New models; old principles.
One of the most common phrases heard in discussions on the future of older people’s care and support is ‘new models of care.’
Behind these discussions and the desire for change and reform, is the presumption that the present way of delivering services and supports needs to change. Increased levels of dependency, an emphasis on personal control and choice, a focus on maintaining independence and advancing self-treatment and rehabilitation – all combine to encourage change. In addition pressures of demography, workforce and austerity have come together to create an environment clamoring for doing things differently.
But what lies behind the language and conversations? What are these oft mentioned ‘new models of care and support’? What will older people’s services and supports look like in the future? What do people want now and tomorrow?
Scottish Care is hosting a workshop where providers and other stakeholders are invited not to come and hear from ‘experts’ but to share with one another what is happening currently in Scotland and also to explore together possible future developments and ‘new models of care.’
First and foremost, however, what will be important in our discussions is the identification of what are the key characteristics or principles, which should lie at the heart of any ‘new’ models. There is always a danger that the metaphorical baby is disposed alongside the bathwater in our search for the new and the innovative.
So what is it that should lie at the heart of all services and supports, whether already in existence or still to be imagined?
Part of my response to that question is influenced by the work of John and Connie Lyle O’Brien. In 1987 the O’Briens embarked on a piece of research in Seattle on what makes a good quality of life.
Their Framework for Accomplishment proposed five areas which, over thirty years later, have become widely agreed to be important in shaping everyone’s quality of life. The Framework argues that the task of human services and support systems is to support people to fulfill their needs in these five areas. Their model has deeply influenced the development of learning disability services including its use as a tool to assess and judge whether services are working towards or against these five ‘service accomplishments’. The O’Briens argued that services should be judged by the extent to which, as a result of their input people are:
- Sharing ordinary places
- Making Choices
- Developing abilities
- Being treated with respect and having a valued social role
- Growing in relationships
So when we re-design older people services, I think – as a starter – we could do worse that ask ourselves the O’Briens’ questions.
Community presence – are the models of care home we are seeking to develop ones which will enable the inclusion and participation of individual residents at the heart of their communities or do they rather serve, by default or design, to cut off, withdraw, separate by location and thus exclude? How do they serve to increase the presence of a person in local community life?
Community participation – are the models of care at home which we hope to develop ones which foster and embed the ability of individuals to expand and deepen personal relationships? Do they act against loneliness, rejection and marginalisation or do they rather subtly confirm these?
Encouraging valued social roles – do our supports enhance the status and role of those who use them, recognising their continued and intrinsic membership of local community, family and society, affirming their contribution and individual capacity?
Promoting choice – is the ability of the individual to exercise informed and meaningful choice at the heart of what we are developing? Is control with the individual or the system, with the person or the professional?
Supporting contribution – are we fully developing the capacity and contribution of those who use supports or are they passive recipients of service with little ability to influence or change, to be valued as contributors and co-designers in their care?
I might wish to add some other ‘marks’ or characteristics of what today constitutes the heart of any new models – respect for capacity, emphasis on human dignity, the articulation of human rights, a stress on personalisation and individuality.
Whatever happens in the reform of social care in the next few months and years in Scotland, whatever new models of care and support are designed and developed, there must be a set of underpinning principles which guide that discovery and design, or we risk being reactive to passing fads and responsive to fiscal necessities. And that’s a conversation that involves us all.
We will be launching a new section of our website at Scottish Care to explore new models and supports, including the principles which should lie behind them. Join us in that conversation.
Dr Donald Macaskill