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Guest post from Local Development Officer, Stephanie Graham

A Social Work Practitioner perspective of SDS

 

Those three little words…………………………………….

 

Yep we love to hear those important three little words – no not those three little words – Valentine’s Day is long gone – the second most important three little words – Self Directed Support!!

Jings – I hear you all gasp in horror – oh no not those three little words!!!!!!!

Those words many practitioners and people who use services still do not fully understand, the words that make beads of sweat appear on the foreheads of budget holders.

The Act brought a sigh of relief for practitioners, allowing them to really help service users and support them in a way that was meaningful, that was until the reality of the effects on every day working started to fall into place.  The realisation that for older people, it is difficult to think out of the box when it comes to care needs given that older people rarely have money left in their budgets after personal care need costs are met.  Practitioners are not actually able to build relationships with service users and really get to know them in the way that legislation suggests, as they are so bogged down with budgets, costs and charges, they are actually no longer able to spend time with people.

It seems that all people see with SDS is cuts.  Practitioners stuck in the middle between budget holders telling them they need to cut packages, and service users seeing their packages being cut to essential care only.  Waiting lists for day centres soar as it is cheaper and easier to source than one to one support.  SDS encourages moving away from traditional services, yet more people are being pushed into them as it is an easier option.  The transparent system is in no way transparent, with many people not knowing they have a budget or how much is in it, never mind the 4 options that many practitioners still do not fully understand.

Practitioners are still being asked by budget holders “what services does the service user want?” and “how much does it cost?”, before the budget has been agreed – panicking that a service user may want supported in a different way – oh no!!  The power imbalance, further tipping the scales in the budget holder’s direction.

The new legislation that is meant to make everyone fair and equal has in practice created a postcode lottery and instead of bridging the gap of inequality, only widening it further.

How do we fix it?  SDS is a fantastic idea on how service users should be supported yet budgets, paperwork, systems and fear do not allow it to work in an easy and seamless way. This needs to be challenged, and some of the work I have been doing with Scottish Care  around promoting and implementing SDS is starting to gain traction in this area. For instance, I have been invited to work in a local area who have recently acknowledged they are “behind with SDS”, to improve their SDS systems and promotion, and have been working with Carers organisations in advance of changes to legislation for carers, giving them access to SDS. But I continue to wonder if a 10 year strategy is the solution!? It’s 30 years until I will be an older person and I wonder if even that is enough time to get it sorted; to allow me the power to be the expert in my own life (which I am) and the ability to be supported in a way that is meaningful to me, and enables me to have a good life.  Just in the same way that every older person should be today.

 

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Latest Blog from our CEO: Facing up to care reality

Speaking at a fringe meeting of the Conservative Party conference the Social Care Minister Jackie Doyle-Price suggested that people should not expect that the houses they live in should be able to be passed on to the next generation as an inheritance. She said that it should not be seen as the role of the state to pay for our care in old age if we can afford to do so ourselves.

Her intervention has led to the start of a strident debate and media discussion. Language such as ‘dementia tax‘ has reappeared in the political lexicon. Inescapably, however, as I said on the BBC last week this is a discussion we badly need to have in Scotland.

Over the past year Scottish Care has continually articulated a message that the older peoples care sector in Scotland is at a point of real challenge if not crisis. We have a nursing shortage of 28% average vacancies; 9 out of 10 care at home providers are unable to recruit to key posts, and nursing care home providers have recently told me they are paying £1000 for one agency nurse to do a night-shift in some parts of the country. Pressures from growing costs, increased registration and regulatory requirements and increasing levels of clinical demand are pushing providers to the very edge.

Faced with such realities people can react in diverse ways.

There might be a tendency on the part of some to bury their heads and assume things will get better without any strategic intervention. They won’t!
There is an equal tendency to seek to do less for more – however, any short term financial gains achieved by such an approach will soon evaporate as individuals no longer deemed eligible for support become more and more unwell and are put at increasing risk. The reduction in the use of care home placements combined with a lack of adequately resourcing care at home and housing support is a game of care roulette with only one victim, the vulnerable older person desperately in need of support and care.

Another reaction is the desire to reform and change. This is undeniably necessary not least in the way we purchase care and treat older people in a discriminatory manner with regards to choice and control such as through the operation of self-directed support. Equally important is the desire to innovate and re-design but if ‘new models of care’ are viewed as some sort of panacea for our current ills we risk losing creative innovation and care entrepreneurship as fatigue and failure take root. Even with progressive use of technology we aren’t going to find a magic chic of gold at the bottom of the care garden.

Overarching all this is a response which says we are doing a lot anyway, we are doing better than others and that we are spending more than we ever have. All of these might very well be true as is the oft heard statement that we need to transfer resources from acute clinical delivery into primary and community health and social care.

But …
and it is a big but. The fact is we have not robustly undertaken an analysis of whether even with reformed, dynamic, localised, non- institutionalised interventions, there will indeed be sufficiency of financial resource it is difficult not to conclude that there is a substantial inadequacy of resource in social care. That is what frontline staff and providers are telling me up and down the country. In particular as we live for longer and with better health, how will we pay for increased dependencies and an even greater volume of care and health need?

Integration is part of the answer to that puzzle but so too is a serious debate about the mechanisms needed to be able to pay for health and care. We need to collectively have a debate about the ethics of being treated free at the point of care if you develop one condition such as cancer but if you live with dementia there will be a greater likelihood you will have to pay. We need to have a debate about the ethics of inheritance and contribution. We need to start to shape the nature of decisions around personal insurance, income tax, separate taxation for care etc.

And we need to do so urgently. This goes way way beyond our politicians. In no way should the care and support of the most vulnerable be used as a party political football. We deserve better and need to find political and societal consensus, agreement and collective resolve.

The debate is urgent. The decisions are necessary. The desired resolution desperately needed.

In our capital city you can now earn more from being a dog walker than supporting the old in their home to live independently and with dignity.
I’m not sure that is the sort of society most of us would want but that is what is our real inheritance unless we act to change it.

Donald Macaskill

@DrDMacaskill

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Guest post from Local Integration Lead, Janice Cameron

Older people living in Care Homes are some of the most vulnerable people in society. Due to complex needs, illness & frailty they can be at higher risk of developing a Pressure Ulcer.

The announcement that a collaborative of the Scottish Patient Safety Programme, Scottish Care & the Care Inspectorate were asking for HSCPs to submit applications for a programme beginning in May 2016 running to Dec 2017 to look at reducing pressure ulcers in care homes was met with much enthusiasm in East Dunbartonshire.

The aims & objectives of the programme were: SPSP would work with HSCPs, NHS territorial boards, Scottish Care and other local authority, private and third sector care homes across Scotland to reduce the incidence of pressure ulcers for residents in care homes.

Following submission of an application from our partnership, then attending an interview panel on a very rare sunny day in Edinburgh we were one of four Partnerships across Scotland to be accepted onto the programme.

The initial excitement of being accepted onto the programme soon lead to feelings of terror.

Five Care Homes volunteered to take part and we were a team of three enthusiastic but naive colleagues from the NHS & Independent Sector.

I have to say that following initial collection of data from all participating Care Homes from the four HSCPs in Scotland, it was very apparent that there was a very small incidence of Pressure Ulcers.

Therefore, it was decided that although we were aiming to reduce the incidence of pressure ulcers in care homes by 50% by Dec 2017, we also had to look at how we were going to prevent them.

Now, I could spout on forever over how we introduced Pressure Ulcer Grading training for all staff, pressure ulcer peer grading, red day review tools, data collection tools and graphs but that may get boring, however  I would urge you to go on to the website www.pressureulcer.scot and have a look at all the innovative work  happening across Scotland, along with some great information and tools.

I can’t pretend at times it’s not been a hard slog.

It has taken a lot of resource to get the programme up and running, also to keep enthusiasm and engagement consistent when the day job takes over, but our gang of three and our five Care Homes have been magnificent in achieving just that.

At our first Learning Set where we looked at the PDSA cycle as a tool for improvement, I did find that, in fact I am not any good at building paper aeroplanes!!!

Below is a nice picture of two of the team with their aeroplane which shows we also had fun along the way.

Through the hard work of everyone in East Dunbartonshire who has taken part in the project, we have been selected as one of three areas to have one of our homes evaluated.

This home is trialling a Pressure Ulcer Daily Risk Assessment Tool and when complete, the evaluation will be available on the website already mentioned.

We are also extremely honoured that members of our team have been asked to attend the Pressure Ulcer World Summit in Manchester in December to talk about how we approached the project and some of the Assessment Tools that we have successfully implemented in the Care Homes.

If you get the opportunity to take part in something like this I would urge you to get involved. No one wants a resident to get a pressure ulcer. In some cases, this is unavoidable but by making small changes and improvements through a programme like this we can reduce and even prevent it happening.

There have also been the fringe benefits. Existing relationships with care homes become stronger due to being in frequent contact, meeting new colleagues who broaden your network of skilled people you can call on should you require their specialist knowledge, true partnership working and many more not forgetting there is fun to be had along the way!!!

Officially the programme concludes at the end of December 2017, however the bigger challenge will be how to ensure improvements already made are sustainable. How do we spread this to our other care homes and then……. take over the world!!!

Janice Cameron

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Celebrating Older People’s Day – A message from our CEO

Today, Sunday 1st October, is Older People’s Day across the UK which coincides with the UN International Day of the Older Person

The theme of the International Day of Older Persons 2017 is

“Stepping into the Future: Tapping the Talents, Contributions and Participation of Older Persons in Society.”

The theme is about helping us all to recognise that older individuals in our community have a massive amount of untapped potential and contribution to make to our society.

For those of us who work in social care, in care homes or care at home, we daily recognise that the individuals who are supported are contributing a huge amount to their local communities, despite often living with limiting illness and conditions. Yet all too often they are a part of the community, which others choose to ignore or consider to have nothing to offer and give.

I have written many times in this blog about the creeping ageism, which limits potential and despoils our communities. Older People’s Day is an opportunity not just to celebrate what older individuals have contributed to our society, but to start to work to remove the barriers of attitude and behaviour which are preventing them from giving more, contributing greater and participating better.

There is a real truth in the acknowledgement that we are not a community unless we enable the full participation of every single member of our society.

Between 2015 and 2030 the number of older persons worldwide is set to increase by 56 per cent — from 901 million to more than 1.4 billion. By 2030, the number of people aged 60 and above in Scotland will exceed that of young people aged 15 to 24.

Stepping into the future with our older citizens, wherever they live in our communities, is making about making a commitment that no one will be left behind, no voice will be unheard because it has lost its strength, no contribution will be dismissed because it is articulated by age.

To be valued, to find a place, to be able to give, to contribute, to participate are fundamental to our health and well-being. So as we all grow older in Scotland I hope we can also tap the potential of all in order to maximise the health benefits which come from feeling you can still make a difference.

So in your place of home, in your place of work, in your place of relaxation, think today about how you can include all the generations, and value especially the gifts, abilities, capacities of those who are older.

Let us all therefore work together to step into a future where all can find their place to give, share and be.

Dr Donald Macaskill

@DrDMacaskill

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Guest Post from National Director, Karen Hedge

‘We care because we care’

When I heard this I sat up, I listened and I remembered.  What this lady was telling me was that no matter what challenges she faces, she will turn up, she will be there.  But I couldn’t help but wonder if, with the need to cover long hours with limited support networks in a socially undervalued sector, there will come a point when she can’t care.

I was fortunate to meet this lady, and many other care sector staff, from front line to senior management and executives, when I recently had the honour to accompany Becca Gatherum in facilitating mental health focus groups with a view to exploring both the various mental health pressures experienced by care staff and methods to alleviate these. The resulting report will be launched at Scottish Care’s Care Home Conference on 17th November.

This lady happened to be a care home manager, but I have since heard the theme repeated by front line staff and by home care and housing support providers.

The whistle stop tour of people, places, policies and politics that I have been on since starting at Scottish Care in June has also been a whistle stop tour of emotions; echoing the sheer joy, shock, awe, laughter, sadness, satisfaction, confusion, pleasure, frustration, and hope that I (and I wager many others) have experienced throughout a career in the care sector.

But all the while I have been wondering: ‘who will care when you can’t?’

Pressures such as:

  • A workforce shortage, with 77% of care homes and 89% of home care services having staff vacancies, in a context of increasing need as the population ages and lives for longer with complex needs. The workforce itself is ageing, with 22% of independent sector care home, care at home and housing support staff aged over 55, which puts added pressure on shortages, and of the course the impact of Brexit is already being felt as we lose European workers. And whilst it is becoming increasingly likely that you will hear the phrase ‘social care in crisis’, sadly the impact that the mainstreaming of this rhetoric may be having is to further compound the situation by making it more difficult to retain and attract staff into a profession which is being negatively portrayed. We need to find and share some positives. I know they exist – I am fortunate to be chairing the judging of the National Care Home Awards.
  • Providers being unable to invest in staff training and support because they cannot spare them the time off rota, at the same time as knowing that providing that training and support is what is necessary to enable them to continue to care about care.
  • The impact of the ‘time and task’ nature of many commissioning packages which put a time limit on caring. Imagine an actor, had to repeat a 15 min script to a succession of audiences over an 8, 10, sometimes 12 hour shift, then go home leaving the character and any emotional connections behind. But these are not actors playing a part, they are real people forming real caring bonds and connections. As a former commissioner I remind my colleagues that the fourth part of the commissioning cycle is review, and that is not just a review of the provision, but also of the commissioning itself.

And whilst there are many more pressures I could go on to list, this activity in itself does not answer my question, but it does help me to see my role at Scottish Care more clearly. As a membership body, we have responsibilities to our members, but we also have unique access to a wealth of knowledge and information about the sector which we can promote and use to provide the evidence for change.

So, instead of asking ‘who will care when you can’t?’, I will now be asking, ‘what can I do to support you to keep caring?’.

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Guest Post from Local Integration Lead, Carolanne Mainland

From Creativity to Compassion

"Every block of stone has a statue inside it and it is the task of the sculptor to discover it."

           Michaelangelo

Within our complex social landscape, compassion fatigue is emerging, virus-like, to further fragment natural synergies.

Compassion is the barometer from which our time on this planet will be judged by future generations. Our time is one in which we have accepted the normality of people languishing in hospital, people struggling to access care within their communities, people living and dying in loneliness.

With our media constantly bombarding us with images of disease, war, famine and death we have simply become immune to Human suffering, Human need.

Even within our caring professions, where the ability to empathise and demonstrate compassion are central to the nature of their being, we see the dread of working with certain people and in some cases avoidance of them completely. We further see a reduced ability to feel empathy and a frequency of sick days, accompanied by a host of physical and emotional problems.

We fail to truly notice. And noticing makes all the difference. Noticing gives us purpose and forms the heart of our Communities. Noticing engenders respect and caring. Noticing improves mental and physical health. Noticing builds tolerance and understanding.

You could say noticing is being mindful, but many of us dismiss mindfulness as a passing fad of adult colouring books and self-help manuals. Yet mindfulness has been recognised by the world’s greatest philosophies and utilised to nurture compassion for thousands of years.

The recent rediscovery of mindfulness in our society is no longer confined to complimentary therapy publications, we are increasingly seeing evidence emerging within the pages of respected Journals of Cardiology, Psychology and Neurology. Functional MRI scans are showing that mindfulness practice activates a region of the brain known as the insula. The insula is linked with both empathy and creativity. Meditation studies evidence that, with sustained practice, growth occurs within insula. Recent thinking indicates that creative pursuits also increase activity in this area of the brain with a growth of an increased ability to notice more detail being a by-product.

For many, the notion of meditating will be so alien that they will never engage with it.

You may never have learned to play a musical instrument and school art classes may have long since put you off picking up a paint brush. But what if making some time to do a little focused gardening or some photography with the camera on your phone could improve your ability to notice? As well as the sheer pleasure of immersing yourself in something that is pleasurable to you, you might also be inadvertently be growing your ability to build Human capital, one relationship at a time.

 

Carolanne Mainland   

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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)