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New Scottish Care Blog: Brian Polding Clyde

Apologies for the delay in writing up this blog but it is something I did not wish to write. For some time my mum has been living with dementia. As a family we adjusted to my mum’s needs as she progressed in her journey; from thinking that there was something wrong, which she could never put her finger on to visiting the doctor and discussing worries, ultimately receiving a diagnosis. To be honest the diagnosis was largely confirmation of what we already suspected and gave us a focus for discussing how we could adjust the support we offered to my mum to ensure she could continue to live well. As a family we thought we had been proactive and put plans in place for future needs. Power of Attorney, DNR had been openly discussed and agreement reached about how to honour my mum’s future wishes. However although meaningful discussions had happened, what we were not prepared for was the emotional impact of having to follow up with some of these decisions. My mum started to leave her home at night, and concerns were raised about her safety and the risk to her wellbeing, this ultimately led to a hospital admission and numerous reviews and plans for her long term care. We attempted to support my mum back home and enjoyed a weekend with her in her home. However this required 24 hour support with my brother or I present to maintain safety, which was not sustainable in the longer term but was an attempt to honour my mum’s wishes as expressed in her POA which was that she would live and die within her home with extra support if this was required. Ultimately my mum moved to a care home and slowly we are adjusting to this change. My mum is taking an active part in the routines of the home in maintaining the garden, doing some cleaning up of dishes after meals and has a sense of pride in what she has been able to achieve in the short time she has been there. I have been working in care for over 30 years and hope that I have been able to advocate on behalf of providers and the positive impact that they can make but my own reflection would be that the decision to support my mum to move into care has not come without a profound sense of loss and guilt. My mum has been a strong independent woman, who has dealt with major events throughout her life in a resilient fashion and shown that not only would she survive but also thrive. The move to a care home appeared to shrink her as she attempted to adjust to her new environment, which I think she believes to be a hotel she is temporarily living in, the gardening and cleaning being something she is expecting to be paid for, which my family are happy to help facilitate. The fear associated with my mum moving into care is wrapped up within feelings of my mum losing her sense of self and the coming to terms with how we can support her to maintain a level of independence and a sense of agency. My mum has been supported by some wonderful staff who when spending time with her appear to intuitively have developed an understanding of how to best approach my mum, they know that gentle banter and a humorous interaction will be more successful in fostering a relationship with her. My mum’s consistency in reaction to these individuals gives me a sense of content that when supported by such staff that she is safe and well and family members are of the same opinion. We are a reasonably articulate family with experience of health and social work services and reflecting on the last year I am aware of outstanding issues which I do not think have been resolved to our satisfaction. On diagnosis I expected and requested post-diagnostic support, more than a year after diagnosis we still await this and when it is, if it is offered, it will be at a point when my mum is not able to use it meaningfully. Attempts to arrange home care and daycare opportunities did not appear to be supported by statutory services and the response from statutory services appears to be have been in the light of major concerns about health and safety, concerns about imminent danger, rather than a planned therapeutic intervention which may have delayed the move into a 24 hour care setting.   Brian Polding Clyde Local Integration Lead, Inverclyde & West Dunbartonshire

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Our CEO’s Latest Blog: When is a village not a village?

When is a village not a village?

I come from a long line of villagers! Indeed my siblings and I are the first in a family line stretching back hundreds of years who were not both born and brought up in a village. So the nature of village life and the difference between that and other forms of settlement has always intrigued me. My interest has increased in the last few months with the growing number of people talking about ‘care villages.’ So I set out to try and discover what these ‘villages’ were all about. Care villages have been with us for some time. They are commonplace in the United States, Australia and to a lesser extent in parts of Scandinavia. In the US, about 6% of all over-65s live in self-contained retirement flats or bungalows with communal facilities and on-site care provision. Their growth and development in the UK have been slow but is now gaining rapid pace, indeed there is even a London based organisation called the Associated Retirement Community Operators (ARCO) dedicated to their development and increased prominence in the health and social care landscape. However, a lot of the commentary in the last year about care villages has come from a growing awareness of what has been happening in Holland. The principal idea behind the care villages is that you buy or rent your own apartment within a built environment and as a result have access to care and support services when you need them within close proximity to your flat or house. They are all different. Some have on-site shops, cafes and restaurants and offer a range of activities ranging from golf or fishing, tennis to bowls. Others have dedicated buildings to support you when you grow older and less independent, develop dementia or have had a stroke etc. Recent criticism around some of the care villages has centred around so called ‘exit fees’ which, depending upon the length of stay in a village, can be up to 10% of the original property purchase price. However, in some cases it can be as high as 30% after just a few years. The Law Commission in England[1] has declared that such fees are causing ‘anger and distress’. Providers argue that such ‘exit fees’ enable weekly or monthly charges to be kept low. Without getting into the contractual detail, it’s worth exploring some of the much vaunted Dutch models. The community which is often quoted and heralded is at Hogeweyk, thought to be the world’s first ‘dementia village’, which is near Amsterdam.[2] This is a self-contained village for individuals who have advanced and ‘severe’ dementia. It has its own supermarket, beauty salon and leisure centre. Hogeweyk is a gated community where 150 residents live in six-room houses, each designed around one of four ‘lifestyles’. These are selected for residents after tests and interviews alongside their families. Residents are placed according to their former lifestyles which is meant to establish continuity based on reminiscence therapy and its focus is on familiar environment. There is a permissive philosophy which grants small ‘freedoms’ to individuals within a boundary of support and self-contained security. There is a developing desire in many parts of Scotland of the need to adopt the environmental reminiscence model which Hogeweyk has successfully promoted. However it would be erroneous, I believe, to think that reminiscence environmental and design approaches can only be adopted within a ‘village’ as understood at Hogeweyk. This is also care which comes with a price, partly because of the strong State support for such models within the Netherlands. The Netherlands spends 4.3% of its GDP on long-term care, the highest in the OECD. Scotland spends a lot less. So what does all this have to say to social care in Scotland. Well, firstly there is a growing number of ‘care villages’ in existence, being planned and starting to be developed. [3] But might I suggest that it is important that we take a step back and reflect on what it is that is being developed in our midst. There have been a number of voices being raised in concern at such developments. Some are alarmist, others are worthy of attention. Have ‘care villages’ a validity and is this a trend which is illustrative of societal change at a fundamental level? Or are they a concept which might lead to exclusion and fragmentation within communities? The classic dictionary definition of a village is that it is ‘a group of houses and associated buildings, larger than a hamlet and smaller than a town, situated in a rural area.’ But most folks who live in a village, such as the generations of my family, would very quickly say that that definition only paints part of the picture of what village life is really like. They will rather talk about it being a place where they belong, where you feel connected and involved, included and valued, where you feel safe, are known and recognised; that each has its own character- and that each has its own characters! Now granted this is maybe a bucolic image – because for some people villages can exclude, can make you feel you don’t belong or fit in or feel welcome. But, in general and for the majority, villages are more than just a set of buildings – it is the people who make the village. But what about care villages? Recently I wrote a piece for Architecture and Design Scotland called ‘Re-imagining Age and Home’  about the concept of the city centre becoming a place where older people could feel as if they belonged; where care homes and accessibly designed individual accommodation could flourish, and which in turn would become caring places. I suggested that we are now faced with a real potential to redesign our city and town centres as positive locations to grow old in and to become places of age acceptance. Technology enabled care can re-connect and renew not just individual lives, but entire communities. Is there an issue that some models of ‘care village’ serve to withdraw people from connection or at least only enable connection and relationship with a limited few? Do we want to isolate the reality and visibility of people living with advanced dementia and palliative and end of life into locations separated off from the mainstream community? Is there a socio-economic issue that we risk creating communities of the like, both socially and by default diminish diversity? Is there a danger that we are sub-consciously creating a message that older age needs to be distant from the centre rather than at the heart of our society? Or are we just recognising the changing nature of the human person which wants increasingly, some would argue, to be ‘an island apart from the main’? I acknowledge many of the proposals and plans speak about inter-generational living but it might be argued that a gated community (for whatever reasons the gate is there and in whatever form the gate exists) is still a community excluded from the rest? I think we need to start to ask these questions and also to, as a society, begin to explore what our answers might mean. But I also wonder if we need to re-vision our concept of the village and create it into an urban model for care and support? I mean by that, why cannot we re-imagine a care village – to make it not a community that is gated and separate but rather a ‘physical but invisible’ bonding and binding of a set of physical buildings in a community, such as a housing with care building, a care home, a specialist dementia unit, a community care hub, an inter-generational centre, a mixed nursery and older person’s day support centre? The connections would be not that they are all behind a physical boundary but rather that they are in a real connected partnership. They are places who collaborate together, share commitment and share resource. There is, I believe, a real opportunity for homecare, housing support and care home providers to re-imagine care around the person and to form partnership and co-productive re-design models not just with those organisations who provide care and support but those who receive it and their families. That might be a model for a village or town with care at its centre. The Scottish Care National Care Home Conference, ‘A caring place’ will explore some of these issues and ideas in different sessions throughout the day, and indeed we are pleased to announce that the University of the West of Scotland and the School of Innovation at the Glasgow School of Art are starting a project with us in the next few weeks around the future vision for care homes in Scotland. To paraphrase the old African saying, that it takes a ‘village to raise a child’, I would suggest it ‘takes a village to grow old in’ – it’s just that we might need to change what we define as a  care village?   Dr Donald Macaskill   [1] https://www.lawcom.gov.uk/project/event-fees-in-retirement-properties/ [2] For the story of Hogeweyk see  https://www.theguardian.com/society/shortcuts/2018/mar/12/life-dementia-village-development-kent-hogeweyk [3] Some links to existing villages and recent news stories about plans for new villages in Fife, East Renfrewshire and elsewhere: http://nethanvaleretirementliving.org.uk/ http://www.heraldscotland.com/news/13157026.Plans_revealed_for_Scotland_s_first_retirement__mini_town_/  http://www.scottishhousingnews.com/19442/plans-unveiled-new-methil-care-village/  http://www.scottishhousingnews.com/19362/250-home-retirement-village-planned-newton-mearns/    

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New Scottish Care Blog: Elaine McCourtney

I would like to discuss a subject which I find deeply fascinating and intriguing, but more importantly, it’s one which really matters to me: how we can make a difference in an individuals’ life through good conversations.

It is crucial, I believe, that I deliver in my role, and try to make a difference for everyone I come into contact with, regardless of the reason that brings us together. They could be my managers, my colleagues, the care and support staff and other professionals, the individuals we provide care and support for, or indeed, my family and friends. We are all individuals who deserve to be treated as the independent, fascinating people we are.

Dare I say it, but let’s forget the National Care Standards for just a moment. I, like many others brought up in the 1970’s and 80’s, understood and shared the positive, ‘old-fashioned’ values of being respectful, keeping true to your morals, demonstrating self-discipline, keeping a firm determination, and thinking of others and not just oneself. The National Care Standards Principles very much mirror these values. They propagate the ability to empathise with respect. It promotes a compassionate dignity and a responsiveness to need. Many of us already commend and admire these principles in our private lives, as we know the true value they hold in our relationships and in communication with others. So why then, in our working lives, do we need a manual to sanctify what should be so self-obviously apparent?

When we step back from our subjective view, we may even notice that as a society, we show tremendous exertion in obtaining personal rights and liberties, whilst all too often neglecting the responsibilities that these entail. This is a sad indictment, but one that I come across all too often. Within health and social care, this tendency is continuously impacting our roles. Some individuals are resolute in acquiring their rightful due, whilst disregarding the duty they have to themselves and others in our workforce.

Personal Outcomes are at the heart of the Scottish Government’s policy and, if used effectively, should go some way to reverse a dependency culture that is manifest, and re-instate a positive value and focus on responsibility and resilience. With a quick change of perception, and a touch of empowerment, we can change the recipe; we can build a model of a responsible society.

We all know why we have to change. In addition to the values and principles I have mentioned, our demographics are changing. Our population is getting older; there are more illnesses and multi- morbidity. This is set against the backdrop of decreasing financial resources, cuts in services, and lower funding in many other vital public sector bodies.

When I was first employed in my role with Social Care Services, I used to wonder how I would interpret someone’s ‘personal outcomes’ after a brief introduction. We really have to understand that individual, and what matters most to them, in a short space of time. The same is true when inducting a new member of staff, too. Whether you are supervising a team or mentoring a specific colleague, you are aware that what matters to them and what impacts them will also impact yourself.

What I have learned over the years, throughout my various experiences, is that a good conversation can inform us of an individual’s outcomes.  After the initial greeting, once the pleasantries are over, we can then begin to connect. However, conversing is a skill some of us are better at than others. Our purpose – why we need this information – will motivate and direct the progression of holding a meaningful good conversation with someone.  If it is an individual we have not seen for a while, we may ask them what they have been doing; to catch up with them. If it is someone we are in regular contact with, we might chat about a specific topic from a previous conversation. If we are sharing instructional learning we should have the specific training and skills to do this effectively, for different learning styles.

So, what is a Good Conversation?  It is a process, with applied techniques and skills, for the facilitator to use while with an individual.  The techniques support an individual to share their issues, investigate their opportunities, make use of their abilities and strengths, and display resilience, in order to achieve what is important to them. These methods include listening skills, with deeper listening, various types of exploratory questioning, asset mapping, and measuring what is important to them; scaling/scoring how they can to improve on this.

Good conversation skills and techniques are so vitally essential to empowering change in resilience in the lives of the individual’s support. Still maintaining their personal rights but shifting more towards their personal outcomes. I am a campaigner at Good Conversations training courses that the same skills and techniques can also positively impact on the resilience of our staff teams. How do we change society as a whole? Well, we are making the first ripples and that is important to me.

 

Elaine McCourtney

Scottish Care Liaison Officer, Dumfries & Galloway

 

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Our CEOs Latest Blog: Spiritual care is everyone’s business

Spirituality is everyone’s business. Scottish Care has recently launched its latest Care Cameo. Its central theme is spirituality and spiritual care. But what is it all about? Two definitions to start our reflection: “Spiritual care is that care which recognises and responds to the needs of the human spirit when faced with trauma, ill health or sadness” (NHS Education for Scotland,) “A person’s spirituality is not separate from the body, the mind or material reality, for it is their inner life. It is the practice of loving kindness, empathy and tolerance in daily life. It is a feeling of solidarity with our fellow humans while helping to alleviate their suffering. It brings a sense of peace, harmony and conviviality with all.” (Spiritual Care Matters, NES 2007) As will be clear once you start exploring the Cameo, there are many divergent views on what is meant by ‘spirituality’ and also what it means to offer and deliver ‘spiritual care’. This is for some people a difficult area both to explore and to engage with and that is precisely why we decided to dedicate a Cameo to this important issue. It is written by three authors with a particular experience in working in this field. Spirituality has to do with the heart and pulse of being human. It is the soundless language which communicates our deepest emotions of love, anger, fear and belonging. It is the rhythm which gives form to many of our innermost thoughts and feelings. It is the space where we rest in the awareness of meaning beyond comprehension and experience beyond description. To offer spiritual care is to give opportunity, time and place to enable an individual to explore and to express who they are as a human individual. As we seek to embed a human rights-based approach to care and support through the new National Care Standards it is an important that we not only understand the role of formal religion and belief systems but wider understandings of spirituality. As a care sector and as carers we need continuously to explore what this may mean for the work we do and the services we offer. Spiritual care is care both at the margins and at the centre of the life experience. The way we commission care and support at the moment in Scotland leaves very little room for spiritual care. For spiritual care is a care that needs space, relationship, time and the chance to grow and nourish in a mutual dynamic of respect and understanding. Spiritual care happens in the ‘touching place’ between the carer and the supported person. It cannot be pressured into allocated seconds in a task-oriented approach. So when, I wonder, will our commissioners prioritise spiritual care? For if we are truly commissioning to the new National Care Standards then there has to be space to be spiritual in our care giving and there has to be funding to enable that space and time to happen. I hope you will read the Care Cameo, and I have no doubt it will raise as many questions as it will seek to offer answers, but I hope you will find it, as I have, a thoroughly interesting and thought-provoking piece of work which is all about putting the individual and their holistic needs at the heart of person-led care and support. Dr Donald Macaskill

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Support at the heart of protection – Latest Blog from our CEO

It is now over ten years since the Adult Support and Protection Act (ASPA) became law in 2007. As someone involved in its early stage development and roll out it is amazing to think that ten years has passed. Scottish Care was funded at the time to develop a programme of training and support, called ‘Tell Someone’ , which brought the Act alive for those working in frontline care in care homes and homecare services. It is still a resource which is much used today. Last week the Care Inspectorate, Her Majesty’s Inspectorate of Constabulary in Scotland (HMICS), and Healthcare Improvement Scotland (HIS) published a ‘Joint Inspection of Adult Support and Protection’,  the first inspection looking specifically at how well the agencies responsible for keeping adults safe are working together to protect those at risk of harm. The Inspectors looked at a representative sample of six local areas: North Ayrshire, Highland, Dundee, Aberdeenshire, East Dunbartonshire and Midlothian. In each area, they looked at the experiences of individual people, the extent to which key protection processes are in place, and how well local leaders were performing. By and large the Inspectors found that there was evidence in most areas that adults at risk are safer and better supported because of the Act and the supports which underpin it. This is positive news but conversations with those who work in the world of adult protection and safeguarding would caution against over assurance that we have got everything completely right. My concerns are as follows:

  • Quite rightly the Adult Support and Protection Act has been lauded as a very solid piece of legislation and it is much envied elsewhere in the United Kingdom. Part of that admiration is that it has a set of overarching and underpinning principles which are firmly rooted in the Human Rights Act. The concepts of ‘least intervention’, of ‘proportionate response’, of ensuring any action ‘benefits the individual’; all of these are squarely human rights principles in practice. However, there is a legitimate growing concern that at times the actual practice of the Act is paying only a passing lip service to the principles which lie at its heart. At best I think we need to do more to assess whether or not we are intervening and utilising the Act in all necessary circumstances and instances. For instance, are we using ASPA within health settings as much as we should?
  • When the Act was being implemented a lot of good work was undertaken in the care home sector and that resulted in the development of confidence and skill amongst the care home workforce. My concern is that some of that earlier inclusivity has been lost. Are care home managers and staff as fully included in the implementation of the Act , e.g., in case conferences, in multi-disciplinary reviews, as they might be?
  • I am less convinced that there has been sufficient and appropriate attention given to issues of adult protection and safeguarding for our care at home sector. There are real challenges of lone working and being able to identify and act upon concerns of harm. Associated with this is the inevitable issue of resources. As training and learning budgets are being slashed by contractual practice across the country, are we properly equipping our social care workforce in the community to properly understand issues of adult protection, to be able to recognise the signs of harm and to have confidence in knowing what to do if they come across concerns? I am not convinced in all instances that this is the case. It is time for us to do some serious capacity building within specific sectors.
  • On a wider front the Act did a lot to try to change the cultural and popular understanding of adult protection. If you look at the legislation and its associated Guidance you will not find the word ‘abuse’. At the time of its development there was a considerable debate on this matter, but the idea won out that ‘harm’ needed to be used as a term to identify a wider range of behaviours than the word abuse described, including actions which were pre-meditated, conscious and deliberate, but also unintentional and unplanned behaviours, such as potentially neglect. I am not convinced that at a popular and societal level this broader understanding of what constitutes harm has gained much ground. That might be because we have failed as a country to properly invest resource in public awareness around adult protection and what constitutes harmful behaviour.
  • A related issue is the extent to which despite the Act’s existence for over a decade we have seen a rise in behaviours which have been discriminatory and thus ‘harm-full’. This is especially a concern when we consider the sharp rise in discrimination and hate on the grounds of age. How, one might ask, does the reality of increased discrimination and harm on the basis of age relate to the implementation of the Act when it impacts on someone who is defined as being an ‘adult at risk’?
  • At a national level I have expressed a personal concern that we now no longer have an Adult Support and Protection Forum. Up until three years ago this was a body which brought together individuals from diverse sectors with a common purpose for improving practice, disseminating knowledge and advancing the issues around adult protection. Its loss has been a matter of significant concern especially at a time when the lessons of the benefits of national multi-agency co-operation around child protection have become so obvious.
  • My final observation about the Act is that, in part because of financial constraint, we have as a society in our practice focussed on only one part of the legislation, namely the ‘protection’ of individuals who might be at risk. This is a real disappointment. The originators of this legislation envisaged the importance that as adults individuals who might require protection would of necessity benefit from ‘support’ to enable them to be free from harm. We have failed to adequately focus on a permissive, enabling approach to safeguarding and perhaps unsurprisingly have concentrated on the ‘protection’ element. This is to miss the primary energy of this ground-breaking legislation. It is to fail to recognise that in our vulnerability we all need support to prevent us from being the object of another’s wish to harm. It is to fail to give equal weight to Adult Support as much as Adult Protection.

We have come a long way in ten years. Practice is on the whole sound. But it is time for us to re-discover some of original intent and energy within the Act and its Guidance and to re-invigorate a system of right’s-based support which fosters true adult protection. Dr Donald Macaskill @DrDMacaskill    

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‘Sharing good practice in Krakow’, Blog from Margaret McKeith

What is the link between Prof. Jason Leitch, pressure ulcers and Krakow? Up until March of this year I would have said “none”. However, an invitation to co-present a poster at this year’s European Wound Management Association Conference (EWMA) made the link very clear and was an excellent opportunity to fly the flag for Scotland’s independent sector on an international platform.

Prof. Jason Leitch (Clinical Director, The Quality Unit, Scottish Government) announced his aim that pressure ulcers were to be reduced by 50% in all care settings by December 2017. He shared this with delegates at the NHS Scotland event in 2015 and set the Reducing Pressure Ulcers in Care Homes Improvement programme’s wheels in motion.

This programme was a collaboration between the Care Inspectorate, Healthcare Improvement Scotland (Scottish Patient Safety programme) and Scottish Care, and saw for the first time, our three organisations working on such an improvement project. This is detailed on the microsite developed as part of the process www.pressureulcers.scot.

Having being involved in this since the onset and very aware of its success, I was delighted when Joyce O’Hare (Improvement Advisor, Care Inspectorate) took the lead in developing a poster abstract to be submitted to the EWMA conference being held in Krakow. Joyce’s abstract was accepted and we were invited to prepare a poster. With an emphasis on collaborative working, integration of health and social care and improvement methodology, Joyce worked with Jill Gillies (HIS) and me in preparing and submitting the poster. We were delighted when this was selected and we were invited to present this to delegates from around Europe. With support from Scottish Care and the Care Inspectorate, Joyce and I set off for Krakow on 9th May.

RPUCH postert Krakow 2018

 

Although our presentation was short our poster was on display for the duration of the conference. Our collaborative approach, the independent care home sector, the role of the Local Integration Leads, our commitment to improvement and the opportunities created by integration were all shared. With an audience consisting of such a wide range of health professionals from across Europe we feel we certainly put our sector and organisations we represent on the map.

 

Margaret McKeith

National Lead

Partners for Integration and Improvement

 

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Guest Post from Local Integration Lead, Rene Rigby

Test of Change

We are living and working in an inter-connected environment. The use of email for sending messages, exchanging information and assisting with workflow is common place across the public sector. There are many links between the health and care system, but it’s often difficult for health and care professionals to share information. Access to the right information about patients and users of services at the right time is essential to ensure continuity of care.

When patients are discharged from hospital, care homes are still receiving information about that individual by fax, in person or post. Often, key pieces of information are not received at all. This makes it difficult for care homes to prepare for a new patient’s/resident’s arrival or the return of a resident who has been in hospital. As well as being inefficient and slow, paper-based communication is not a secure delivery method.

Lothian Unscheduled Care Board have agreed to fund costs for a one year test of change –Secure emails access for all care independent care homes (circa 103) in Lothian. Each care home will be provided with up to three nhs.net accounts for a period of one year. Care homes coming on stream during the next few months have also been included in this test of change.

CEO’s or equivalent of each individual independent care home must sign the Data Sharing Contract, as must the staff identified as secure email recipients. Following on from this each identified recipient must sign a NHS Lothian User ID Request Form

The provision of secure emails to all care homes in Lothian will markedly improve communications between care homes general practice and social work. Specifically, it will enable faster discharge of patients through the electronic communication of patient assessments and subsequent discussions rather than this being by post.

Secure email will transform how healthcare organizations in Lothian share and work collectively to provide coherent joined up services for the people concerned the public. Good timeous information underpins good care and on-going support.

Care homes will benefit greatly from having a consistent electronic transfer of medical discharge summaries (typically sent to a GP within 24 hours). This will enable the care home to fully prepare their service for supporting people discharged from hospital by preparing for the persons needs well in advance of their arrival.

Pre admission assessments will be carried out and shared timeously thus supporting early discharge to the care home and help improve the efficiency of the discharge process generally.

Secure emails offers the potential to share Anticipatory Care Plans from statutory services. E.g Person moving into a care home. Referrals, assessments, multidisciplinary review summaries, flu vaccine consent forms will be immediately accessible to care homes. Opportunities for Tissue Viability, Health Protection, Care Home Liaison, CPN’s and pharmacy specialists instant ability to network and support and safely communicate sensitive information with care home staff.

Other benefits are the ability to send and receive patient/resident information quickly and securely. No confusion from messages taken over the phone or illegible writing on faxes. Improved awareness of care home staff in relation to  information governance rules on handling patient information. Secure paper trail in place for example, time emails were sent, removal of fax machines which are costly and require maintenance. Costs of postage for partnership reduced. Reciprocal communication time by health and social care professionals markedly reduced and this initiative supports positive change in service.

This test of change Secure e-mail access for care homes in Lothian should seek to demonstrate measurable improvement in outcomes either directly to individuals or indirectly through improved service design and delivery. There will be on going monitoring to make sure the project is achieving the desired results and to demonstrate the impact of the project to others; as well as to identify issues or problems as they arise within the project so that actions can be taken to change or redesign the project while it is in progress.

 

Rene Rigby

Local Integration Lead, Edinburgh City

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Big Community: the return of the Big Society – Latest Blog from our CEO

Big Community: the return of the Big Society

In recent months there has been a developing discourse which goes somewhat like this:

‘In the face of the growing demographic challenge and pressure on health and social care services coupled with acute financial austerity, we need individuals in their communities to take more responsibility for the care and support of their family members and neighbours. This is after all not the responsibility of the State but rather the individual. If you are ill, we will treat you as a last resort after you have self-managed your condition and used whatever technology that is available which will avoid expensive direct human intervention. We are no longer able to pay for you to be fully independent and achieve what you may want because we simply cannot afford it.’

Maybe I am being a little generalist and overly simplistic in that description, but I suspect not that much. Is this not broadly the message which the Edinburgh Integrated Joint Board has been communicating to the good folk of the capital? Is this not the underlying message from the Westminster administration?  Is this not the message which landed Glasgow’s HSCP on the front page of the newspapers with their threat to remove (after minimum consultation of)  sleepovers in the lives of some of that city’s most disabled citizens?

So somewhere out there at the bottom of the garden is an empathic, time-rich, resource-endowed group of individuals just waiting to step in because the State (also known as that group of individuals created and employed through the taxation of the populace) chooses no longer to afford the cost of care. Oh and as in the past, it is the role of the female members of the community to do all this work. After all care is a woman’s work.

And as I hear and read this developing and subtle narrative where some of our most vulnerable are expected to be supported for less resource by utilising the untapped potential of the community, accessing community ‘assets’  then part of me philosophically says “Yes, it’s good that people have more control and choice, autonomy and power; that people do need take responsibility and collaborate with professionals, to self-manage and exercise responsibility. But ….”

Are we in danger here of unintentionally slipping into a new mode of social responsibility and a new model of social care without having thought through the full consequences of such a move? Is there a danger that decisions essentially made on financial grounds and dressed up in the rags of a social philosophy, are taken without a robust and appropriate moral, ethical or human rights underpinning? Is this idea of the Big Community not somewhat resonant with the failed and flawed concept of the Big Society? Remember the Big Society?

Every political era and every politician looks for a catchy phrase, slogan or idea which will capture the public mood and define them as distinctive and visionary. For Tony Blair in the halcyon days of New Labour it was the Third Way, though we weren’t that sure what the other two were. For Bill Clinton it was ‘community’ – a word which appeared more in his pre-presidential speeches than any other idea. For Gordon Brown it was a brief flirtation with the idea of Britishness. For Obama every change was possible. For Trump it’s the myth of ‘false news.’ But for David Cameron it was at least before the Brexit Fall– the Big Society.

‘The Government indicated that the Big Society is communities feeling empowered to solve problems in their neighbourhood, having the freedom to influence and discuss topics that matter to them, and a more local approach to social action and responsibility.’

The term “Big Society’ aimed to create a climate that empowered local people and communities, building a “big society” that would take power away from politicians and give it to people. It aimed at “integrating the free market with a theory of social solidarity based on hierarchy and voluntarism”.

Doesn’t that all sound remarkably similar to some of the political rhetoric that we are hearing today about the need for social care to be devolved to the individual; for communities to use their assets rather than the State to support and provide anything other than life and limb supports?

I think we are in the midst of an unarticulated political paradigm which I will term as the ‘Big Community.’ Its failings are not insignificantly the failings of the Big Society. Primarily it is a concept based on a naïve and utopian understanding of community or society. Its foundations are therefore weak and insubstantial. We are not in a bucolic age where people are living in families in geographically proximate communities. We are not living in an era where individuals have so much time that they can spend it in activities to help communities become more cohesive. Most are doing two or three jobs to pay for the mortgage. We are not living in a time when we can be assured that skilled clinical health and social care is being delivered by the State and what we do is an added extra in an individual’s life. Indeed it is an insult to the professionalisation of social care work to suggest that ‘care’ can be undertaken by anyone – that it doesn’t require training, ability and developed skill.

I am more and more convinced that just as the Big Society was called out as a naïve political mantra divorced from the reality of fractured and failing communities, that we now need to challenge the rhetoric of the Big Community and insist that we adequately fund social care beyond our already high levels of eligibility; that we adequately remunerate and resource social care staff and organisations so that we attract the best and deliver real quality; and that we help to use community assets to really advance our togetherness and not to paper over the cracks caused by austerity and fill in the gaps of a failing national health and care system. If not then neither community nor society are big but detached, distant and absent.

 

Dr Donald Macaskill

@DrDMacaskill

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Social Care Luddites: Latest blog from our CEO

At a recent conference I attended one of the speakers made a statement almost as if it was a fact that ‘the social care sector has a Luddite attitude to technology and digital innovation.’ When I’ve mentioned that sentence to a few others they have confessed some agreement with his sentiment. I want to suggest in this blog that it is a wrong representation on two grounds. The first is that it’s historically inaccurate and more importantly, the second reason is that it couldn’t be further from the truth.

The Luddites were a radical group of English textile workers and weavers who just over 200 years ago in the Nottingham area destroyed weaving machinery as a form of protest. The Luddites were not against the machines themselves but against how they were being used to undermine what today we would describe as ethical working practices and health and safety. Unfortunately, the term has become adopted  to mean someone opposed to automation or new technologies per se. What has been lost is the sense of protest against the misuse not the existence of technology and automation.

Before turning towards the second assumption that the care sector is antithetical to technology I want to reflect a little upon the critical contribution of technology.

Paul R Daugherty and H James Wilson have recently published a book called ‘Human + Machine: reimagining work in the age of AI.’ It is a very good read and explores the potential of Artificial Intelligence (AI) in the work environment against the framework of a generally suspicious cultural narrative. They explore the way in which popular culture not least in examples like the ‘Terminator’ movies or ‘2001: A Space Odyssey’ suggest a polarised man versus machine view of things often depicting a future when human beings are replaced by machines. The knee-jerk reaction and negativity is echoed when we explore the debate around social care and technology.

Daugherty and Wilson forcibly argue that key to understanding the contribution of AI in any context, including the care sector, is to understand its transformational power. If we only think of AI in social care as something which will automate certain functions and tasks, then we will miss its power. Rather they argue that we need to recognise the potential of AI to complement and augment human capabilities. They envisage organic teams that partner humans with advanced AI systems. Can we imagine a mixed care team of robots and humans? Is that the stuff of dreams or nightmares? For some it is already a reality as evidenced in some Advinia care homes in England. 

The authors suggest that we are about to enter a ‘third wave’ of societal and workplace transformation. The first wave, they argue, was when people like Henry Ford introduced ‘standardised’ procedures. The second consisted of the automation of processes. The third, they suggest is the ‘missing middle’ where humans and machines interact. In this space human and machines are not fighting each other for dominance but seeking to complement the role of the other. But this requires new skills and employee roles, a new understanding of team and management, and maybe even a new understanding of work. Personally, I think there is real potential here for social care to take the lead in creating workplaces where AI contributes to a reformed and developed role of the social carer. It is not a case of one or the other but both contributing. As I have often said, technology can enable human presence but it should never replace it.

Dougherty and Wilson argue the leading organisations are already riding the ‘third wave’ by adopting a MELDS Framework – comprising mindset, experimentation, leadership, data and skills. What might a MELDS Framework look like for social care in Scotland? We need to find out and engage in that discovery sooner rather than later.

Already there are an amazing group of highly innovative and entrepreneurial social care companies and technology developers trying to enable a new approach to care. The next few years will be critical for shaping that future as one with the person at the centre rather than the process. It is becoming time critical that we work together to shape person-led and person-centred models of technology in care. I am confident that we can achieve models of AI which are truly grounded in a human rights based approach to technology enabled care.

As part of that journey, Scottish Care is delighted to announce that we are hosting our first ever event dedicated to technology and social care. ‘Tech Care, Take Care.’ will be held on the 24th August at the University of Strathclyde Centre for Technology and Innovation. It’s an event which will bring together some of the best designers, technologists and innovators from across Scotland and further afield. But it is also an event where we will spend some time looking at how we develop an ethical, rights-based approach to technology and care in Scotland. We hope to publish on the day a study on the relationship between human rights and technology in social care. We will explore the contribution and also the limitations of AI amongst other areas of innovation. We will consider the personalisation of care from a technological perspective in this ‘missing middle.’

So the only sense in which the term ‘social care Luddites’ fits is in the desire to develop an ethical personalised approach to technological innovation rather than a desire for social care to break up the machine! It’s going to be an intriguing ‘third wave’ to ride, why don’t you join us?

Dr Donald Macaskill

@DrDMacaskill

 

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The promise of care: Latest blog from our CEO

We are just two days out from the annual Scottish Care, Care at Home and Housing Support Conference which will be held in Glasgow on Friday 18th May. If you haven’t already got your tickets there is still time to join us at what looks to be an intriguing and enjoyable day.

This year’s conference is entitled ‘Practical promise: making the vision of home care real.’

The word promise is an interesting one. In strict definitional terms a ‘promise’ is a ‘transaction between two persons where the first person undertakes in the future to render some service or gift to the second person’

What’s that got to do with care in someone’s home? – I would suggest everything.

At a very basic level the concept of promise is at the heart of the human exchange which good care and support offers. Every time an act of care takes place there is a service offered and a gift exchanged. Not a gift in the literal sense but the gift of support and person-led care which enables an individual to live their life to the full. At its heart that is what good home care is – it is an enabling process which offers an individual the prospect and ability to live as independently as possible for as long as possible.

All too often in some of the debates I take part in about the future of care and support in our community there is a presumption that care at home and housing support are about maintenance – keeping people safe and healthy. Of course, that is part of the story, but it is by no means the whole.

People who require to be supported in their own home require that support not just to keep healthy but to enable them to lead as fulfilling and as rewarding lives as possible. Life does not just stop with a diagnosis it moves to a different level. Affective, human-centred care at home and housing support is about providing the support to enable people to still dream their dreams, achieve their goals, and create their future. Homecare should never be seen as maintenance – it is always about the promise of a life still to be lived; good homecare is not about a set of tasks to be performed but enabling people through support to achieve their full potential, regardless of age.

The relationship of care is infused with promise at its very centre. It says that I as I support you and care for you, I will be here to make sure that you have a life which is as full and meaningful as possible; that you are not limited by your need of care or support, that you have contribution to make and abilities to share.

But there is also another sense to the word promise which will no doubt be reflected upon during our conference on Friday – and that is the degree to which a promise has a future orientation and perspective. Within the word promise there is a sense of hope, of expectation, of things yet to be achieved… a sense that things will be better and that new direction will be found.

The care at home and housing support sector is at a critical juncture in Scotland at the present time. We are living and working in extremely challenging financial environments, and with great uncertainty and fear for the sustainability of the care at home and housing support sector. But there needs to be promise.

With political conviction and appropriate financial investment, the future direction can indeed be one of promise. Rather than disintegration and paralysis. There simply has to be a future vision of homecare where grounded in the realities of day to day care-giving, we can create a social care system in Scotland which values the human rights of the individual, treats all with dignity and respect regardless of their chronological age, and which seeks to ensure that the individual person is in control not only of their care but of the direction in which they want their living and dying to move. There has to be a vision which gets us beyond the reckoning of support by segments of time for allotted tasks, which seeks to purchase that care at the cheapest price and pays lip service to the principles of choice, control and involvement of the supported person.

We all know what the ‘promise of care’ in the future needs to look like. It is a rooted, grounded practical vision of a Scottish society which cares and manifests that care not just in word but in action. The time is surely here for fulfilling that promise and building that vision into practical reality rather than uttering yet more pious platitudes.

That is the promise – a system which would make all of us who do the work of care and support rightly proud – a social responsibility for a nation. Join us as we continue creating that practical vision rooted in the promise of dignified support and care.

Dr Donald Macaskill

@DrDMacaskill