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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