Swaran’s Blog October 16

This is a very challenging period for our sector within social care, with issues regarding funding and workforce shortages as major concerns. We have highlighted to our strategic partners the fact that we have a considerable vacancy rate for nurses employed within our sector and are looking with our partners at trying to address this issue in the short, medium and long term. There is no easy answer!

This made me think about my nursing career and the reasons why I commenced my nurse training many years ago in 1978. In those days I was young, fit, looked like Jesus with long hair, dressed in cheesecloth shirts and I pretended I was from the hippy generation whilst the punk scene and drain pipes were the “in thing”!!

In those days I wore my hair in a bun, with two Kirby grips on either side to pin my hair up! I think I got away with this as folk thought I was a Sikh (my background) although a practicing Christian, and in those days I was called Nurse Singh!  (Nursing!!!!) OK looking at me now I can imagine it’s hard to believe, as we all change as we get older, but I’ve got the photos as proof, honest!!

I felt drawn to a nursing career due to the compassion I felt for others and wished to ensure that I was someone that could make a difference. It is a privilege and honour to be able to look after someone who is unwell, who trusts me to do and say the right thing!

So often I heard folk saying “I could never do that”, however I believe that each one of us has the potential of showing compassion and care towards others in society, at various levels!

Most of my nursing career has been spent working with older persons in a variety of settings, and I truly believe that the area of “geriatrics” as it was in the old days, is an area of care which has been maligned, forgotten about and devalued by society. Poor funding, complex and challenging work undertaken within social care settings such as care homes and care at home services, needs to be recognised. It requires being valued, attracting proper funding, drawing nurses and carers as a career, and properly rewarded for the work they undertake!

I was recently encouraged to hear about my niece Jen who qualified as a nurse earlier on this year. After a period within academia she decided to take some time out and work within Erskine hospital as a care worker, and the NHS bank as an auxiliary nurse. There were several nurses within her family and with some encouragement she decided to commence her nurse training. She always said that she would return to Erskine, as she believed that that was where her heart lay, working with older clients!

When she completed her training it came as no surprise to me that she decided to work as a nurse within a busy surgical unit to gain further experience as part of her nursing career!

I was disappointed within myself, as I thought yet again another potential nurse was lost from our sector to the NHS, as this has happened on numerous occasions, hence the vacancies within our care homes!

I am conscious that Scottish Care are very concerned about this and are working with providers, strategic partners and the Scottish Government to look at the whole area of nursing, and ask questions about how to attract nurses to work within our sector. Working within a care home can be as challenging if not more so than working within a hospital setting. You still have to deal with the complexities of old age such as dementia and palliative care,  and the various infirmities that that brings; working within a pressured, highly regulated environment, perhaps being the only nurse on shift, and also having management responsibilities!! Supernurse comes to mind!!

Well, my story has not finished,. When I was offered the post within Scottish Care, I was excited, as I was coming back to my first love, a position related to nursing and care of the older person (by and large). I am still involved with care, utilising my experience and nursing, my focus being within the social care sector within Scotland. My role is to support the various members and their services, ensure they provide quality care and are fully informed about what is happening within our sector.

Jen’s story is also not finished either! She decided that after enjoying her surgical staffing experience, that she missed working with older folk, and is now working within Erskine as a Registered Nurse within one of their older persons units!  Well she was true to her calling of returning to her “auld folk” and I applaud her for bucking the trend and deciding that working within social care is where her heart lies!

The future for her, who knows!!  Manager, Matron…….Chief Nursing Officer for Scotland, who knows!!!

Swaran

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