

2. Care Home Development Day – “Partners in Progress: Moving from National to Local Experience” 16 May 2017

FeedbackCareHomesdevday16May2017

3. Care at Home Development Day – “My Neighbourhood Team” 19 June 2017

FeedbackCAHdevday19June2017

These events have been strongly supported by the local independent sector and the HSCP. 

In addition, Argyll and Bute have hosted two SSSC events:

  • Consultation on developing a generic induction programme – 09 November 2016
  • Step into Leadership – 28 February 2017

Both these events were well attended by independent providers and we received positive feedback from the presenters on the level of participation from attendees.

One of the major challenges for Argyll and Bute at present is recruitment and retention. In Oban this is particularly difficult for care at home providers.  There is low unemployment in the area and a lot of competition from the tourist industry for the available workforce. We have been working with partners from the ihub on a workforce planning model alongside developing a more generic health and social care worker job description. It is hoped that providers and HSCP staff will work together on a model of care that will attract and retain more people into the care at home sector.

Other opportunities have been presented through the national Scottish Patient Safety Programme (SPSP) project on Reducing Pressure Ulcers in Care Homes. This SPSP programme, with the support of Scottish Care and the Care Inspectorate, aims to reduce pressure ulcers in care homes by 50% and runs until December 2017.  Argyll and Bute (as part of Highland) is one of four Health and Social Care Partnerships taking part in the programme. The project aims to support staff to ensure residents receive the best care to prevent pressure ulcers developing, using reliable risk assessment and care planning. We expect to improve local collaboration between sectors and to encourage the use of quality improvement methodology, whilst developing a learning network to share the outcomes and other improvement activity taking place in care homes. This builds on our previous successful work in Care Homes, where every care home in Argyll and Bute signed up to use the quality improvement methodology to look at falls prevention and management.

This blog gives just a flavour of our day to day work in Argyll and Bute.

On a personal note, I love working in such a beautiful area.  Every day is different and presents new surprises and challenges. I have indeed been fortunate to meet a wide variety of colleagues and people who use services. So many people who are willing to do things differently and be flexible in delivering services that meet the sometimes challenging and unusual requests that help people to live more fulfilling and independent lives.

Anne Austin,

Argyll and Bute Local Integration Lead, Scottish Care (job-share with Susan Spicer)

 

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Latest blog from our CEO: Transforming the social care workforce

Every week there seems to be yet another report highlighting the crisis state in which the health and social care workforce finds itself. We have had dire warnings about the shortage of doctors and their levels of fatigue. We’ve had the RCN stating the pressures resulting from nursing vacancies in the NHS. Scottish Care in the spring stated that 9 out of 10 care at home organisations are struggling to fill vacancies and two weeks ago we reported again on nurse vacancies running at over 1 in 4 posts lying empty and over 2/3 of care home providers struggling to fill positions. With the added pressure of Brexit, the rising Scottish Living Wage and pressure from retail and hospitality it is an operational nightmare to try to fill posts and establish an adequate workforce.

We need a fundamental review of the workforce in social care and that cannot be undertaken in isolation from a root and branch review of the whole sector. At the moment it feels as if we are lurching from one reaction to another without a coordinated and thorough review.

Policy makers declare that we need to develop a workforce to fit the needs of the future. We keep hearing about ‘new models of care’ as if there is a utopian reality where quality person centred rights based care is just waiting to be discovered offering a cheap alternative to current models. That is a naive wishful thinking that ignores that the basics of care are inherently consistent – the heart remains the same whatever the outward form of delivery. That heart requires people, namely a well-equipped, resourced, valued and skilled workforce.

We have to accept that we will never address workforce shortage by under-resourcing the care sector. How can we build stability, career pathways and a future for staff to commit to when we have organisations with no sense of sustainability due in part to one year contracts and a lack of investment in a sector which is a major player in the Scottish economy?

There are new and innovative approaches to the care workforce with the work of Highland Homecarers and the Local Cornerstone model to name but two.  Whatever the specific model for a workforce fit for the future they have some intrinsic and consistent elements:

  • Autonomous frontline workers able to make decisions and supported to take action
  • Self managed teams where the emphasis is on collegiality and outcomes – a sense of making a contribution that matters
  • Professional respect with colleagues in other teams
  • Being part of a multi-disciplinary team with clear escalation routes and an emphasis on locality and flexibility
  •  Light touch oversight through proportionate regulation and appropriate levels of information recording
  • An emphasis on staff physical and emotional wellbeing as critical to a healthy team
  • Excellent learning and development for staff who are enabled through rota planning to learn and to develop their skills for whatever career pathway they choose
  • Appropriate and rewarding terms and conditions as well as a good level of basic pay.

These are some of the ingredients which we know when they are present staff are made to feel valued and are therefore more likely to remain in their posts. Yet what we have today is light years away. What we have at present are reports which like one from Christie & Co tell us that care homes say they are “increasingly competing with supermarkets like Aldi and Lidl who are actively recruiting and offering attractive pay rates”.

Getting it right for our workforce means getting it right for those who are supported and cared for in our communities and care homes. This should be a set of jobs valued and recognised for their benefit to the whole of Scottish society.

 @DrDMacaskill 

 

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Guest Post from Local Integration Lead: Sue Newberry

Community, Culture and Co-production

When our family moved to the beautiful Isle of Whithorn our friends and neighbours said that ‘if incomers make it through three winters they probably stay!’ Well, 16 years later the Isle is still our safe haven – and to be honest, where else would you want to live?

We moved here from the Midlands and soon felt at home - not only because of the familiar stone dykes surrounding the fields, but more importantly because of the local sense of community and the local culture created by residents and our regular visitors.

I originally joined Scottish Care as a consultant to support Reshaping Care for Older People in Dumfries & Galloway in August 2013. Since then, a small team has been developed to support a range of different R&D activities and now Health and Social Care improvements. For this blog, I’m going to focus on one unique element of our work – and, after all,  we all need a bit of culture!

Research has demonstrated that organisational culture is now a major factor in the success of any organisation or partnership. In D&G, all four partners (the NHS, Social Services, Third and Independent Sectors), have started to work together to improve the culture of our partnership. We believe that this is will help to underpin how the partnership is able to co-design, co-produce and co-deliver sustainable care and support services in the future.

Measuring and changing Organisational Culture

Working with Human Synergistics UK, a representative sample of over 2500 individuals from across our partnership completed a questionnaire called the Organisational Culture Inventory ® or OCI. This phase of our work generated two important results:

  • our ‘current culture’ – where we are now, and
  • our ‘ideal culture’ – where our partnership wants to be in the future

The OCI measures what is expected of members of organisations and helps us understand how different team members feel in their work role. Results are plotted on an OCI Circumflex which shows the distribution of results across 12 different ‘styles’. For example, Style 12, (‘Self-Actualising’), is where ‘Members are expected to gain enjoyment from their work and produce high-quality products/services’.

 These 12 styles are grouped into three important clusters:

  1. constructive styles (shown in blue),
  2. aggressive/defensive styles (shown in red) and
  3. passive/defensive styles (shown in green).

The circumflex shown below illustrates the OCI Research Benchmark, the culture of the most successful organisations and partnerships – notice all the blue!

Our partnership results have highlighted differences between different sectors and between different groups of staff – all of which have helped inform our improvement plan. Team members, from all partners, have become accredited in the use of these tools and are working together with colleagues from all localities to create improvements.

Measuring and changing leadership styles

We believe that ‘Culture happens. Leaders and managers can let it happen or they can manage what happens. It is a choice.’ We want to harness and improve the leadership across all sectors, to move us closer to achieving the ideal overall culture for the partnership.

An important element of our improvement plan is already well underway, lead by our IJB members. Research has demonstrated that to be truly effective and efficient leaders we need:

  • a better understanding of ourselves
  • a better understanding of our own way of thinking and how resulting behaviour is perceived by others
  • an appropriate balance between ‘task’ and ‘people’ orientation.

The Life Styles Inventory (LSI) enables leaders to do just that, comparing self-reflections and feedback from our colleagues. Two cohorts of IJB members and senior leaders from across the partnership have already engaged in this process.

Working together

The LSI and OCI work together to help us identify improvements at an individual and at an organisational level. Creating the ideal culture begins with each one of us – we all need to ‘take a good, hard look in the mirror’ and see how we can improve. Is what we’re doing helping the partnership to achieve that long-term vision of our ideal culture? If not, we need to adjust our way of thinking and/or our own behaviours. Remember ‘Leaders and managers can let it happen or they can manage what happens. It is a choice.’ In fact … its our choice. Ignoring ineffective behaviours or ‘walking by’ won’t get the job done for HSCI.

As a partnership we have to be honest with each other to identify and change those things that are no longer fit for purpose. This could include a range of different things that need to be changed such as:

  • improving our understanding of each others’ roles and responsibilities
  • enhancing the way that our meetings are structured and who is invited to attend those meetings (and whose voice is not heard)
  • the way we treat, listen to and respect each other
  • sharing information across all appropriate partners to support the efficient delivery of care and support services

Focusing on the ‘tasks’ of creating new models of care, developing early intervention strategies, delivering sustainable intermediate care etc.  is, of course, vital. But this important work relies on all four sectors working together as equal partners to co-design, co-produce and co-deliver sustainable care and support services in the future. And to do this well we all need a bit of culture!

 

Dr. Sue  Newberry, Regional Integration and Improvement Manager, Dumfries & Galloway

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Latest blog from our CEO: A human right to health and care?

A human right to health and care?

In my role as CEO I often get invitations to go to events and seminars furth of Scotland. As a rule I tend to turn down the vast majority of such invites feeling that they are not directly pertinent to the work of Scottish Care. Last week, however I accepted an invitation to join a small group of economists, senior Government officials from the four nations, and policy experts to explore and contribute to the latest research on how we should fund/finance health and social care in the United Kingdom. Organised in London by the Health Foundation and Rand Europe, during the seminar a group of twenty of us explored the various developing ‘options’ and their relative attributes.

How we finance health and social care in the years and decades ahead is an important issue faced as we are with the potential of a growing number of healthy older individuals and fewer and fewer people of working age to contribute through direct taxation. The technical debate on the relative merits of  individual insurance, direct taxation and mixed contribution modelling etc was all very challenging but what I was left with on the way home after the meeting was a whole range of thoughts on the inequality of our treatment of health and social care.

It is part of our practice and policy DNA to know that NHS services are free at the point of access. Indeed the NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When it was launched by the then Minister of Health, Aneurin Bevan, on July 5 1948, it was based on three core principles:

  • that it meet the needs of everyone
  • that it be free at the point of delivery
  • that it be based on clinical need, not ability to pay

So today nearly 70 years later we would not expect to pay for a hospital bed or an A&E consultation or a GP visit. Indeed in Scotland even services we once paid for are now free, such as prescriptions. In that sense they are universal.

The First Minister has stated her particular desire to see that in terms of human rights in Scotland we will be able to do ‘even more, even better’ (See speech https://news.gov.scot/speeches-and-briefings/snap-human-rights-innovation-forum, December 2015). She at that moment and subsequently has encouraged the consideration that Scotland might become the first part of the United Kingdom to consider embedding the ‘right to health’ as part of our legislative framework. See a fuller description of this debate at http://www.healthscotland.scot/media/1276/human-rights-and-the-right-to-health_dec2016_english.pdf

Now what a ‘right to health’ might mean in practice and for those who access as well as deliver health services is open to much debate. But in this debate what has been noticeably absent is a consideration of how should that right to health relate to social care.

I have written elsewhere (https://www.scottishcare.org/scottish-care-news/blogs/lessons-from-a-boiler-breakdown/) about how integration has enabled us in Scotland to start to embed a whole system approach to the health and care impacts which an individual experiences, for good or ill, during their lifetime. Indeed I am increasingly of the opinion that one of the barriers to truly focusing upon the person is our continued encampment in health and social care camps. Whether it be the lack of fully pooled budgets, a split workforce strategy, an over-emphasis on one part than the whole, we are some way off from effective integrated working. But for individual citizens whether it’s from the NHS or a care home we receive our care is of less concern to than is the quality and essence of the care received.

In practice and policy we are a long distance from a Wellbeing Service incorporating health and social care. Indeed one of the issues that hit home to me in my meeting in London is the inequality of the two (however linked) systems we currently have. Because as much as we would never conceive paying for an NHS provision if we are living with cancer – why should we as an individual supported in the community be means-tested for our care and support if we live with dementia? Why is there an inequality in the way in which we expect people to pay for their social care be it in a care home or their own home, but do not expect the same if a person was in an NHS long-stay ward? Is the care we get from the NHS better or more important than the care we receive from social care staff? Does the presence of a stethoscope or uniform enhance the professionalism on offer? Are we emphasising clinical care as more fundamental to well-being than other attributes such as connection, relatedness, belonging etc?

If we are creating a joined up and integrated system we are going to have to start asking about the equality of access, affordability, contribution and capacity.

If we are to have a right to health, free at the point of access, then we are going to have to start asking not just how we finance social care but whether in a w(holistic) system which is truly integrated why should one part be free for some treatments and some conditions, and another part of the system be chargeable?

In essence if we are to have a right to health I believe that also means we need to have to develop a ‘right to health and (social) care’. In some sense in her speech which highlights the human rights bestowed by self-directed support legislation, the First Minister is making that same assumption. So what does a right to health and social care mean for the way we finance our joint system? What does it mean for the way we reward and recognise the value of the workforce in that integrated system? What does it mean for the contribution of the third and independent sector not just in social care but also in health?

So, all in all, an interesting trip south.

Donald Macaskill

@DrDMacaskill

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Guest post from Local Integration Lead, Janice Cameron

My Hopes

I’ve been asked to write a blog for Scottish Care,  though I’m not sure I’ve got anything interesting to say; I thought that it was only people who have been to exotic places or “High Heid Yins” who write blogs of any interest.

I qualified as a nurse 34 years ago and have had various posts in the NHS and Independent Sector so surely after all those years I must have something of interest to say.

So here I now find myself putting my musings down on paper!!

Recently I had some wonderful news.

My son and his partner are expecting their first child, a first Grandchild for my Husband and I (already I can hear the chorus of “you’re too young to be a Granny”, which echoes my own thoughts !!!) however, I am absolutely over the moon. This got me thinking about the future and my hopes for my Grandchild, what would I hope for them: a happy, healthy, carefree life, safe and secure and surrounded by love.

I then started to think about me as I get older, what are the hopes for my future?

Will I always be independent, healthy, living in my own home or will I require the help of the services which myself and colleagues across Scotland are trying to ensure as part of Health and Social Care Partnerships (HSCPs), which are person-centred, flexible, responsive, innovative and fit for purpose?

As Integration and Improvement Leads, myself and my colleagues across Scotland have been involved in many pieces of innovative work around Falls, Social Isolation, Care about Physical Activity, Pressure Ulcers, Palliative Care, My Home Life and many more across very diverse areas and topics.

I have seen the impact that this has made and is making, so my hope for the future is that this continues to happen for a very long time to come.

On a more personal level, I hope as I grow older that I remain part of my community and that whether I am in my own Home or a Care Home, I am treated with dignity, respect and as an individual.

I hope my opinion will always matter and I will remain a valuable member of society and no matter how crabbit or misbehaved I get. I hope the person looking after me, whether that be my family or a carer, has the patience of a saint!!

This is my first attempt at a blog and I notice all good blogs have a quote somewhere so I have one from the Rev Jesse Jackson:

“At the end of the day we must go forward with hope and not backward by fear and division”

I think I have now exhausted my braincells so I hope my husband has the kettle on!

 

Janice Cameron

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Latest blog from our CEO: Statistics to Shame

Statistics to shame.

Self-directed Support is the jewel in the crown of Scotland’s social care legislation. It is legislation which sets us apart as a nation which seeks to bestow increased control, choice and decision making onto those who need to access care and support. It has been rightly much vaunted and valued and it is quite clearly failing. The creation of such primary legislation requires vision, insight and not a little courage. However for vision to become reality requires equal energy, resourcing and robust implementation especially, as in this instance, where significant cultural change has to be fostered and resistance overcome. This clearly has not and is not happening. Legislation, however innovative, is merely words unless Government ensures robust enactment.

Three years into implementation the Scottish Government yesterday (11 July) published statistics on the progress of Self-directed Support which quite frankly should shame us. They describe a sorry and sad state of affairs two years into the legislation’s implementation.

They describe a situation where:

  • Only 27% of people made an ‘informed choice’ about their care and support using SDS
  • 86% of people over 65 chose Option 3 (Council managed arrangements)
  • Clients who are Frail Older are 3.5 times more likely to choose option 3.
  • 75% of all clients chose Option 3 (Council arranged services)
  • Only 9% of total clients used Option 2
  • Frail Older clients are least likely to chose Option 2.

What does all this mean?

Well of course the instant defence which will be presented is that these statistics describe a reform which is at an early stage of progress. That this is a long-term change in the delivery of care. That SDS is a 10 year strategy. All true statements but equally all inadequate explanations – or perhaps excuses – for the failure of a robust implementation of what has been described as a ‘flagship’ social care policy.

By launching the report, Self Directed Support: Your Choice, Your Right, together with others last week I offered some explanation for both these statistics – though we did not imagine they would be quite as bad – and the wider failure which SDS is in danger of becoming.

One of the reasons for this failure is that there has been a lack of robust implementation. We have allowed a two tier system to build up and the victims of such are quite clearly our older citizens who have been the last in the line of choice, the afterthought for exercising control over their care. There seems to be no real acceptance that the SDS Act was meant to sweep all former practice away, instituting a power shift and culture change in the way people receive social care. The system from initial assessment, through to budget allocation and to collaborative review is clearly failing. We are in a whole system crisis. Granted, SDS is working in glorious technicolor in parts of Scotland but in others the screen is blank.

In particular I am concerned that we are not involving older citizens by giving them the full range of choices available to them and the system is not working with providers to enable them to play their full part in this reform. We have no real evidence that information is being properly communicated in ways people know that they have a real choice. Do we know the 86% choosing Option 3 know that there were other options on the table for them? At Scottish Care we are hearing lots of stories to indicate that the transparency of choice is a mirage.  I am continually hearing from Scottish Care members and families fighting against social work professionals who are wanting to restrict choice on Option 2 and present Option 3 where the Council arranges things as a fait accompli. The old power imbalance still permeates.

The promised creativity and widening of choice which the Act heralded has been strangled by bureaucracy, deliberate blockage and an unwillingness of statutory partners to embed the radical change which has been needed. Within all this obfuscation there is the systemic age discrimination which permeates the whole of our social care system in Scotland.

So what can we do? Well simply accepting the current situation where older Scots are at the back of a very long queue will not do. Simply allowing the keys to choice to be controlled by individuals who will not give up control, loosen the purse strings and give true, transparent information to people in order to allow them to choose will no longer be acceptable. We must, together, provider and supported person, advocate and community leaders, re-invigorate an Act which has the potential to transform, renew and reform.

Some of those first steps were offered last week in a seminar to launch the report I mentioned above, and I publish them again here:

Recommendations:

1. We recommend that the Scottish Government ensure that all partners develop a human-rights based approach to the implementation of SDS and a human-rights based monitoring of the implementation of SDS. We further recommend that the Scottish Human Rights Commission be resourced and supported to undertake an assessment of this human-rights based implementation.
2. The accountability of local and national government for implementing SDS must be enforced.
3. Local authorities must move away from the time-allocation method of care assessment and delivery, which will always be at odds with any effective or meaningful implementation of SDS.
4. The use of electronic and other contract monitoring systems need to be examined in relation not only to fiscal savings but the negative impacts these have upon the well-being of the workforce and the dignity and rights of those receiving support. A rights-based approach to SDS has to be based on reciprocal trust and mutual respect rather than suspicion and distrust.
5. Access to information, and to all four SDS options, must be made available consistently across local authorities and in an independent, non-discriminatory way.
6. The Fair Work Framework should be used as a method of ensuring that individual workers’ rights are reciprocated and protected. This framework should be implemented and used by commissioning bodies, organisations and individual employers.
7. Greater focus needs to be placed on developing models of care and support that give autonomy, control, choice and decision-making to frontline workers and those whom they support rather than commissioners and contract managers.

Self-directed Support can still be rescued but at the moment the flagship is well and truly aground from the perspective of the majority of citizens in Scotland who require care and support and who happen to be over 65.

Dr Donald Macaskill

@DrDMacaskill

Posted on

Guest post from Local Integration Lead, Elaine Rae

Great Care takes a Great Team

 Elaine Rae –Regional Improvement Lead – Glasgow - working with Scottish Care since July 2016

Talking with Scottish Care providers throughout the last year has been an excellent learning experience for me. I have heard such great stories from many courageous managers who find ways to work outside their comfort zone to do things they aren’t always sure they are ready for. Stories of how they took measured risks wherever they thought it would benefit those they cared and how this often paid off.

Like the story about one independently minded resident Alfie, who dearly wanted to go to the shops down the road for a paper by himself despite having challenges with walking. The manager and her team got together and discussed the likelihood of Alfie having a fall, but decided to be brave and take a risk to assess the situation. The following day they facilitated Alfie’s wishes, with a small caveat, to minimise the risk they sent a member of staff dressed in their own clothes to walk some way behind him (incognito) with clear instructions only to intervene if he got into difficulties. However, Alfie the determined surprised them all and went for his paper and back without a fall and only a few wobbles. On the way back he even met a few of his old neighbours and stopped for a catch up. From that day on the team agreed that they would always try to see risk as something to be measured and tested in real time.

For managers and their teams this type of person-centred approach usually leads to more activity and practice improvements and should be applauded. However it can also add more challenges to the average day, so I began to wonder,

How do Managers that are passionate about delivering great care keep finding the energy and motivation to keep doing more?  

 The answers I was given always mentioned the significance of having good people and great teams. Digging deeper Reza Najafian, a Glasgow provider  (Silverburn Care) said:

“understanding the barriers to change and being “Innovative” is how we have always tackled more demands on our time, in this sector we are compelled to be entrepreneurial, focusing on solutions then working out the steps that help everyone get behind ideas”.  

In fact, problem-solving teams featured in all the stories I heard of overcoming adversity, risk or challenge. The consensus being GREAT CARE TOOK A GREAT TEAM, committed to “doing what they could  - where they were  - with what they had” this reminded me that:

So I thought I would share the top tips I learned from managers about how they get their teams to move from good to great:

  1. Get visual. Regardless of your role, or responsibilities, visualising information and ideas is an incredibly powerful tool to get your team thinking. Get off the phone, go in a room together (or a virtual room) and use pen and paper.
  2. Throw out the rule-book. Nothing is off the table or outside the realm of possibility. Avoid words and phrases like “but,” “how would we” and “we can’t.” If necessary, designate someone to ensure those phrases aren’t used and ask everyone to be honest.
  3. Work backward. Figure out the goal or ideal scenario 2 or 5 years down the road. Start there and work your way backward. Don’t worry about the “how.” Focus on the “what.” the road map will literally unfold itself.
  4.  Make a game of it. At the team meeting have everyone write a random idea down, crumple it up and toss it onto the centre of the table. Pick one idea and build on it. Ask those attending, “If you were me, how would you tackle this problem?”
  5. Write down everything. No thought is too small, and no idea is too “mad.” Anything can potentially add value to better care. You never know what word or phrase is going to spark the nextword or phrase, which could then lead to the next big idea. Get it all down on paper. Display it for all to see.
  6. Take mental breaks. A lot of leaders view social media as a time-waster, instead of recognising it as a mental break. It’s practically impossible to nurture creativity in a tired, burned-out brain. Encouraging mental breaks is the key to developing employees’ creative side and boosting morale.
  7. Take a trip. A social evening can relax your brain, making teams less focused on the negatives, and less likely to squash good ideas. The next time a solution is needed to a problem, organise a social event and get to work.
  8. Get physical. Go outside for a run, walk, bike ride or whatever activity suits. This will relax the mind, and afterward you can approach a problem or idea with a fresh brain. Inspiration might even strike.
  9. Play to your strengths. It’s a common misconception that creativity exists only in people with specifically “creative” roles and skills. In fact, any skill can be used creatively. Throw your ideas on to paper to categorise and dissect them and watch them develop.
  10. Get the words out. The hardest part of an innovation session, alone or in a group is getting the ball rolling. So just talk, or write. Start getting words out or down on paper, even if they’re borderline nonsensical. It’s all about getting over that initial hurdle, so the ideas can start flowing.

Two examples (from many) of great care stories happening now: 

  • 18 Glasgow care providers (and the teams they lead) were determined to enhance the quality of daily living for those experiencing memory impairment are involved in a Technology Enabled Care (TEC) project piloting two memory enhancing apps:
  1.  http://www.mindmate-app.com/our-story.html
  2.  https://www.storiicare.com

The apps above can be used anywhere with WiFi access to improve memory and cognition through the gift of story and recording memories.

A year into the project the results are looking great. People using the apps and their families are reporting improved recall & concentration. As well as more shared enjoyment in family visits because of memory and story work that is shared together as an activity.

  • 11 Glasgow providers who had been working hard to find ways to improve advance care planning and end-of-life care in their services… got involved in two Scottish Care research projects with other great teams:
  1. https://www.scottishcare.org/wp-content/uploads/2017/02/PEOLC-Report-final-.pdf  
  2. https://www.scottishcare.org/wp-content/uploads/2016/11/SC-Voices-from-the-Nursing-Front-Line-.pdf

The results of this work led to 12 recommendations. The teams who participated are now using the data to enhance practice and staff training to co-produce anticipatory care plans with people utilising their services - taking account of their wishes around planning a good life and death.

I have given the last word to David Reilly (Operations Director, Baillieston Community Care) one of Scottish Care’s consistently top providers:

Sites to inspire your team to do more great Team Work:

The Royal College of Nursing 

The Centre for Nursing Innovation

Scottish Health Innovations Ltd - Works in partnership with NHS Scotland to protect and develop new innovations that come from healthcare professionals.

Care @ Home and Innovation: https://www.ukhca.co.uk/pdfs/DementiaHomecareDrivingQualityInnovation.pdf

 User-Led approaches to Care @ Home: https://www.theguardian.com/social-care-network/2014/feb/19/user-led-innovative-approaches-to-home-care

School of Health Care Radicals: https://www.cipd.co.uk/knowledge/strategy/development/health-care-radicals-report

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