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Prevention is the best care: Latest blog from our CEO

Prevention is the best care: the potential of prevention

In almost every strategy on health and social care in Scotland which you come across these days the two concepts of ‘prevention’ and ‘self-management’ are likely to appear somewhere. They are the aspirational essence of the modern health and care economy. Yet in reality for all the talk there has been little substance added to their mention.

In public health the mantra of prevention has been assiduously articulated. We know the success of preventative approaches in terms of smoking and the significant decline in diseases of the lung as a consequence. We also consciously recognise the benefits of anti-obesity campaigns and attempts to limit sugar intake even if we don’t always follow them. But in the realm of social care ‘prevention’ is often a political and policy mantra which carries little meaning and certainly not one which is currently deserving of resource commitment.

Last year Becca Gatherum in her report for Scottish Care, Bringing Home Care,articulated a vision of care at home which was firmly grounded in the principle of preventative approaches, was rooted in robust research including that of the LifeCurve and which evidenced real individual and societal benefit.

So what do we mean by prevention in social care? Put simply they are those models and approaches which prevent an individual from either early or unnecessary access to enhanced care, hospitalisation or sharper personal physical decline and deterioration. They are approaches which enable independent living for a longer period of time and are focussed on maintaining a higher quality of life and wellbeing. They are about maximising autonomy and control. And yes, significantly they are not only about personal benefit but providing an economic and societal benefit through the avoidance of expensive clinical and especially surgical intervention. Falls prevention is perhaps the best exemplar of the promise and potential of preventative social care.

Yet nearly a year on from the Scottish Care report I see no evidence of any Integrated Joint Board robustly taking up the vision of preventative care. Well strictly speaking that might not be true. There is ‘talk’ of prevention and there are some attempts to use technology enabled care to initiate some developments. Such approaches which use technology to map and monitor decline and physical change in a person have real benefit but without being part of a bigger prevention strategy they can only go part of the way.

In fact it might even be that we are causing damage to truly effective preventative models by some of our proposals and plans. I have seen in recent weeks some horrendous proposals appearing before IJBs which predicate savings based on reducing care home provision on the basis of using technology and assuming a non-existent robust and coherent homecare system which is enabled to undertake even more advanced clinical support in the community. This is dangerous thinking not deserving even of the mirage of planning and threatens not only individual harm but also any serious attempt to systematically reform the health and social care system.

A holistic model of preventative social care maximises the benefits of technology rather than uses it to replace human presence, professional judgement and instinctive experience.

Yet maybe it is not surprising that we have failed to see the adequate resourcing of preventative approaches – because they are initially costly and because you cannot remove advanced homecare at the same time.

Surely the time has come for us to not only to talk the talk around prevention but to be brave and start to walk the talk? It is time for someone somewhere to invest substantially in a model of preventative homecare AT THE SAME TIME as maintaining and building enhanced homecare. They are reciprocal and inter-dependent processes. The one cannot exist without the other. Prevention cannot be used as a replacement for person-led, rights-based, dignified care. You cannot achieve the beneficial outcomes of preventative approaches without initial investment – just ask any public health specialist!

Social care in Scotland urgently needs a sense of political vision which goes beyond bandaging the present system and dares to heed its own mantras and invests in real preventative social care.

Dr Donald Macaskill
@DrDMacskill

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Creative activities in care settings: survey from Luminate

Luminate - Scotland’s creative ageing organisation – needs your help.  They are trying to find out more about creative activities taking place in care settings in Scotland.  

Following 6 successful nationwide creative ageing festivals, Luminate are now developing a year-round programme and they really need your help to shape this work.  Planned activities across Scotland include artists residencies, a national arts in care seminar and regular training with artists working in care settings, but to do this well the Luminate team needs to know more about what’s already happening, what strengths they should be building on and where the gaps are.

You can help them by filling in this short survey: https://www.surveymonkey.co.uk/r/LumMapSC.

 The team are keen to hear from anyone who knows about the work that’s going on in Scottish care settings – including care staff, volunteers, artists, residents, friends and family members.  Duplicate information isn’t a problem as Luminate will sort that out when they review everything that’s sent.

The survey should take no more than a few minutes to complete, and the deadline for responses is 28th April.  To thank you for your time Luminate will invite you to enter into a prize draw to win a £50 Amazon voucher.

If you have any questions about this survey, please contact Luminate at [email protected] / 0131 668 8066.

 

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Scottish Care statement on delayed discharge

In January Scottish Care published research which highlighted the crisis which is facing Scotland’s home care services. We warned then and re-iterate the message again today that the survival and sustainability of homecare in Scotland is under serious threat because of the lack of sufficient investment. See

Our January survey showed that:

• Nearly 40% of care at home services handed work back to Local Authorities in 2017 on the basis of sustainability and capacity
• Half of home care services did not apply for contracts offered by their Local Authority in 2017 on the same grounds
• 86% of home care services are concerned about their sustainability and survival in 2018, with nearly a quarter extremely concerned
• 9 in 10 home care services are struggling to recruit staff for essential posts.

Scottish Care’s Chief Executive, Dr Donald Macaskill commented:

“The data released by Scottish Labour is concerning. Behind every statistic there is a story, for every day spent unnecessarily in hospital there is a lost opportunity for some of our most vulnerable citizens to be spending time at home with their family and friends. Often these are individuals in palliative care and end of life. Sadly, these statistics come as little surprise to Scottish Care.

There is a real crisis in homecare. Assessments are being delayed, care packages are not being offered, in part because many care providers in both the charitable and private sectors simply cannot deliver quality care on the rates they are being offered. I recently visited someone in hospital and 5 out of the 6 patients in the ward were ready to go home but they could not. That is a shameful waste.

For a long time Scottish Care has been calling for additional investment in social care. We all know the data about delayed discharge but we need to stop talking about statistics. People are stuck in hospital not because care cannot be delivered but because the resource is not being allocated to enable it to be bought. Despite every effort of local authorities to protect social care we have seen year after year a squeeze on the ability of care at home providers to meet the rise in demand and rise in costs.

The home care sector in Scotland is genuinely close to collapse and I am calling on politicians of all parties to work with providers to address these challenges. We will be told that there has been increased investment – well it is simply not enough as any visit to many hospitals will show. I am also deeply concerned that some of the proposed cuts to care home services in some parts of Scotland will see more and more vulnerable people being left unsupported in their own homes without care packages.

We have a huge number of home care services willing and able to provide high quality care in people’s own homes but who are stifled from doing so by a drive to the bottom because of a lack of resources. The inability of services to recruit and retain staff and to pay them a good wage further cripples these essential services. We are faced with a reality where a quarter of services are not sure they will still be operating this time next year.

We can no longer tinker around the edges of social care – the challenge needs to be grasped with both hands and driven forward by a political will to ensure there are a range of high quality, sustainable services available in people’s communities which will allow people to go home.

This holiday weekend when families come together we need to collectively address the underfunding of social care in Scotland which means that for too many often frail and elderly individuals they will be spending the Easter weekend in hospital rather than at home.”

Ends.

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2018 Social Services Awards – finalists announced

The shortlist for the 2018 Scottish Social Services Awards is now available.  Congratulations to all the finalists and those who submitted nominations.

The awards are open to all organisations, services and individuals working in Scotland’s social services and social care sector and attracted over 100 applications nationwide, representing a diverse mix of social services that have made a positive difference to people’s lives.

Introduced last year, the Scottish Social Services Awards aim to cut across boundaries, celebrate excellence and bring one of the country’s largest sectors, with almost 200,000 workers, together.

Scottish Care would particularly like to congratulate our members who have been chosen as finalists in the 2018 awards.  These are:

  • Balhousie Care Group’s Clement Park service, finalist in the Living the Codes category
  • Balhousie Care Group’s Dementia Ambassadors, finalists in the Enlightened Approach category
  • Loretto Care’s Accommodation and Alcohol Support Services, finalists in the Head Above the Parapet category

The winners will be announced at an Awards ceremony on 6 June in Edinburgh.

For more information about the Awards and finalists, click here.

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4 Rs: Packed room sees launch of report

Event Report by Paul O'Reilly (Workforce Development Consultant)

On March 15th 2018, Scottish Care launched its report into recruitment, retention, regulation and representation within social care to over 100 attendees – including frontline workers, managers, owners, regulators and government representatives -  at the Glasgow Hilton Hotel.

Katharine Ross, National Workforce Lead for Scottish Care, opened the day highlighting that the report identifies many concerning trends and advising delegates that the programme would be underpinned by a fifth ‘R’ - reality.

Scottish Care’s Policy and Research Manager, and the report’s author, Becca Gatherum next took to the podium.

In launching her report Becca described the research process, explaining that the purpose of the report was to capture the journey that an employee in the independent social care sector travels along from initial engagement to disengaging.  While the journey is of varied distance for individuals, this workshop would seek to follow it by exploring the 4R themes in order – recruitment, representation, regulation, and finally retention.

Recruitment: Attracting the right people for your organisation

Katharine again took to the stage, alongside colleague Paul O’Reilly, to discuss the recruitment findings published in the report.

Along with statistics highlighting that the majority of job applicants are female (84%) and that there has been an increase in the number of applicants aged over 45years (20%), it was noted that 63% of new entrants are leaving their positions within the first six months.

The need to increase the number of younger people and male applicants was covered, before exploration of why so many people are leaving their jobs so soon.

In a session called Right person...Right job? delegates were asked to consider if we are being up-front with candidates about the challenges of the role, and what more can be done to inform people at interview stage before they accept a role as well as through induction to better support and prepare new colleagues.

This generated many interesting and creative ideas from delegates, while the fifth ‘R’ was present in recognising the challenges.

Representation: Understanding the process - and your rights

 Katharine next introduced two speakers -  Grant Brown, Fitness to Practise Manager at SSSC, and Richard Henderson, an Advocate from the Faculty of Advocates.

Grant explained what is meant by ‘fitness to practise’ and where it fits within the Strategic Plan of SSSC, linking to the Codes of Practice.  Following advice on just when someone should refer a practitioner to the Fitness to Practise team, Grant bust some myths by carrying out an exercise with some True or False statements.

Representation at hearings was explored by Richard, with him explaining the process and what to expect.  This included some background information and terminology, who sits on a panel and what they can decide, and who can represent a worker should they be called before it. 

Regulation: Exploring the reality and potential of working in a regulated social care sector

Ann McSorley, Qualifications & Standards Manager at SSSC, was introduced to discuss regulation and registration of the social care workforce.

Ann explained how qualifications have developed, qualification requirements and how Modern Apprenticeships are a useful tool in achieving these before sharing links to useful recruitment and learning & development resources.

There then followed what for many was the highlight of the day – a panel discussion with three frontline workers, led by Katharine.

Pauline Cumming (Activities Coordinator with Balhousie Care), Dean McMillan (Quality Officer and Supervisor with Carewatch) and Joanne Bilsland (Support Supervisor with Bluebird Care) discussed their individual career journey, their thoughts on SVQ, what needs to change for frontline workers if a career in care is to be more widely viewed as a positive career choice and what they love about their job.

The compassion of the panel, as well as their passion for the work and those they care for, was well received by the room. 

Joanne had the final word on what she loves about her job, saying ‘I get to learn more about Life by providing End of Life care.  I get to see humanity at its best, I get to witness touching family moments.  I get to hold people up when they are struggling to live with their health conditions and I get to hold their hands when they are frightened and alone.  I'm helping people to cope with very challenging circumstances and that gives me a huge amount of satisfaction.’

Retention: Retaining a skilled and compassionate workforce

The final session of the day was led by Scottish Care CEO Dr. Donald Macaskill.

Donald explained that we cannot stop employees from leaving until we have a plan to make them stay before asking delegates to spend some time thinking about their current role and what makes them stay, as well as a job that they may have left and the reasons for this.

A series of slides exploring employee satisfaction within social care were presented, with Donald closing by explaining that other sectors have learned to improve this by ensuring frontline staff wellbeing, engagement, empowerment and hearing of their voice. 

Social care must do likewise.

Paul O'Reilly

Scottish Care, Workforce Development Consultant.

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Care at Home & Housing Support Awards 2018 – Nominations Closed

The nominations to the National Care at Home & Housing Support Awards 2018 have now closed - thank you very much to everyone who has taken the time to participate.

The Awards will be held on the evening of Friday 18 May, 2018 at the Marriott hotel in Glasgow and will follow on from the Care at Home & Housing Support daytime Conference and Exhibition. It will be an evening to highlight and celebrate the best in care at home and housing support across Scotland. We know that around the country, individuals and teams are carrying out work in this field at an incredibly high standard in an era of challenging budgets and an increasingly demanding work environment.

There are eleven award categories:

  1. Care at Home Services Carer(s) of the Year – Individual or Team
  2. Housing Support Services Carer(s) of the Year – Individual or Team
  3. Management & Leadership Award - Individual
  4. Training & Staff Development Award – Individual or Company
  5. Care Services Coordinator / Administrator of the Year – Individual
  6. Innovative Practice Award – Team
  7. Outstanding Achievement Award - Individual
  8. Housing Support Provider of the Year – Company
  9. Care at Home Provider of the Year – Company
  10. Positive Impact Award – Individual
  11. Day Service of the Year - Company or Service

The judging process has now taken place and you can view this year's finalists here. Congratulations and good luck everyone!

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Latest Blog from our CEO: Is choice a human right?

Is choice a human right?

I want to reflect on two remarks within speeches I heard yesterday to celebrate World Social Work Day and the 50th anniversary of the Social Work Scotland Act. They both had to do with choice.

The first speech was making a comparison between different approaches and philosophies around social care and social work, evidencing the change from the spirit of the 1968 Kilbrandon Report which assumed that social work would be delivered by local authorities, much in the vein as some politicians have recently articulated a desire to return to. But then with the passage of the 1970s and 1980s the speaker commented that consumerism and choice within a mixed economy of care had replaced what had happened previously.

The second remark was within an inspiring speech by a young man, Thomas Timlin, who told his own personal story from living in a neglectful environment, being taken into care, experiencing abuse at the hands of foster parents, through the separation from siblings and his natural mother, being told at 16 that the State had fulfilled its duties of care, to enduring periods of homelessness and eventually becoming a children and families social worker. He commented that no-one had asked his views at any time, no-one had given him choice, had asked him what he wanted at any stage whether during fostering or adoption. The lack of choice had denied him a voice.

Two very different comments about choice but they are at the centre of the current debate about social care in Scotland. They are for me at the heart of what a human rights based, person led approach to care and support is all about.

Choice is after all at the core of our primary social care legislation in Scotland. The Self-directed Support (SDS) Act states in its Principles that an individual shall be enabled to have choice whether that be in an outcomes assessment or in support planning or indeed in the delivery of their care and support. They shall have a choice of four options over which to decide how their personal indicative budget should be spent. They shall have a choice on which provider of social care they want and is best fit to meet their own individual needs. There is also a duty upon a local authority to promote such diversity within the ‘market’ and ‘local community’ to enabling a real exercising of choice. After all presenting a person with one provider (statutory or not) as a take it or leave it – is not choice its instruction.

The SDS Act is a true democratisation of control, consent, participation and empowerment. Choice is part of the DNA of social care legislation in Scotland. Our new National Health and Care Standards go even further and articulate this human rights emphasis and root good care and support within the principles of autonomy, control and choice.

So, is choice a right? Is choice just another term for consumerism and therefore should it be limited and curtailed? Is there anything wrong with the consumer (the citizen) exercising control rather than being told what to do or having their options limited by the State? Is choice a human right?

These are all important and critical questions because they are likely to shape debate within the social care sector in the months and years to come.

For me, personally, choice is an alienable right. My perspective is influenced by being a member of the Same As You? Implementation Group nearly two decades ago. This was a key and ground-breaking strategic Scottish Executive policy which stated that someone with a learning disability was deserving of the same rights, dignity, treatment and citizenship as any other person in Scotland. I remember one person with a learning disability speaking at a meeting and summing up what it meant to have choice. She said:

“It isn’t just that I should have the right to choose what to eat, to choose what I should wear, to choose who I spend my time with, to choose where I live as far as I can; it is fundamentally that I should have the right to choose who comes into my home, who attends to my personal needs, who supports me to fulfil my life. It is my right to choose who sees me naked.”

Choice for countless thousands who have been denied control and autonomy means absolutely everything. It is the vibrant spirit of freedom that gives purpose to activity and underpins individual contribution.

So be very careful of those who wish to undermine the choice that has been achieved for citizens in Scotland, whether they have a disability, live with a mental health condition, or live their lives in a nursing or residential care home.

Choice is fundamental and that choice critically includes the right to decide what organisation provides care and support to me should I require it. Our politicians need to tread warily on any of the human rights citizens have struggled for, rights for social care choice which have been achieved over the last two decades.

For many the freedom to exercise choice is about the ability to be fully a person. Choice has no sell-by date; choice is not an option, it is intrinsic to being an autonomous human being. Choice is a human right.

Dr Donald Macaskill
@DrDMacaskill

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Care at Home & Housing Support Awards – deadline extension

The Scottish Care team has taken the decision to extend the deadline to submit nominations to our Care at Home & Housing Support Awards 2018. 

A number of members have been in touch to ask for a little more time. A lot of people are reporting they have been delayed with their nominations because of the extraordinary weather conditions and the additional challenges these have created for those working in the sector in recent weeks.

At Scottish Care HQ we think the stories we've been hearing of late about hard working individuals and teams going above and beyond to deliver care in extreme weather are all the more worthy of celebration! So, if you know someone in your organisation who deserves recognition, take a look at our 11 award categories and let us know all about them. 

The new deadline is Monday 26 March.

To access more details, including the guidance notes and nomination forms please click the button above. Good Luck!

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Scottish Care launches new report highlighting changing picture of social care employment

Scottish Care has released a new report which explores recruitment and retention of individuals working in the care sector.

Read the 4Rs: The open doors of recruitment and retention in social care

The report findings show:

  • Employers have seen an almost 20% increase in those over the age of 45 applying for care vacancies.
  • Providers are operating a wide range of workplace benefits and initiatives to help with the retention of staff, most of which are premised on the importance of giving staff a voice and a sense of value.

However, it also highlights:

  • 63% of staff who have left the sector in the last year did so within the first 6 months of employment, mostly because of mutual unsuitability identified by the employer and employee.
  • Providers believe the lack of responses to advertised care vacancies plus competition with other employers and sectors to be the main reasons for recruitment difficulty.

The report will be launched at an event in Glasgow today (Thurs 15 March) attended by over 100 staff from across the health and social care sector including a number of those working at the front line of care delivery.

Speaking ahead of the launch, CEO of Scottish Care, Dr Donald Macaskill, said:

“Our new research shows the need to consider how we attract people to enter the care sector and to pursue a fulfilling career within it. Whilst more needs to be done through education and careers advice to encourage young people to work in social care, the findings show an increase in older people applying for care jobs so we must also make sure that employment opportunities are suitably flexible and promoted appropriately amongst people of all ages and backgrounds.

“Yet concerningly, we know that a huge number of people are leaving the sector at an early stage of their employment, predominantly because they are not suitable for the work or it wasn’t what they expected it to be. Whilst working in care is undoubtedly challenging, it is also a hugely rewarding and skilled profession with lots of opportunities and we must therefore ensure that there is better awareness of all that comes with a career in care –to better recognise the importance of this profession but also to ensure we have the right people delivering complex care to our loved ones and that we have a sustainable care sector going forward. Without a committed workforce, we won’t have social care services.”

Scottish Care’s National Workforce Lead, Katharine Ross, added:

“A career in care is not the same for everybody but it needs to be available to everybody. This report captures the employment journey of so many committed, dedicated and skilled individuals of different ages, backgrounds and experiences working in care homes and care at home organisations across Scotland.

"However, it also shows the reality facing the care sector:

  • The reality of trying to develop, train, qualify and lead a workforce against a backdrop of task and time commissioning, fifteen minute visits and the persistent denial by policy and decision makers of the true cost of delivering dignified, person led, preventative care and support to older citizens across the country in care homes and care at home organisations.
  • The reality that the potential of health and social care integration is yet to be realised in Scotland and we continue to see the confliction of a health or social care workforce.
  • The reality that a largely unappreciated and undervalued social care workforce, delivering compassionate care to individuals with multiple complex mental and physical illness, is at breaking point.
  • The reality that fewer people are choosing to work within the sector, and more people are leaving.

“Only by acknowledging these realities will we be able to shut the door through which dedicated and skilled individuals are flooding out from, and create conditions where people enter, stay, develop and thrive in the care sector. It is the only way to ensure the development of a rights-based, dignified social care system for the tens of thousands of older people receiving care in their own home, or in a care home.”

Read the report here.