Let’s not lose the potential of technology in homecare

In August this year Scottish Care published ‘TechRights: Human Rights, Technology and Social Care’. It was launched at our event called ‘Tech Care, Care Tech.’ which was the first event of its type held by Scottish Care.

Since the publication of the report a great deal of debate has ensued both in Scotland and further afield not least about the role of robotics and the Internet of Things.

In the months that lie ahead Scottish Care will continue to work with partners on a range of projects relating to technology and its use in social care. One area we are investigating with a wide range of colleagues and academics is the potential to develop inter-operability which would enable providers to use the best software offers for their service delivery and enable them to ‘speak’ to one another in an integrated way. We will keep you up to date on this and related work.

However we have to state that the positive use of technological interventions in order to maximise rather than replace human encounter is facing some real challenges.

The first is the way in which some technologies are being used to restrict rather than to promote human relationship. Scottish Care has long argued that the use of call monitoring hardware and software within the care at home sector needs serious review. There are real benefits to organisations and individual workers not least in terms of safe lone working practices. However, what we have at the moment is the use of systems like CM2000 by Scottish local authorities which serves to effectively treat the frontline workforce in an unacceptable manner. Effectively workers are being electronically tagged and we have clear evidence that workers are leaving organisations who are forced to use this technology – a valuable resource the homecare sector can ill afford to lose.

This needs to be challenged as a matter of urgency or we will witness a whole generation of frontline homecare workers who will be resistant if not hostile to the benefits of technology for frontline care. Call monitoring models need to be person-centred and human rights based in use and implementation and not act like some sort of ‘Big Brother’ device to instil suspicion and mistrust.

A second challenge relates to the data that we are already gathering. Hundreds of homes are increasingly utilising the benefits of smart technology. There is an astonishing breadth of smart technology that is already and very shortly will be taken for granted in most homes. There is as some have commented a danger of ‘tech clutter’ in some of our homes, especially the living room from smart devices like the now commonplace Echo Dot, to music speakers like Sonos, smart televisions in abundance through to heating controls like Nest and Hive.  But less rare but growing are smart lighting devices, alarm clocks, radios, vacuum cleaners, microwaves, kettles washing machines and doors.

The volume of data that is being collected is astonishing but it is not utilised. We could do much better than we are already in using this data to move from a reactive model of homecare to one that is truly preventative and builds the support and care service around the distinctive needs of the individual. Such an emphasis requires resourcing and trust between commissioner and provider. It also requires those creating national data platforms to speak to homecare organisations and providers in order to maximise benefit.

A third challenge is something we alluded to in the TechRights report and that is the extent to which we need to re-envision the role of homecare to enable it to attract people who are technologically confident and competent. But for the tens of thousands of staff who are working already in homecare we need to do more than we are at present to invest in training and development for them, so that they overcome fear and cynicism and see technology as an asset to care. Such training and learning is the first to be cut in contracts during austerity and this is a fatal flaw for the development of a responsive, prevention focussed future model of care in the home.

Lastly the way in which care technology is introduced must bring the wider general public with it, especially as we move to an age of greater use of home robotics and artificial intelligence. At the moment there is a real lack of knowledge on the one hand, and a fear on the other. Such an articulation has to be based on an assertion of what should always remain the essence of homecare. This must surely be the sense that in ultimate terms , not least palliative and end of life care, that contact has to be human and that whilst technology can assist and add value it should do so in order to support and enhance human presence rather than replace it.

We live, as has been numerously said, in very interesting times. As innovation and technological discovery accelerate into areas and abilities we can only imagine, we have to be clear that a rights-based, person led, citizen controlled technology for homecare needs to be a priority in all the design and debate.

Dr Donald Macaskill

 

Yesterday I was having a discussion with a colleague about the various bits of research we are currently undertaking within the social care sector and the privilege we’ve had of leading various focus groups with front line staff working in services across Scotland.

“Have you ever done it?”, she asked.

“Done what?” I enquired.

“Worked in a social care service?”

My answer was no, and I explained that this means you can feel like a bit of a fraud spending your days researching and advocating for a sector you’ve not worked in, never mind forged a career in doing so.

But we both went on to reflect that it was a job we didn’t actually think we would be able to do, recognising that it requires a particular set of skills and personal attributes in order to be able to deliver the high quality, personalised and complex care we’ve come to expect, not least of home care provision.  We shared our mutual sense of admiration for the thousands of individuals who do undertake these roles and make a huge difference to people’s lives on a daily basis.

At the same time, I’ve been thinking about an exercise we have been conducting with home care providers and workers in recent weeks, asking them to reflect on something that stands out to them about the year they entered the home care sector, as well as something that comes to mind about the reality of home care provision in 2018.  Whilst we’ll be publishing this data more fully in Spring 2019, initial findings are already showing the huge changes that have been experienced within the home care sector, not just over the past few decades but even in very recent years – something we’d already begun to explore through Bringing Home Care.  With the pace of change, it means that those not directly connected to this sector (but who are reliant on its existence and success) may have no real idea what working in home care looks like or entails in 2018.

In terms of policy around home care, we’ve seen a real drive towards supporting people in their own homes for as long as possible, including those who would traditionally have accessed medical and residential care, based on the knowledge that most people would want to remain in their own familiar environment if at all possible.  Policy changes relating to Health & Social Care Integration, Self-Directed Support and changes to service regulation through the new Health and Social Care Standards have also emphasised the importance of individual choice and control, independent living, self-management and prevention.

Hopefully, these reforms will progress us towards a new age for home care – where services are planned for and commissioned in a sustainable way which reflects their criticality to our communities and infrastructure, and where services are empowered to be flexible enough to deliver the support that individuals want in order to achieve their personal outcomes.  Those are the ambitions, I think, that make a policy drive towards supporting people in their own homes for longer truly worthwhile.

However, these positive drivers don’t necessarily mitigate the reality of extremely limited resource – financial, human and sometimes, imagination around the commissioning, planning and delivery of home care which, in effect, makes it the Cinderella service of health and social care.  And given the exercise we’ve been conducting alongside Scottish Care’s previous research, we know that that challenging reality is biting.  But is the speed of reform sufficient to alleviate the very serious pressures on the sector now?  We know that home care services are concerned about being here in a year’s time, we know that recruitment and retention is more difficult than ever, we know that hospitals and care homes don’t have the capacity to deal with additional demand and we know that care packages and associated home care hours are increasingly hard to get and maintain at required levels.

My concern, therefore, is that the consequences of positive ambitions yet slow reform coupled with an already overstretched sector creates a reality where the policy becomes skewed.  With a drive towards more care in the home but without the pace needed to protect, sustain and develop this sector and its workforce, it means that not enough home care can be delivered to meet demand.  It puts the responsibility on relatives and informal carers to step into the gaps to provide often intimate and complex care at what can already be a distressing, emotional and exhausting time for them. 

It also undermines the truly professional and highly skilled role of home care workers who do their utmost to deliver care without the access to the wider support that they should have.  Even if you have a care package to support you in your own home, it’s regularly commissioned around task and time for the lowest cost – almost saying ‘this is an unvalued job that anyone can do’.  This is an unhelpful message to reach people considering working in home care who, in reality, need formal qualifications, require to be registered with the SSSC and will be delivering complex care to people living and dying with co-morbidities.

We need to turn this on its head quickly and loudly.  We need to be emphasising that radical reform needs to take place in this sector because its sustainability is absolutely vital to the lifeblood of our communities, the NHS and all services involved in integrated health and social care delivery in Scotland.  We need to be ensuring that people can positively choose to stay at home safe in the knowledge they will have holistic support that’s predicated on their needs and ambitions rather than minimum cost.  We need everyone to know that the image they may have of home care in years gone by – mopping, shopping, cups of tea – is not the home care of 2018.   It’s not even recognisable to that delivered 5 years ago.

And we need to be celebrating the fact that not everyone can be a home carer (including me) because they are truly special individuals who we need to admire, reward appropriately, and value.

We simply cannot afford to be without them, or to shy away from brave thinking and radical changes in the home care sector.

@BGatherum

 

 

 

 

 

 

 

 

 

 

 

 

 

The My Home Life team has had the pleasure of working with Care at Home Managers in Scotland in the last few years. Although the MHL programme was originally designed for care home managers to improve the experience of people living, working, visiting and dying in care homes, in many local authorities the programme has also been offered to Care at Home managers with success.

Within West Dunbartonshire health and social care partnership, care at home teams have been included in the programme. On the current cohort we have a senior manager and three team leads from the Care at Home team as participants.

The model of care within care at home teams means that the managers face to face contact with their large number of colleagues, particularly those who are providing the care, can be limited.

MHL encourages the participants to do things differently, not necessarily do different things and so Care at Home managers have been creative in how they can demonstrate the difference, and co-create solutions with their colleagues.

Using an appreciative approach and the Caring Conversations Framework, communication with colleagues internal and external to the main office has been transformed. Meetings of every kind are conducted differently, ensuring every voice is heard, using creative approaches such as the use of images to help colleagues explain to each other how they feeling. Supervision has been transformed from what used to be a tick box approach to a genuine interest in what is going on for each other and how colleagues can continue to give of their best. Care at home staff tend to be in touch with their managers when things are not going well and telephone calls with colleagues used to be stressful. Now time is given to listening and working with the colleague to come up with a solution which works for everybody, and when things are going well, managers are taking the time to call or text their colleagues to thank them specifically for their work. How manages recruit and support new colleagues into the workforce has also been considered with a view to enhancing the experience for them all and thus improving retention of colleagues.

Managers are also beginning to spend more time with the users of the service, particularly at the assessment stage, where they can find out more about what the expectations and needs of the user are in order to provide the most suitable package of care. Some of them are using emotional touch points to explore how clients are feeling about allowing carers to come into their homes to provide personal care which is giving them further insights. Should a complaint be received, managers will now visit the person who has made the complaint and use one of the creative tools to understand how the person is feeling, how they would like to feel and work with them to come up with a solution together.

 

Below are a couple of quotes from Care at Home participants:-

‘A client I find difficult and challenging contacted me. I spoke to him about MHL and he invited me out to discuss his care.  I realised no one had asked him how he felt or what could be done… I used the positive inquiry tool and what he said was valid and we had caring conversation. I managed to go get to core of his complaint and we discussed other options. I was able to give feedback to his carers. MHL and the 7 Cs stopped me taking it personally and it…was amazing ,  he gave me feedback about me and my influence.  I agreed to talk with my line manager and have done similar with carers.’

‘I’ve been taking time to speak to families and relatives who can tell me what is working well with the service. I have become more proactive and not so much reactive. This is the first Christmas I have not been looking for a new job, the shift is in me. I can’t change other people. But I’ve changed.’

 

Care at home teams offer such an amazing service to enable people to stay in their own homes, it is wonderful to see how managers using the MHL approach are transforming personally and professionally, modelling and appreciating different ways of working which are achieving different outcomes for colleagues at all levels.

 

Below are a couple of poems created by Care at Home Team Leads

 

M.H.L. and ME

 

I have the ability
live with me forever
deal with difficult situations
fellowship and support of others

 

Live with me forever
sharing the challenges
fellowship and support of others
different directions

 

Sharing the challenges
deal with difficult situations
different directions
I have the ability

 

My ‘Yes!’ Moment

 

I do think I am of value

I felt an instant shift, my ‘yes!’ moment

Fiona’s words of wisdom struck a chord within me

I own my insecurities now

 

I felt an instant shift, my ‘yes!’ moment

My journey has been slow and steady

I own my insecurities now

I can, and I will, keep on growing

 

My journey has been slow and steady

Fiona’s words of wisdom struck a chord within me

I can, and I will, keep on growing

I do think I am of value

 

Written by Fiona Cook – external My Home Life facilitator

 

 

12 minutes to Midnight 5 months on

On 17^th June 2018 Scottish Care published its short report, ‘Twelve Minutes to Midnight: 12 challenges, 12 solutions, 12 months to save the homecare sector.’

The report received, as might have been anticipated, significant media reaction though not all of it got beyond the headlines into the actions and suggestions that we were making.

We are now 5 months on and given today is Home Care Day, it might be appropriate to revisit progress.

So firstly what were the issues and suggestions?

 

1. The Scottish Living Wage

The last few months have seen the reality on the ground look even worse than it had been in May. It took several months after the commencement of the Scottish Government 2018 commitment for the monies which should have been allocated to finally reach the pockets of the providers. In some instances it was as late as September before several Scottish Local Authorities sorted themselves out and decided to pay external providers. This is unacceptable meaning either that frontline workers were not paid their increase because providers had no assets or reserves thus making retention very challenging. Or providers used the little additional reserves they had in order to pay workers until they received their payments. This again risk the sustainability of many organisations and meant in practice that resource that could have been used for innovation and development  was lost.

It is a great pity that the flawed implementation of a well-intended measure has resulted in even less sustainability within the homecare sector.

We are very concerned of what the future might hold. One thing that Scottish Care is clear upon and that is that if this initiative is to continue it must be appropriately resourced, clearly ringfenced, properly implemented and externally reviewed. We simply cannot leave it to a wing and a prayer.

We must also seriously address the fact that the failure to pay differentials has now resulted in many organisations struggling to attract senior staff and managers.

With renewed pressures from Brexit and from the hospitality and retail sectors we must do more than a badly implemented and poorly resourced Scottish Living Wage initiative to secure the future of the valued homecare workforce.

 

2. Time and task commissioning

There is now no shortage of initiatives, including those of the Adult Support and Care Reform process from Scottish Government and work on a potential National Framework facilitated by Scotland Excel within the commissioning landscape. There are also emerging models in practice of collaborative models including alliance models. There does indeed seem to be a willingness to move away from the obscenities of time and task commissioning which has served to drive quality down and to develop outcomes based approaches. This cannot be done on the cheap and must be resourced to enable the step change which citizens require. Care in fragments, deserves to become a thing of the past.  We must re-imagine the potential of as preventative, time-flexible, outcomes focussed approach to commissioning.

 

3. The model of care is not appropriate – not holistic not person led …

 Scottish Care’s report, ‘Bringing Home Care’  was a call to develop prevention focussed, time flexible and relationship-based care. More than ever individuals accept the validity of these options but we are still struggling within a system that is failing to join up the dots. Despite the mantra of integrating health and social care and creating one system approaches, we still witness a fragmentation of resource and leadership. More than ever before we need to re-envision the sort of care we need to deliver. Investing upstream by re-shaping homecare will in the medium to long-term make significant fiscal savings and lessen an unhealthy dependence upon the acute NHS. But this requires courage and an active disinvestment from buildings and roles which are weighing down innovation. It is hard to prove a future which is calculated on not doing something  without at least testing new approaches. We know what they are we need political will to start implementing them. Scottish Care is committed to continue to demonstrate the clear personal and societal benefits of a reformation of homecare and the development of housing with care models.

 

 4. Recruitment of staff

As the Scottish Care Autumn Care Tour goes around the country  there is one singular issue which is concerning providers of housing support and acre at home service s- that is recruitment and retention. All the evidence is that things are getting worse rather than improving. Providers tell us they are massively struggling to recruit staff.  IN previous years people came through the door and were then sifted , now there are not even individuals who are showing an interest in social care. This isn’t too much of a surprise when we have a highly regulated sector, with qualification demand,. And low level remuneration. Go along the road and there are plenty of equally well paid jobs in retail and hospitality without the level of demand and external oversight, and societal stigma. We have a massive recruitment crisis. Inevitably this is already being made worse by the cloud of uncertainty which is Brexit. Providers are reporting that loss of staff is a reality now rather than an anticipation for next year. It is very difficult to encourage and recruit in such a negative atmosphere. We are pleased that there will be a Scottish Government funded campaign to attract workers and are happy to collaborate in its development. However, on its own, and without addressing the elephants in the room, it will be insufficient.

 

5. Holding on to existing staff

‘The Four R’s’  and the ‘Experience of the Experienced’ reports from Scottish Care’s Workforce Matters team have been published since the spring of this year. They paint a picture of real challenge around retaining the staff that we have in homecare. We know that 63% of staff leave within the first six months of joining an organisation. Retention is critical. We have to get better at holding on to the workforce we have because we know that for every 10 people who leave 3 never come back into social care. We have to explore with partners what are the reasons that people are leaving. We know that some leave because they and the work is not a fit; we also know some leave because of the stress and strain of the work and the way it is structured. But we also know that people say that they are not happy with the lack of autonomy, too much emphasis on regulation and compliance, and insufficient time to be with people.

 

6. Qualifications and especially older workforce fitness to practise…

Registration opened for frontline care staff a year ago and with it came a requirement to be appropriately qualified within a set timescale. Scottish Care shares the desire to have a well-trained, valued and recognised care workforce. But there are real fears out there, and these have been compounded over the last few months, that despite the supports, we will lose some of our most experienced and talented older staff because they will not want to go through the rigours of our current qualification system. Added to that Scottish Care believes that we need to radically reform the qualification system. We hear from providers that there are real problems in accessing local training providers, inflexibility in forms of assessment, an over-dependence on text and academic models amongst other concerns. We dare not lose the gifted resource of trained and skilled individuals who have worked in the sector for years but whose life-skills and prior learning is not being appropriately valued and acknowledged.

 

7. Emotional fatigue… mental health stress and distress

 After terms and conditions, we know from our research at Scottish Care that the second main reason that people choose to leave social care is because it is such an emotionally draining and demanding area of work. ‘Fragile Foundations’ was published nearly a year ago and describes the often draining and exhausting reality of care and its impact on the mental health and well-being of the workforce. There have, over the last few months, been a considerable degree of political focus on mental health and wellbeing, not least of children and young people. We need the same level of commitment to older person’s mental health in general and a particular emphasis on the mental fatigue being faced by the care workforce.  As we have said we must all get better at caring for the carers.

 

8. Integration

The establishment of a Review of Health and social Care Integration is to be much welcomed. Scottish Care is grateful to be included in that review which is an important acknowledgement of the fundamentally important role that the independent care sector plays in delivering services across Scotland. We all want the aims and vision of integration to work in reality. The next few months will involve the need for courageous thinking and creative work to ensure that the benefits of a one system approach are truly achieved. We look forward to building upon this early work both at national and local level. In the midst of this we continue to encourage local Integrated Joint Boards to give formal recognition to our contribution by having a representative from the sector on the Boards. Since we last reported the Scottish Care Partners for Integration staff have produced a report and held a conference which highlights the work of the independent sector across integration authorities. It is clear from that when we work together we achieve the joined up and positive outcomes which our citizens desire.

 

9. Technology used to limit rather than to liberate

 There is tremendous potential in technology to transform and deliver a more person-led, preventative approach to home care and housing support. Scottish Care has long argued that this technological contribution has to be undertaken for the right motives – to enhance person-led care and support, and in the right way – embodying human rights at the heart of care. To that end we published a report called ‘TechRights’ in August.  It is a call for a human rights based approach in the developing use of AI, Big Data and the Internet of Things within social care. It is our hoped that the partial engagement of the independent sector by other stakeholders will increase over the next few months. The future of care necessitates all of us working together.

As part of that future for homecare we have been delighted to have been working with the Glasgow School of Art School of Innovation in  a project which has technology at the heart of a vision of homecare for the future. We hope, after our Autumn Care Roadshow, to write up our findings and specific recommendations.

 

10. SDS needs to work better for older people

Self-directed support (SDS) is the only way that citizens should be accessing social care – but for many older Scots the principles of choice, control, participation and dignity are still being daily ignored or only partially offered. We are still hearing stories from across Scotland, often on the grounds of fiscal austerity, that older people are not getting the same access to choice. This is not the fault of SDS , this is the fault of a social care system not enacting the legislation properly and a lack of resource to implement the change we all want to see.

Scottish Care is absolutely committed to ensuring our citizens are able to exercise choice and control, have a clearly identified personal budget and that there is a diversity of the market to enable real choice to happen. We will resist any attempts, including political ones, to water down or neutralise this potentially life-changing legislation and delivery model. We will continue to be strong advocates of self-directed support and its potential to put the citizen in control of their own care.

 

11. Social care is underfunded

 We are a few weeks away from the Scottish Budget Statement and over the next few weeks Scottish Care will be publishing our own Budget for A Caring Scotland. Every year we are faced with the uncertainty of lack of finance in the social care system in Scotland. Every year at budget time we at Scottish Care make a call for substantial funding to bridge the care gap which is getting wider and wider as our population ages, as dependencies increase and as services cost more and more.

We remain deeply concerned that there is a lack of political energy beyond political party interest and ambition to gather around the table and properly explore how we will fund social  care in the short and medium term. As others elsewhere, for instance in Wales, are holding robust conversations with citizens on funding care we hear a deafening silence in Scotland. We need to start having a debate which will be central to the social fabric of our communities and to the maintenance of effective care at home and housing support.

 

12. Discriminated and devalued

 Our last statement was that we believed that one of the most significant issues facing the social care of older people is the pervasive discrimination which many older Scots and those organisations who support them continually experience and talk about. We have not seen this alter over the last five months, indeed if anything, because of a simplistic analysis of Brexit voting we have seen it increased. Such stigma and stereotyping needs to be called out for what it is – discrimination based on age. The creation of an inclusive Scotland cannot be created on a foundation which is inherently ageist.

 

 

Starters at midway point 

Our previous report listed 12 specific starters – let us see how we are progressing…

 

1.Emphasis on prevention

 We called for investment in tests of change, in developing new models rooted in prevention and self-management for the old and frail, which is non-condition specific  but designed to enable independence and is person-led. We asked any Integrated Joint Board willing to work with us to get in touch. We are still waiting.

 

2.

We called for a change in commissioning to make it collaborative and relational. We are thankfully beginning to see a growing collective and governmental desire to make this happen.

 

3. Learning needs to grow up

We called on partners to work with us to radically alter the way we validate and recognise care worker learning and experience. We invited the SQA and SSSC to work with us so that together we can create a  qualifications framework which is built around the needs of the person rather than the system. We have started the process of discussions and debate but we believe there is still a resistance to making the radical change we need to see.

 

4. Utilise technology by equipping workforce

We called for the creation of a five-year Technology for Social Care Project Fund – to fund creative technology designers to work with frontline care workers for a month and then out of that experience to design innovative solutions for practical problems in collaborative partnership. We still believe this is a good idea – we are still waiting on our colleagues in the Scottish Government’s Digital Health and Care Team to get in touch.

 

5. Let us all try and make the Scottish Living Wage initiative work

Scottish Care is committed to the maintenance of this initiative from the Scottish Government. We have to get better at its implementation and adequate resourcing. We are continuing to work with our partners in seeking to achieve this positive outcome. The next Budget has to clearly delineate priority for social care staff. We would encourage our politicians to note that the Welsh Government has made social care its fourth area of economic priority.

We called for the creation of a Pay Commission to be established to decide what is an adequate rate of pay for those engaged in the increasingly skilled and challenging tasks of care in our community. We are still waiting for buy in.

 

6. Prioritise learning and development

In order to recognise the critical role of training and learning in homecare , and in response to the growing reduction in funding through contracts for staff training, we called on commissioners to ensure that at least 10% of the whole sum of a tender should be committed to the training, learning and development of the workforce. We have not seen anyone do this.

 

7. Respecting the workforce 

In recognising that it is time to trust our workers by giving them power to make decisions, to act autonomously, to feel that they are trusted and valued, professional and capable, we called upon SSSC and others to work with us to change the workforce regulatory culture from one of compliance to partnership, one of fitness to practise to freedom to perform. Discussions continue but we believe we have not got the balance right and that regulation is still disproportionately heavy.

 

8. Care for the Carer Fund

Faced with all the evidence we have published on worker stress and distress, on burnout and fatigue and the critical importance of retaining the workforce, we called on the Scottish Government to establish a Care for the Carer Fund dedicated to ensuring the mental health and well-being of frontline social care staff. They are our greatest asset to hold on to and our easiest treasure to lose. We have not seen this come to fruition.

 

9. Distinct bereavement support for every worker

In accepting that most social care for older people is at the interface of palliative and end of life care, that the social care workforce offers solace in distressing times, we argued the need to support that workforce better. In so doi9ng we asked Scottish Government to prioritise bereavement support for the workforce through a joint national project with Cruse Bereavement Scotland to establish a network of bereavement support for care professionals. We have not seen this suggestion taken up.

 

10.  

We argued that in order to make integration work it should be a requirement to include representatives of the independent sector social care providers and frontline workforce on IJBs to have their voices heard.  We still believe that you cannot have partnership without presence and yet still most IJBs do not have a sector representative.

 

11. 

In recognising the substantial contribution of social care to the wider Scottish economy we called for the creation of a special division or unit within Scottish Enterprise dedicated to enabling the greater promotion and development of social care and to fostering and co-ordinating innovation and entrepreneurship for the benefit of the wider economy. None such has been developed.

Alongside this we are called for Skills Development Scotland to strategically work with organisations like Scottish Care to focus more of its priorities and resource on the social care sector. We have had constructive dialogue and progress in parts of this over the last five months.

 

12.  

Our last suggestion was that we create a cross-party and independent Commission on the Future Funding of Social Care in Scotland. We acknowledge the reform work that is ongoing but our call for an urgent exploration of the financing of social care and health in Scotland has gone unheard

 

So overall…

Scottish Care as the representative body for the majority of older people homecare organisations is disappointed that five months after we identified 12 critical areas to be addressed and offered 12 solutions to meet the challenges facing social care that the vast majority have not been accepted or acted upon.

On our calculation we are seven months closer to a point of real breakdown. Every day across Scotland we are faced with a homecare sector struggling for survival and sustainability.

The thousands of women and men who work in the services , and the thousands who receive support, deserve better than a countdown to even more chaos and disintegration in the care and support they received. We need to all of us work together to make the change that is needed, and to nurture the care that changes us all from bystanders to active citizens in creating an inclusive Scotland.

We hope next May to say something very different.

 

 

 

 

 

 

The challenges facing the home care sector are well known and increasing. There is a need for improved sustainability, greater recognition for care staff and for a shift towards a preventative, relationship-based and person-led model of care that will support people to live independently for longer and lead to better outcomes for those being supported. Sadly this story is supported by statistics such as a staff turnover of around a quarter, and quotations from frontline staff such as in our report ‘Fragile Foundations’ on staff mental wellbeing “a lot of the time I drive out, pull into the next stop and cry”.

This subjectivity can make it harder for us to re-imagine a better future and so we commissioned work with the Glasgow School of Art (GSA) Innovation school to challenge our thinking and turn it into areas of opportunity based upon current trends, and to make tangible the way in which home care could change in the future.
The Project Aim was to creatively explore and prototype a future of care at home that is underpinned by the National Health and Social Care Standards and engages a dynamically different sector.

Methodology

The methodology was in two parts.

Firstly on the ‘Here and Now’, with the purpose of identifying challenges, aspirations and opportunities they carried out desk research, observation and shadowing and a ‘pop-up’ engagement at the “Design, Technology and Dementia” conference, finalised by a ‘sense-check’ with Scottish Care. Out of this, the following 4 current themes were identified:

 

 

 

 

 

 

The second part to the methodology was on ‘There and Then’ and using a ‘future-orientated design approach’ in which creative and visual methods were used during participatory design workshops. The GSA used the ‘fortune telling’ theme to make the project less formalised and inspire people to get involved. The decision was made to base thinking in twenty-five years time firstly, to free our thinking from existing challenges. In twenty-five years, our ways of living will be different, we will have different views and life experiences and will have grown up in quite different technological, social and economic climates. We will have different family structures, friends and relationships, and people will hold different opinions on what it means to ‘live well’.

This time focus groups were held with care providers and frontline staff, specialist experts and members of the public, to creatively explore a future vision for care at home.

The following emerging and underpinning themes were identified:

 

 

 

Designing the Care at Home workforce of the future

The themes were translated into a set of principles which were used as a basis to develop a speculative collection of personas to depict three future care at home roles not designed to be concrete examples, but instead as a way to support further engagement and stimulate debate and conversation with the wider care at home sector around the purpose, key activities and skills, and training specific to each future role:

Care Navigator

Specialising in coordinating the multidisciplinary care team through gathering, making sense of and organising different flows of data in order to provide responsive, personalised and relationship-based care at home.

Care Connector

Specialising in facilitating meaningful relationships – both physical and digital – for people receiving care at home and supports clients to work towards their aspirations and goals.

Care Technologist

Specialising in facilitating the interactions between assistive technology, people receiving care, and the wider care team in order to provide meaningful and personalised support.

 

What next?

Out of this, the GSA developed a set of tools with the purpose if supporting people to actively be involved in imagining and shaping the future of care at home by exploring some radical possibilities of tomorrow.

Scottish Care has been taking the tools out as part of their Roadshow around Scotland and hopes to take them to partners such as the Scottish Social Services Council, Care Inspectorate and Scottish Government as well as others. Collaboration really is key to the success of this project – by bringing together experts in homecare with experts in thinking, the tools provide a platform for shaping the future that we want rather than a continuation of the reactionary response that the sector often makes in a crisis.

But this activity cannot happen in isolation, the GSA also made recommendations which need to happen alongside the use of the tools, and these include, sharing good stories of care and celebrating the sector, matchmaking technology with current needs and exploring new collaborations.

The results of the workshops will be collated into a report with the purpose of shaping the future of care at home. There is also a second project now considering similar questions for the future of care homes and this will be led once again by the GSA Innovation school, but also in partnership with the University of the West of Scotland.

If you want to get involved, please get in touch [email protected],  or consider running a workshop yourself and sending on the information and ideas that you create.

I invite you to imagine what might be possible, given what we know today.