Friday, 21 December 2012

A Confident And Skilled Workforce In Social Care



How will the adult social care workforce of the future be affected by public health changes in England? Vic Citarella, Director of health and social care consultancy CPEA, talks to the CfWI.

Vic Citarella is cautiously optimistic about the transfer of public health to local authorities in April 2013. But he believes it will take time before more integrated services and commissioning have an impact. To start with, the majority of people working in social care are unlikely to notice any difference. But with directors of public health championing the need for preventive investment, the benefits of integration and more long-term thinking, there should be positive outcomes for both people who use services and the social care workforce.

“The changes in public health are part of a wider picture of change, which includes personalised care, more emphasis on prevention and adult safeguarding,” he said. “In future, we will expect people in the social care workforce to work across health and social care and to be trained in new areas. This will include making the most of people’s strengths through self care and taking into account components related to their particular conditions, including medication and assisted living technology. A shared approach to training, support and supervision will have to be part of a more integrated approach.”

Inequalities in education and training will need to be addressed, said Mr Citarella. The healthcare and social care workforces are of a similar size, at around 1.35 and 1.56 million, but there has been comparatively little investment in training for social care. If people working in social care are to be trained in areas such as dementia and end-of-life care, the cost will be significant, but will lead to savings and benefits in the longer term.

New organisations such as consumer champions Healthwatch may also help to develop the skills, competence and confidence of the social care workforce.

“Greater integration may be an opportunity for people working in social care to be more innovative and challenging. Sometimes they can see ways of doing things better, but are not in a climate where they can raise issues. If they are all part of the same infrastructure there will be a place for this type of discussion. We may see a more confident social care workforce which is less deferential to medical professionals.”

More personalised services might also mean a more personalised workforce. If social care workers are employed directly by service users or their families, they may take more individual responsibility for their own training, development and practice. With greater choice in the system, they may follow the service user across commissioning boundaries, making workforce planning a challenge.

With many volunteers, community groups and individual carers working alongside paid social care staff, there is a shift towards a more enabling role.

“There is move towards refocusing the paid social care workforce on supporting carers and developing community capacity and networks of volunteers. Investment in self care and assisted living technology also makes the resources go further. There’s an emphasis on ‘doing with’ rather than ‘doing to’.”

There is a huge opportunity for the public health sector to help improve the health and wellbeing of the social care workforce, said Mr Citarella. Directors of public health could play a central role.

“There are high levels of stress and ill health in this workforce. Public health could be more sensitive to the welfare needs of an individualised and isolated social care workforce of over a million people. Occupational health ought to be high up the agenda.”

Planning for the future social care workforce will not be easy, however. “Many people don’t yet understand the complexity, fragmentation and diversity of the social care workforce. Thanks to organisations such as Skills for Care we now know a lot more about this sector than before, but workforce planning will still be a challenge.”

Want to know more about our work in social care? Contact rhidian.hughes@cfwi.org.uk.

Tuesday, 11 December 2012

CPEA Works With Care Providers in a Safeguarding Workshop

In October 2012 CPEA Ltd worked with SARCP (Staffordshire Association of Registered Care Providers) to run a workshop on working together to keep people safe. The day was attended by many providers and health and social care agencies from Stoke and Staffordshire. Vic Citarella, company Director of CPEA Ltd chaired the day and speakers included the Chair of the local Safeguarding Boards and safeguarding and other social care professionals. Claire Crawley from the DofH provided an update of progress at a national level to agree a definition of safeguarding. Pat Bailey, from CPEA, reminded us that the role of the registered manager is to champion, lead and protect and it is important to raise the profile of the manager as lead professional, responsible and accountable. Reviewers and regulators will not embed good practice as this is the key role of managers and a basic fundamental if we want to improve practice.

Citation, a company providing HR support, demonstrated the differing advice available from CQC, within No Secrets, The Government Guidance on protecting vulnerable adults and employment law. Essentially in a case of harm or risk of harm CQC advice, and generally the local authority, is to suspend the employee immediately but employment law warns against a knee jerk reaction, that suspension isn’t always appropriate and investigation should take place in a timely manner. It is the employer’s responsibility to suspend staff, based upon their investigation, and also their duty to report conclusions to the relevant professional bodies. The role of a good employer is to undertake any actions in a proper and proportionate manner and Claire Crawley said we need responsible and capable providers to do this.

A major concern amongst providers is the suspension of contracts and that this should only happen when there are serious risks and then local authority representatives need to tell providers what they are doing and why. Sarah Hollinshead Bland, Commissioner Adult Safeguarding in Staffordshire County Council explained that contracts are often suspended during large scale investigations and placements can re-commence when the investigation has concluded and required improvements in practice can be sustained.

Key messages from the day were

• The Safeguarding framework is about improving wellbeing and Adult Protection investigation is just one aspect of the safeguarding process. Many practice concerns are now falling into safeguarding processes and this was on the increase. Managers said if they tried to argue they were told they were failing to act. Social workers couldn’t cope with this increase in activity and whilst they were dealing with safeguarding they were not carrying out personalised assessments and reviews.

• Those investigating safeguarding/abuse allegations, however important they perceive their investigative role, are not outside the general law and have to have proper regard to and for those who face allegations and natural justice whereby there should be no bias against the accused, that there is a right to be heard, to know the case against you, what the evidence is, what statements have been made and a fair opportunity to correct or contradict.

• There are occasions when negotiation is appropriate; that not all bad practice should lead to safeguarding scrutiny. Remember - residents in care homes can be subject to more abuse by poor safeguarding procedures and actions.

Janet Pearson, Director, CPEA

Monday, 10 December 2012

Margaret Flynn Provides Notes From A Department Of Health Stakeholder Event On Positive Behaviour Support

What is restraint? An array of interventions, some of which are coercive, the merits of which may not be known. The ways in which restraint is perceived differs markedly – with many professionals broadly asserting its necessity – typically by citing extreme examples –  and people with learning disabilities and autism and their families questioning its necessity.

Which principles should underlie physical intervention? The following elements of principles should underlie physical intervention:

• The context should be known i.e. there are risky environments, risky management decisions, risky managers and practitioners and risky practices. The latter would include, for example, undertaking a physical intervention without any knowledge of a person’s biography.
• The traumas people are known to have endured should not be reinforced by any form of a physical intervention e.g. people who are known to have been sexually assaulted should not be placed on the ground and immobilised by body weight
• People’s experiences of being subject to restraint, for example, should be known – are they doing to their peers and staff what they have endured in previous settings?
• Individuals should never be restrained when they are naked or partially naked. Furthermore, when naked or partially naked, they should never be immobilised by body weight
• Any intervention has to be part of an agreed and positive approach
• Chemical restraint, physical restraint, mechanical restraint and/or seclusion should not co-occur

What data is required? Every incident of physical restraint should be recorded as a patient safety incident. What is the point of counting incidents if nothing other than the fact of a physical restraint, for example, is known? Information concerning physical interventions requires a single route.

How we get from where we are now to where we want to be? The NHS Commissioning Board should issue a series of edicts, i.e. Thou shalt…

• Adopt a life-span approach to people with learning disabilities and autism, referencing this in their service specifications
• Put a moratorium on building new secure services or extending such services in the knowledge that if there is a building it will be filled
• Ensure that the Care Quality Commission does not register units which are outwith national policy i.e. Assessment and Treatment units
• Review and challenge the use of the mental health legislation as it impacts on adults with learning disabilities and autism on a locality basis
• Discontinue the office function of long distance commissioning in favour of investing in effective and credible local supports - if Winterbourne View Hospital patients and their families had known the telephone contact details of individual commissioners – it is unlikely that they would have had to resort to calling the police
• Promote the piloting of micro-commissioning – with people with learning disabilities and autism, their families and their local authorities
• Only invest public money and commission services from agencies which are owned by accountable individuals i.e. not opaque corporate bodies
• Ensure that a service’s Statement of Purpose cites “positive behaviour support” and that this is reviewed by the Care Quality Commission
• Cease to believe that (i) compliance with minimum standards results in a safe and valued support service which requires neither monitoring nor evaluation and (ii) that professionals know everything

Margaret Flynn, contributor and note taker, November 2012

Friday, 7 December 2012

Positive Behaviour Support – Thoughts In The Light of Winterbourne View SCR

There is no doubt that the lives of Winterbourne View Hospital patients were undercut by terrible treatment which resulted in them feeling blamed and abandoned and being physically harmed. It appears that an excessive emphasis on people’s labels and perplexing behaviour has taken us too far from making sense of their biographies and the complexity of their lives – and from the basics of caring about them and attending closely to their needs and caring for them with capability, respect and compassion.

The Serious Case Review relied on a BBC broadcast of May 2011, information from the hospital’s ex-patients and their relatives and information from a range of agencies, including Castlebeck Ltd, which owned Winterbourne View Hospital. These thoughts rely solely on what we have learned about the circumstances of adults with learning disabilities and autism who have been placed in hospital settings offering “assessment and treatment.” We believe that the practice of physical restraint at Winterbourne View Hospital is a bracing indictment of inadequate management (remote and long distance) and inattentive commissioning.

We suggest that five sets of observations clear a path to viewing the circumstances of adults with learning disabilities and autism in secure settings. We believe that they point to the necessity of developing very different service responses. We begin with a single tragedy:

1. During July 2006, Derek Lovegrove died as he was being restrained. He was a blind and deaf patient with learning disabilities at Cedar Vale Hospital. The Deputy Coroner observed that “…the system was there, the policy, the care plan – but no one seemed to check that it was followed.” Cedar Vale Hospital was owned by Castlebeck Ltd. After the Inquest they stated, “We will take time to fully consider the proceedings of this past week to ensure that any lessons which must be learnt are learnt and acted upon.” Five years before the exposure of the violence associated with restraint at Winterbourne View Hospital, Castlebeck Ltd could have led the way and distanced themselves, and perhaps other services, from the practices associated with Derek Lovegrove’s death. However, during 2009, Castlebeck still had not learned the lessons. A Heathcare Commission visit found shortcomings in Cedar Vale Hospital’s management of serious incidents and patient restraint. The sequel to the BBC Panorama’s expose of May 2011 was broadcast in October 2012. This gave coverage to a recording of a Castlebeck Ltd employee training Winterbourne View Hospital staff in methods of physical restraint. He recalled an occasion when instead of restraining a patient, he “kicked him in the bollocks.” The programme advised that this trainer had been “suspended some weeks ago.” Thus the “learning the lessons” claim apparently did not impact on either the training or practice of harmful means of physically restraining adults with learning disabilities and autism. Heartlessness and amnesia appear to go hand in hand.

2. All policies concerning physical restraint emphasise that it should be the “last resort response.” Castlebeck Ltd’s own policy concerning physical restraint was no exception and yet it bore no resemblance to the practice filmed by an undercover journalist. It was the first line response. We came across no examples of physical restraint being the intervention of last resort. The practice of wrestling patients to the floor and lying across them occurred on a daily and routine basis and yet was not identified as constituting abuse by any professional. Chance determined that there were no tragedies at Winterbourne View Hospital given the filmed evidence of restraint practices and those promoted by Castlebeck Ltd’s own trainer. Records attested to the excessive and harmful use of restraints which involved wrestling adults with learning disabilities and autism to the floor and immobilising them with bodies and objects. These incurred physical pain and injuries, some of which required the attentions of Accident and Emergency services. Even patients who were naked or partially clothed were physically restrained on the floor by staff. It does not appear that exceptions were made for patients whose early lives had been compromised by sexual assaults. Neither was any attention paid to patients’ care plans. As an NHS commissioner observed, “…it is…documented that a mask was used on two occasions. This approach is not written in care plans as being agreed to.”

3. Restraints as practiced at Winterbourne View were pre-emptive. Staff physically overwhelmed patients using whatever means they wanted. Patients were ill-served by their imprecise label of “challenging behaviour.” Staff responded to patients as if self defence was their principal priority.

4. The volume of physical restraints which wrestled patients to the floor and held them there – sometimes for many hours – were under-reported by hospital staff and described in records in fictional terms. Inadequate as these records were, no one took any notice of them. Oblique references to patients “having an unsettled day” and “re-directing patients” were euphemisms for unknown numbers of staff pinning patients onto the floor.

5. It appears that adults with learning disabilities and autism who are patients in hospitals, assessment and treatment and secure services are outwith the protection of legislation. During 2009, it was with some prescience that a Public Protection Unit investigator urged Winterbourne View Hospital to install CCTV cameras. The investigator noted that in view of two incidents, “in which two service users had their teeth knocked out by carers during a restraint situation, both patients appear to have been punched in the face…restraint is usually carried out by two or more people so any allegation of improper or criminal conduct is countered by two people’s word against the victim – the victim always unlikely to make a good witness in a criminal prosecution…no doubt something your staff are aware of…” After the initial Panorama broadcast, staff emphatically denied all allegations made by Winterbourne View Hospital patients which were not captured on film – and even those which were filmed were described by the staff concerned as “horse play…play-fighting…sparring…boxing games…playing.” Accordingly, the Crown Prosecution Service relied solely on film footage provided by the BBC. The Serious Case Review confirmed that Winterbourne View Hospital patients lacked any means of asserting or protecting their rights. They were scandalously silenced.

These findings buttress our concern that adults with learning disabilities and autism have been disproportionately disadvantaged in secure service settings where they may be subject to violence on an unknown scale. Winterbourne View Hospital has taught us about the arbitrariness of cruelty under the guise of restraint and the lamentable lack of interest of all professionals, most particularly Castlebeck Ltd and the commissioners of this service, in ensuring that patients were protected and safe. Such stark findings led us to conclude that there is no place for the practice of getting adults with learning disabilities onto the ground and pinning them there. This form of restraint, as imposed on adults with learning disabilities and autism, in these settings, should not be countenanced.

Margaret Flynn and Vic Citarella

Thursday, 1 November 2012

A Non-Adversarial Approach To Resolving Social Care Disputes

Vic Citarella of CPEA Ltd and Helen O’Brien of the Centre for Justice propose a non-adversarial approach to resolving social care disputes

This is to let readers know about Centre for Justice, an independent not for profit arbitration service developed for the public sector. The service has been created in response to the growing cost of local government disputes and conflict management, the need to save public money and as a way to improve services.

As we all know, going to court or tribunal is a costly business for councils. The process is damaging to staff morale, the council’s reputation and the client relationships which people work so hard to develop. Courts and tribunals are acknowledged to be slow, risky and expensive. These and complaints procedures can inflame a sense of grievance and cause positions to become deeply entrenched.

CPEA Ltd is exploring the Centre for Justice’s non-adversarial approach to dispute resolution. The model uses a simple process with one specialist lawyer who works with the parties to investigate the problem. This reduces the cost to a fraction of that of going to court or tribunal. The arbitrator offers to mediate between parties at each stage to find a constructive solution. Centre for Justice provides a legally binding result in every dispute. It also enables most disputes to be concluded with positive outcomes through discussion and agreement.

The Centre has been speaking to Heads of Legal Services from London Boroughs and many have mentioned social care disputes over personalised packages and direct payments. Conversations with charities also indicate support for processes which reduce the time and stress involved in going to court or tribunal, and which provide a less intimidating forum for discussing sensitive issues with the local authority.

The primary aim is to save money and time spent preparing for costly tribunals, Judicial Reviews and contract disputes. We believe this time should be devoted to providing essential services to children, families and adults.

The case involving Stephen Neary that came before the courts last year is a good example of how a non-adversarial process could have saved both time and money. The Council involved spent more than a year defending its decision to keep Neary in care.

A judge later overturned that decision, saying the care was neither wanted nor needed. If these decisions go to court, on judicial review or otherwise, it results in a great deal of legal cost and staff time. Not only can this generate considerable stress and hostility, but it can still leave both parties in limbo. While a judge can quash the original decision, this still provides no solution and can force the case back to the start.

If the case goes instead to Centre for Justice, a specialist arbitrator helps Council and client agree the right outcome. The arbitrator advises on the legal issues and decides these where necessary. This enables the local authority and client to find positive solutions for the most intractable and emotive issues.

CPEA Ltd is supporting the Centre is ensuring its work has the best social care practice and professional back-up to its work. Contact: info@centreforjustice.org or info@cpea.co.uk Website: www.centreforjustice.org or www.cpea.co.uk

Monday, 1 October 2012

Adult Safeguarding – an ‘also runner’ in the new NHS

The NHS is currently in the process of implementing a major programme of reform following the passage of the Health and Social Care Act 2012. This is designed to support the creation of a health service that is clinically led, patient centred, dedicated to the delivery of world-class outcomes and focussed on improving the health of the population.

It is essential that there is clarity about responsibilities in relation to safeguarding within these new arrangements – and about how the new system can help drive continued improvement in practice and outcomes.

In the final report (May 2011) of her review of child protection, Professor Eileen Munro expressed concern about the possible impact of the health reforms on effective partnership arrangements and the ability to provide effective help for children suffering, or likely to suffer, significant harm. In response, the Government committed to establishing a co-produced work programme “to ensure continued improvement and the development of effective arrangements to safeguard and promote children’s welfare as central considerations of the health reforms”.

The Government is also committed to working to prevent and reduce the risk of abuse and neglect of adults.

Thus reads the background and context of the new Interim advice from the NHS Commissioning Board on children’s and adults safeguarding – with adults as an ALSO. It goes to recognise itself as primarily geared to children when it says: Although this advice focuses on the statutory requirements to safeguard children, the same key principles will apply in relation to arrangements to safeguard adults. There are, of course, one or two fundamental differences of principle but never mind.

For those who have been wrestling with the health and social care interface in adult safeguarding for many years there is the welcome prospect of the incoming NHS CB and CCGs having statutory responsibilities. Particularly important for patients in commissioned services such as those that were at facilities such as Winterbourne View Hospital - the interim advice is unequivocal about where statutory responsibility will lie in the future.

The description of the designated professionals’ roles in adult safeguarding is interesting in that it expects expertise in the Mental Capacity Act as well as a broad understanding of policy and training across local authorities, police and the third sector. It anticipates this expertise stretching across older people, people with dementia, people with learning disabilities and people with mental health conditions. It does not see them as being hosted within the commissioning support services. Thus their host is likely to be an NHS provider. It is to be hoped that the proposed service level agreements will recognise the potential for conflicts of interest in such arrangements - conflicts that come to the fore in serious case reviews scenarios.

As the advice develops the ‘also ran’ status of adult safeguarding becomes more apparent. Funding is acknowledged only to the Safeguarding Children’s Board. The Director of Adults Social Services may be able to offer advice. Priority is given to numbers of children in need. A muddled message emerges on inspection between CQC and OFSTED. Reminders appear about designated professionals engaged with Looked after Children, around the DfE production of the revised Working Together and about the Royal College of Paediatrics and Child Health. A Safeguarding Children Transition Board is established.

Missing is recognition of the issues around continuing health care, the messages around the care programme approach from Winterbourne View and any acknowledgement of the fact that safeguarding in health and social care involves a massive diversity of provider settings. The third sector is recognised but not the private sector – yet residential nursing care is largely a private enterprise in the small business sector. Private providers are a vital aspect of support at home services - where they are well placed to initiate much needed joined up health and social care in the community. These developments will be enabled by a policy and practice climate that draws on advice that is cognisant that personalised services are safe services and vice versa. That is a climate where providers are partners in the truest sense of the word.

All in all the interim advice smacks of a cobbled together document to allow the timetables for the NHS CB and CCG infrastructure to be met. It has clearly suffered from delays in the production of the revised Working Together and uncertainty about what the eventual Care and Support Act will actually make statutory requirements and when. As a consequence it has the effect of relegating adult safeguarding to an ‘also ran’ shadow to the priority of children.

However the advice ends with the statement: We anticipate that it will be replaced by a more comprehensive document in the autumn, alongside the revised Working Together statutory guidance. It being September we also look forward to adult safeguarding soon emerging from the shadows before the winter sets in.

Note
Available on: education.gov.uk

Even Google finds it first on the DfE website but also available after several search clicks on: commissioningboard.nhs.uk

Thursday, 27 September 2012

Breakfast with the National Skills Academy for Social Care at NCVO

Richard Banks of CPEA Ltd and SCA

About 15 participants - care home training staff, owners and a few consultants plus Charlotte Tuck a communication person from DH enjoyed an educated breakfast at NCVO this week. All the (non-edible) materials for the session can be found at www.nsasocialcare.co.uk

This was one of two NSA member events (another is scheduled in Sheffield on 30th October) to:

  • Update on the social care climate
  • Report on the survey of Registered Managers – ‘Everyday Excellence’
  • Inform about the ‘Careship’ programme on leadership and registered managers with different descriptions aimed at different roles with in sector
  • Report on research for NSA on care sector reputation – ‘Who cares’
  • Advise on integration thinking with Skills for Care

Sir Stuart Etherington (CEO NCVO) provided a welcome to building and a summary of the environment for the charitable sector. After what might, in hindsight, be regarded an a era of growth the charitable sector he said it was now suffering from reduced giving related to recession and cuts in contracting as public sector reduce costs. Ideas of government about the ‘Big Society’ appear to have gone but he thought they did encompass hopes for increase in social investment, localism and public sector reform. The response of the charitable sector has been more mergers and a focus on core or particular successful areas of work. Sir Stuart acknowledged that the charitable sector were often pressed into contracting for poorly considered care services whereas good social enterprises had access to start up funds to support more radical redesign of services. He expressed a belief that the definitions between charities, social enterprise and public interest were getting blurred in people’s minds if not in legal status. He remarked on the success in changing government proposals that would have damaged tax on contributions.

Debbie Sorkin reminded us of demographic demand and that mismatch with public funding quoted David Behan ‘austerity is the new real’ and Clive Bowman ‘social care is being brutalised’
She thanked SCA for support on pointing out the need to focus on registered managers and introduced the report. NSA response is to support registered managers to overcome defensive practice (illustrated by a story about therapeutic use of pets being banned from a home after a dog tripping incident which caused no harm) and develop links into networks. Marcia Asare will be in charge of registered manager activity for NSA.

Discussion was about poor inspection practice on nutrition, lack of leadership from government but mostly focused on the positive ideas of networks for managers. Some interest was vocalized on ideas about registered managers as local resources (information on issues of ageing for example) but main focus was on dealing with isolation of managers and providing a source for sharing and gaining thoughts on good practice.

Tuesday, 25 September 2012

Interested in Well Being in Schools, at Home and in the Workplace?


If you are a teacher, trainer, a social care leader or HR professional wanting to make a difference, then here’s an opportunity definitely worth looking into.

A Quiet Place Ltd. is a well established company in the fields of educational therapeutics, personal development for all and well-being in the workplace. It has a national reputation for its evidence-based, high quality service, offering effective programmes for both prevention and intervention adaptable for all ages and abilities. Deliverable in all settings – the great news is that A Quiet Place is seeking partners across the UK to enter into a franchise scheme help deliver its benefits to new clients.

If you are interested in finding out more and seeing how you or your team could join this important and growing field see here for the prospectus.

Monday, 3 September 2012

Haydn Davies Jones - Short Obituary


After a career in the Navy in which he was seconded to the Royal Navy Detention Quarters as Education Officer, Haydn was appointed as Commander (Deputy Head) and then Captain (Head) of Wellesley Nautical Training School, an approved school which trained boys for a career at sea. He held these posts from 1953 to 1961, and was then appointed as Lecturer in the School of Education at Newcastle University. He was promoted to Senior Lecturer and then Dean of the School, working at the University from 1961 to 1989 when he retired. He was head of a post-qualifying course for residential child care staff, which led to the University's Diploma in Advanced Educational Studies and the Central Training Council in Child Care's Senior Certificate in the Residential Child Care of Young People. This course was, together with its Bristol counterpart, highly influential in introducing new ideas and well over three hundred heads of schools and homes and other senior staff will have been on the course during his tenure. Haydn himself, following a sabbatical in continental Europe, was an early - and keen - advocate of social pedagogy long before it was piloted in the United Kingdom. Haydn died on 4 August 2012 and a memorial service will be held in Ponteland on 6 October 2012.

David Lane, Editor of Children Webmag

A full obituary is available here: http://www.icse.org.uk/
 
For more information please email DCL@DavidLane.org.
 

Friday, 10 August 2012

When Monopsony Met Monopoly

Some blogs I would like to write about the Serious Case Review of Winterbourne View Hospital:

1. The institution was a hospital and not a care home
2. The hospital was a CQC registered and regulated service with a statement of purpose concerning the assessment and treatment of people with learning disability, mental health needs, autism and behaviour which challenges services – and sometimes families
3. The service was one that was bought for individuals – by 14 NHS Primary Care Trusts
4. Care management and contract monitoring were not effective either through the care programme approach or through linking payment to service delivered.
5. Strategic Health Authorities had responsibility for the performance of NHS Primary Care Trusts
6. The professional and managerial leadership of the hospital should have derived from a Registered Manager and a Medical Director with Castlebeck company oversight from a responsible individual
7. The responsible individual has not been called to account
8. A GP was responsible for the health care of the patients on a day to day basis and for prescribing medication
9. There were troubling incidents which merited a large scale investigation procedure by the adult safeguarding and the police - notwithstanding the belated reaction to the whistleblower
10. The support worker-led culture at the hospital of ‘its them or us’ was abusive and corrosive. It is one that nurse managers chose to ignore and one where all other professionals failed to pick up the warning signs
11. There is a debate to be had about the possibilities of prophylactic technology
12. Physical and chemical restraints are indicative of regime failure in treatment terms as well as those of control
13. Closed institutions require proactive inspection, care management and challenge to their very closed nature through rights to advocacy and visiting
14. The very existence of Winterbourne View Hospital, and how it was used, ran counter to government policy and local commissioning intentions
15. Finally, the regulator should have a much stronger role wherever ‘monopsony meets monopoly’. This is an inherently dangerous market scenario.

Tuesday, 24 July 2012

ON DUTY - the ROTA in RESIDENTIAL CARE

I was reading the Residential Care Association’s 1980 publication Staffing Ratios in Residential Establishments and was reminded of the truism that: If you divide resident need by staff availability you can arrive at the number of staff required.

The challenge being to quantify both the numerator and denominator. I then embarked on a personal mind search to list the items of resident need and staff availability required to complete the calculation. It is extensive with some items measureable and other less so. There is little value in me sharing the list as it will vary from home to home. It is also an exercise that should be undertaken with residents and staff together. Checklists are useful but no substitute for participation and ownership in something so important. Staff sufficiency is the foundation stone of residential care with their capability, skills and confidence making up all the building blocks.

What this brought home to me is that a rota is a lot more than ensuring sufficient cover by documenting who is on and off duty. A rota is in fact a workforce plan or even a strategy! Think about it.

Monday, 2 July 2012

Let Me Know

Whatever your question the answer is the workforce. A turn of phrase oft used by the former Chief Executive of the, already lamented, Children’s Workforce Development Council gives rise to a few questions of my own.

Question: How will a 25% saving be made on social care budgets that are 80% spent on workforce costs?


Question: When policymakers say we must focus on early intervention and prevention what do they actually mean in practice?

Question: Do personalised services imply a personalised workforce?

Question: Is safeguarding becoming ‘job creation’?

Question: Why is what should be safest service (residential care) the most regulated and that which poses most potentially harmful risks (privately employed personal care arrangements)the least regulated?

Question: Should compliance inspectors at CQC and their opposite numbers at OFSTED rejoin the social care workforce?

Question: What is going on with the College of Social Work?

Any questions? There remain plenty of organisations to address them – too many some say – but sadly not one with a specific set of answers around integrated children’s services.

One thing that is certain is that, thanks to the National Minimum Dataset, we now know more about the social care workforce than ever before. Surely it is time to start using that data to start answering a few questions and stop the often devastating swings of the pendulum that see workforce initiatives follow scandals and crises – only to wither away during times of ‘other’ priorities.

The social care workforce has enough inbuilt dichotomies and paradoxes of its own – paid/unpaid, regulated/unregulated, professional/vocational, relationship/task, adults/children even life and death – to have to deal with the us and them of politics. The sooner policy makers really permit a sector-led approach to answering the workforce questions the sooner we will all secure improved benefit from the 2 million plus people working to care and support adults and children in the UK.




Monday, 14 May 2012

POVA Training to Pennaf Housing Association staff in North Wales

CPEA Ltd has been awarded a second contract by Pennaf Housing Association to deliver Level 2 POVA training to their staff. The first contract last year was targeted to housing contact centre staff, though other staff such as maintenance teams, who had contact with vulnerable children and adults, were involved in the sessions. Separate training was provided to the senior management team.

Pennaf have opened a number of residential care and nursing homes in North Wales and had new starters within their group and therefore required further training. This year the target audience are care practitioners working with older people in the care/nursing homes, project workers dealing with children and vulnerable adults and again maintenance staff who are in contact with vulnerable groups when carrying out repairs.

A total of 18 sessions are being delivered in various Pennaf training facilities in St Asaph, Colwyn Bay, Chirk and Wrexham from April to July 2012. The bespoke courses help participants gain an understanding and confidence about safeguarding children and vulnerable adults. The courses provide a brief outline on how to recognise abuse and appropriate actions to take in respect of any allegations, disclosures or concerns within the context of local safeguarding procedures.

Sunday, 29 April 2012

Andragogy vs Pedagogy in residential care

Attending a major conference for residential child care practitioners last week in Cardiff it was rewarding to participate in sharing how theory and practice interact. Being a children’s event inevitably the topic of social pedagogy arose with those in favour and against expressing their opinions. Great that there is the space and confidence to do this. What passed through my mind was what would practitioners in older persons home make of all this?

A couple of years ago I had the same thought when undertaking some work on possible implications of social pedagogic thinking in the youth services. At the time I googled around a bit and discovered the notion of andragogy. Returning to these thoughts I am increasingly convinced that social care practice in older persons homes benefits from underpinning vision and clarity of theoretical models. Ideas around andragogy offer such a model based on self-directed and informal learning, the diversity of groups, adults as a resource for each other and the pursuit of self-actualisation.

Whilst andragogic thinking may sound a long way from practice reality it has the potential to give greater credibility to self-directed care and personalisation in care homes. Good practitioners know that choice, dignity and individualised approaches based on relationships is the right way to work with residents. For them practice is not about ‘task and finish’ but about ensuring a valued life experience. Andragogy offers the practitioner the theory to put these beliefs into practice. It creates a platform for debate and discussion to share good practice at conferences and workforce development events. It could create the same space and confidence for care practitioners in older persons homes to learn from the views and opinions of professional colleagues as residential child care demonstrated last week in Cardiff.


Educationalists debate differences between pedagogy and andragogy – between children learning from teachers and instructors as opposed to a more self-directed model for adults. Social pedagogy advocates that children grow and learn in different ways at different times – using hands, head and heart. Social andragogy could be shaped as the theory that (re) introduces lifelong learning, self-directed support, cooperative care and the benefits of group living into all forms of residential care including older persons homes. Find out more and google ‘andragogy’.

Thursday, 22 March 2012

Action for Ageing

297 Tips To Improve The Health, Safety And Wellbeing Of Your Ageing Loved Ones. Chris Minett and Robin Minett ISBN 978-0-9568220-4-8

A pleasant surprise benefit of tweeting was being sent this interesting book. A colleague at www.cpea.co.uk was optimistic she could get some tips that would be helpful for her 83 year old mother and agreed to read it. She reports by way of our blog:

The book is well presented with an introduction and list of contents and the hints are set out in alphabetical order – Ageing, Alzheimer’s, banking, bathroom etc. Each topic has its own chapter and is attractively laid out; beginning with a simple fact/numerical comparison, often relating to costs. There is then an explanation of issues, things for a carer to consider along with some essentials. Each section closes with an action list of things to do, web links and signposts for further more specialist information, which is mostly helpful. The text is interspersed with cartoons and pearls of wisdom from carer Min. However fewer pearls would have been wiser.

There is much helpful information contained within the book but it is rather thick and information is somewhat unruly and could be better organised. For example there is some useful information about key locks, which many people would not know about until they needed one, but it could usefully have been linked to the section on security. Likewise kitchen safety could be better linked to fire in the home and the section on fridges. There are various sections covering safety in different parts of the home and similarly different sections on gadgets, aids and Telecare.

The book feels rather expensive at £19.95. A smaller tome at less cost may tempt more people to purchase the handy hints – and make no mistake they are useful. However if ‘prevention is better than cure’ then at under 7p a tip what I have learned may prove priceless to my mum.

Tuesday, 20 March 2012

Social (Net) Workers

There can be few social care professionals not aware of the popularity of social networking technologies such as Linkedin, Twitter and Facebook – and some may even have put a toe in the social media water.

But how many recognise the enormous possibilities these technologies present to our sector? After all, they make available for all frontline social workers and social care managers the ability to have more relevant discussions with colleagues and with the communities they serve.

They offer a less intimidating, people friendly and very affordable way of engagement. As an antidote to loneliness and isolation – professional or personal - they offer a new and panoramic window to practitioner, manager and service user alike.

Perhaps you can see a need to move forward here. What would be a good first step? Here are my top tips for starting to embrace these technologies.

  • Get together a social networking roadmap that will clearly identify social networking sites that could be usefully embraced by your team. Each site should have a realistic description of the benefits, current and future risks your employees could open you up to
  • Start with some form of survey or assessment of current social networking practices and if possible, future needs too. A policy that does not fit the actual circumstances of your organisation will be ignored - and thus do more harm than good
  • A Facebook ‘Page’ can be set up for your organisation, similar to a personal profile. People will ‘Like’ your ‘Page’ and this will show in their individual News feeds and will promote your organisation: you can import a database of names and invite people to join up and ‘Like’ you, so include your workforce, partners, influencers and so on. Think carefully about the information you post there. Don’t make it too text heavy, don’t use very formal language and try and use multi-media regularly to add interest
  • On Twitter, you need to follow people in order to have interesting tweets to comment on and to get the latest industry news. Mix it up – choose Twitterers from your personal and professional life. Check the profiles of people who are following others who you follow. Follow at least 30 people to get a lively home page. Then start posting your updates. Don't expect many to follow you immediately
  • One, perhaps often overlooked benefit of using Twitter, is how good an informational digest it provides. In that sense, it’s less about what you can bring to the conversation, but instead provides (very much like the RSS feeds of old) lots of very short snippets of news from a wide variety of sources. Some of the ‘news’ is not news as we would know it – and a lot of it can be extremely funny, moving and entertaining. Judge for yourself!
  • LinkedIn operates as the equivalent of business card system and it’s an ideal way to keep in touch with or do research on your peers, people you’ve met at events, key people in social work, and so on. As well as having your individual profile, note that your organisation may also have a presence. Such a profile can tell people a little more about the work you do and the value you add. It also links to the profiles of all your staff, providing another way for your clients, service users and job seekers to connect with you on a professional level
  • Be warned that Facebook and Twitter – and even LinkedIn – are not the place for safe, slick public sector communications. People want to hear what the Head of Social Services at X council thinks – but not the emasculated ‘official’ version – but the message that sounds like it’s from the heart. That’s what will engage people…
  • Don’t forget to offer frequent training regarding these technologies and the organisation's approach to social networking. Insist that employees think before they click, tweet or post! State unequivocally that employees must comply with all policies covering confidential information.

What's not to 'Like' about social media in the social care sector, in other words?

Vic Citarella’s twitter address is @cpeanose


Wednesday, 29 February 2012

CPEA Nose Guest Blog from Steve Scott: Leadership and Mental Health

The Shaw Trust reported in 2010 that only 2 in 10 employers have a reactive or proactive mental health policy to support staff with mental ill health. What role does leadership have in addressing this challenging issue?

Employee mental well-being should be an integral part of the boardroom agenda, on a par with physical health. Leaders should insist that regular monitoring of progress or issues is reported to the board. The Chartered Institute of Personnel and Development (CIPD) has found that 70% of employee mental health problems are either directly caused by work or by a combination of work and home. In light of this, there simply is no excuse for this not be a mainstream issue for leaders to address. By proactively managing mental well-being in the workplace, leaders are not only dealing with their legal and ethical responsibilities, they are also looking after their bottom line as well. Absenteeism and presenteeism are responsible for losing British organisations billions of pounds, so how can this subject be ignored.

All employers should include safeguarding mental well-being into their standard operations, particularly when employees and/or organisations are embarking on change processes, which can be and are very challenging times for everyone. Training from the leadership down in proactively managing mental well-being, including offering additional support to staff or simply leading by example, is essential. Safety net support such as coaching and occupational health needs to be incorporated into health and well-being policies.

Leaders should be ensuring that management have a huge positive impact on mental health. Good line managers are essential in spotting early signs of distress and initiating early intervention, whereas poor line managers may make the situation worse or even be the cause of mental health problems through their approach, management style of behaviour.

Leaders should be insisting that comprehensive and, more importantly, mandatory mental health training for line managers is introduced and embedded into the culture and development plans for their employees. This training and change in culture will ensure that the organisation develops employee resilience and emotional well-being.

Steve Scott is co-founder of CSP Coaching LLP steve@cspcoaching.com

Monday, 27 February 2012

Guest Blog From Rosemary Milmine: Life As A Registered Care Manager

As an actual Registered Manager, doing the 60hrs plus a week, (at the moment working the night shift because a member of staff went off suddenly and there was no one able to cover at short notice), I can only applaud any move towards better recognition that the job we do is often complicated and quite frankly often unrealistic. I am being put under pressure by the local authority to reduce the fees we currently charge for residents – (basically telling me how I must cut down on basic good care) and whilst I am digging my heels in for the moment I am not sure for how much longer I can hang on and I am not the only care home facing this. The upshot will inevitably be staff reduction and managers’ workloads will become even more unmanageable.  

Focusing on Registered Managers is a good idea, I have a lot more confidence than I had when I started in this role and I know that I provide a good service, (a CQC inspection last week confirmed this!), but it has taken me quite a few years to get to this position. It would be good if Registered Managers were supported to get to the same point quicker than I have! I still haven’t worked out how to get down to a 40hr week!

My worry would be whether Registered Managers could be released from their roles to attend forums and training – when I undertook my Registered Managers Award seven years ago most of us were doing it in our own time and since then thinks have got busier. However I think we need to somehow start taking control we can’t have all and sundry waltzing into our homes telling us how to run them…

Thursday, 16 February 2012

Guest Blog from John Burton at The Association of Care Managers: In Defiance of Compliance

A care home that is run simply to be “compliant” is unlikely to be a good place in which to live or work. Compliance is alien to the ethos, principles and good practice of the social care profession and residential social work 
 
Compliance, the principal tool of measurement used by the Care Quality Commission, has no place or validity in the life and work of a care home. It is a negative and submissive concept. Nothing ever grew and developed, no initiative, no advance was ever made by compliance. Compliance is static and change is dynamic. The notion of compliance could only be of use to check important but secondary technical services to the home, and such checks should be made by suitably qualified and experienced technicians. For example, the lift must be properly maintained, medication managed well and accounted for, and food stored and prepared safely, but such compliance is not the primary purpose of a care home. 
 
Those of us who were trained and qualified as residential workers or residential social workers - trained to practise, manage and lead - received a thorough grounding in such areas as human growth and development, loss and change, social psychology, group processes, community and institutionalisation, leadership, ethics, ageing and society, social work methods, social policy, counselling, dependency and power relationships, family and individual therapy, etc. etc. We were encouraged to enquire, to challenge, explore, and debate ideas. We thought, read, and argued. We were not taught “compliance”. Courses differed and, of course some were better than others, but I very much doubt if any residential social work course ever mentioned “compliance”.
 
No, I’m wrong. In the early 70s, when I did my qualifying training, the word compliance described a worrying aspect of, for example, a child whose infancy and early years had compelled them to keep their heads down and to find a way of surviving the hostile and persecutory world around them. These days, we might take compliance in an eighty-year-old resident of a care home to indicate that they may be being abused, bullied or medicated, and they had attempted to avoid further pain and humiliation by withdrawing into themselves and being “quiet”, compliant and unnoticed. “No trouble.”
 
“The creativity that we are studying belongs to the approach of the individual to external reality . . . Contrasted with this is a relationship with external reality which is one of compliance, the world and its details being recognised but only as something to be fitted in with or demanding adaptation. . . in a tantalising way many individuals have experienced just enough of creative living to recognise that for most of the their time they are living uncreatively, as if caught up in the creativity of someone else, or of a machine.” D.W.Winnicott, Playing and Reality.
 
Care homes are caught up in what the machine of CQC has created - compliance. We will break free of the constraints of compliance only if we start acting like professionals and leaders of our care communities. We must stop acting like quiet, frightened, compliant children, anxious to please by fitting in with the rules and restrictions imposed on us. We must grow up, join forces in taking responsibility for our own profession, and lead the development of care homes as highly valued local centres of care and support.
 
Over ten years, the national regulators have turned social care upside-down. Instead of the needs of users instigating the form and operation of care services, and those services, led by the registered managers, being designed and managed at a local level to meet those needs, the regulators have imposed their misinformed and blinkered design for care. This top-down approach has in turn spawned a new layer of quality-assurance, management and consultancy which is now seen as essential to prove to the regulators that providers are compliant. And this self-perpetuating arrangement flourishes alongside the cosy pretence of personalisation. Compliance-centred is the very opposite of “person-centred” care.
 
It seems extraordinary that while those at the head of this appallingly wasteful and dysfunctional system have had the advantages of sophisticated management training and mentoring, they seem incapable of understanding their part in it.
 
According to Paul Hoggett (University of the West of England), social work/social care professionals need the capacity . . .
  • to tolerate and contain uncertainty, ambiguity and complexity without resorting to simplistic splitting into good/bad, black/white, us/them, etc.
  • for self-authorisation, that is, the capacity to find the courage to act in situations where there is no obvious right thing to do
  • for reflexivity, that is, to take oneself as an object of inquiry and curiosity and hence to be able to suspend belief about oneself; all this as a way of sustaining a critical approach to oneself, one’s values and beliefs, one’s strengths and weaknesses, the nature of one’s power and authority, and so on
  • to contain emotions such as anger, resentment, hope and cynicism without suppressing them and hence to be both passionate and thoughtful. 
What do we think Tom Kitwood would have made of this compliance culture? Would it not fit perfectly with his description of a “malignant social psychology”? Is it not understood at any high level in Government, Department of Health or CQC that the malignant effect of compliance does not merely “filter” softly down to the way residents in care homes are treated, it is - albeit unwittingly - aimed directly at them and blights their lives.  
 
When senior members of CQC are cornered, and when they cannot bully their way out of the corner, they resort to the excuse that they have no choice and are merely following the orders given them by government but are short of resources, and “give us time - we’re a young organisation”. Such excuses are a betrayal of professional ethics.  
 
As social care professionals and leaders, registered managers must take their cue from their own professional standards. We must support each other, learn from each other, and always put our clients first.  
 
John Burton, ACM

Monday, 13 February 2012

In tribute to Ian Mallinson

It is now five years since Ian Mallinson passed away. I am very pleased that Janti asked me to say these few words at this Masterclass and annual Birmingham seminar where we in the SCA remember his contributions to social care. Now what to say about a unique man that some of you will have known better than me, some of you will have just heard his name and wondered, whilst others may not know of him at all.

 In these circumstances I did what many of you may do. I Googled him and in doing so I realised that this was something that Ian would have appreciated. In so doing I lighted upon the theme of what I want to say about Ian today. Although it is only five years since Ian’s death, with his illness, it is all of ten years plus since his last major publication on social care practice. For those of you that don’t know that was the 2000 Personal Care Planning in long term social care of older people - empowering service users - written with Susan McClean. As an aside, and I am getting diverted from my chosen theme here, this publication is still available from SCA and was and is ahead of what a lot of social care organisations are practicing even now.

In the preface it says “personal care planning is about workers jointly identifying needs with service users and then finding ways of meeting them. The personal support plan, defined by a named worker in conjunction with the service user, helps to provide a framework that gives a sense of clarity and focus to the activities of all involved”. I hope that says enough to give you a flavour of his work.

Now in the 10 years since that Mallinson/McClean publication Google has exploded alongside other technological advances and social media. In 2000 the information revolution and knowledge economy was just being ignited in the UK and it is only now just beginning to explode and change our world, including social care, forever. What would Ian have made of this? What would he have made of there being 5 professional Dr. Ian Mallinsons on LinkedIn, pages and pages of Ian Mallinsons on Facebook and many people with Twitter accounts who own up to being Ian Mallinson. Well I tell you what he would have loved it. You see Ian was an early adopter. Ian had a steam driven computer in the loft room where he lived and worked at Policy House in Bourneville - this was the place that most of the thinking and creation of Ian’s work for the SCA took place - before we even knew what a home computer was. He had CDs while the rest of us were still buying Vinyl and what an eclectic collection - jazz, choral, classical and rock/folk. There is no doubt in my mind that Ian would have a top of the range iPod, iPad and phone if he were around now. He would have switched to Mac no doubt about it and probably would have tackled the technical side of home computing as well.

I think Ian would be a driving force in social media and social care today. He would be promoting best practice through Twitter, running forums on LinkedIn and challenging leaders, managers and academics with a popular blog. The blogosphere was made for Ian’s knack for joining theory and practice and working alongside people on the ground to get the messages out far and wide. I think Ian would have invented a keyworker App by now that we would be debating the ethics of using and discussing how this can benefit service users and the risks be minimised. For those of you that don’t know keyworking was Ian’s middle name and as Janti said to me yesterday - you can’t get more person-centered than keyworking.


Yes Ian would have liked being googled, he would have liked that Social Care Online (SCIE) has 24 of his publications listed and that you can buy his books on Amazon. He might have even taken issue with the fact that apparently his most read book - Keyworking in Social Care - is now ranked 1,416,711 in books sold. He would have expected us all to do something about that. Ian believed in credit where credit is due, gave it and expected it in equal measure, and hated plagiarism and academic snobbery.

Those of you lucky enough to have been tutored by Ian at Bourneville College know that he would not have been fearful of social media. He would have been building it into learning and best practice, he would be using it to benefit his students and getting them to address how technology could improve quality of life for service users. He would be fighting to get a voice for people, for himself, in
the busy world of social relationships on the Internet - he would addressing the issues of communication up front. As a distinguished man he would have found a way to distinguish himself and those around him.

I have concentrated on one particular strain of thought that hopefully does justice to Ian’s memory. If you do Google Ian you can read all about his achievements in social care and other fields. In particular I would commend Joan Becks memorial piece to this event in 2007 published in SCAs magazine and available online or Natalie Valios’s item in Community Care 2000 when Ian was Association President.

However for me the inspiration in Ian was not about looking back, however valuable that maybe, but in forever looking forward and side ways as that was the type of man he was. I was lucky to have been his colleague, collaborator and conspirator for some 15 years and just thinking about what he would be doing today excites and inspires me still. He would probably be preparing an electronic wallchart of the forthcoming changes in legislation in social care - now there’s an idea worthy of Ian.

(I gave this address at the annual Ian Mallinson masterclass in September 2011)

Saturday, 7 January 2012

Breathing Life into the Excellence Award

Richard Banks and Vic Citarella of the Social Care Association make the case for a consumer-led approach to excellence in care homes and with support providers.

‘In all the consultations I’ve been involved in all my life – and there have been many- no proposal was as unpopular as the excellence scheme for adult social care’. A reported quote from Care Quality Commission Chief Executive Cynthia Bower as the Department of Health confirmed that the proposal for a scheme to assess and recognize excellence in adult social care services was dropped. The proposal was undoubtedly flawed in many ways, but it is important that employers and care professionals in the sector don’t leave it at that. A means to identify and communicate high quality social care must be found. People who use social care have a right to expect it and those of us privileged to work with them require a way to support constant critical examination and improvement.

What we have now in England is the Care Quality Commission whose job is to make sure that care provided by hospitals, dentists, ambulances, care homes and services in people’s own homes and elsewhere meets government standards of quality and safety. These essential standards cover all aspects of care, including:
  • Treating people with dignity and respect.
  • Making sure food and drink meets people’s needs.
  • Making sure that that the environment is clean and safe.
  • Managing and staffing services.
Truly excellent
Previously inspection of social care support such as residential care homes and home care services have been judged against a star rating system that has now finished and the Care Quality Commission are concerned with compliance to the standards alone. Many organisations that provide social care support believe they do better than the standards and want recognition of their higher standard. People seeking support services are interested in a way to differentiate between the merely compliant and the truly excellent. So there is nothing fundamentally wrong with the basic idea of an Excellence Award. The positive responses from the social care sector to the Social Care Institute of Excellence underpinning work commissioned by CQC shows the commitment to improvement. It identified four essential elements of excellence. Three concern improvements in people’s lives as a result of using the service, these are:
  • having choice and control over day-to-day and significant life decisions
  • maintaining good relationships with family, partners, friends, staff and others
  • spending time purposefully and enjoyably doing things that bring them pleasure and meaning.
the fourth relates to the organisational and service factors that enable the outcomes to be achieved and sustained.

This is good foundation material for excellent practice and cannot be wasted. Given that the Department of Health and CQC have not found a way to build on such solid theory maybe it is time for the adult social care sector in England to take the lead; learning from the flawed implementation to date and the consultations.

Instead what appears to have happened is that providers and commissioners have come together to torpedo the proposals. This makes it even more important that they stop treating social care excellence as an issue to do with financial management, contract compliance and procurement and accept a consumer-led model. There is a real need for a ‘think shift’ here that really strengthens the position of people who use social care services.

From compliance to quality
The public must have confidence in compliance with essential standards and understand what that means. Providers should be able to market their services on the basis of consistently meeting those standards. However if there is to be system of getting recognition of going beyond those standards it should be open to all. There is a need to debate whether a proposed Excellence Award is voluntary or not. Should all compliant providers be supported to go further as at least an aspiration? The shift here is from compliance to quality.

Providers resented having to pay more for a lesser service from CQC. There is a ‘financial shift’ required here as well then. The money spent by commissioners on double checking compliance through contract monitoring is money squandered. That this is being repeated in each of the 150 local authorities across England in different models is costly for providers and confusing for the public. Local authorities should refocus their contract monitoring investments on supporting providers to evidence quality (through an Excellence Award). They should do this by creating a partnership managed sector-led improvement fund across local economies. This can both assist achieve excellence but also support failing providers if necessary.

Aspiring to excellence
Consultations have pointed up that any excellence award must be:
  • Consumer-led
  • Open to all providers who are compliant with essential standards and want to participate
  • Funded as an alternative to the prevailing model of contract monitoring
  • Simple but be capable of gradation as in: aspiring, progressing and demonstrating
  • Consistently and credibly evaluated involving both service users and qualified sector specialists.
Good care support providers are involved in a programme of constant improvement with the people who use their services and it is this dynamic activity that they would like to be reflected in a new approach to marking excellence. What we are striving for is for care homes and support providers that meet standards excellently now but are seeking ways, alongside those people supported, to secure that excellence by aspiring to further improvement.

An approach that achieves that would be one that starts and finishes with the consumer - those people who depend on the social care support service. Such an approach would be both about what matters to those who use the service and carry the authority of the lived experience of those people. Clearly the managers, care workers, family and other carers need to be party to this approach but it should stand or fall on the capacity to truly engage people who use the service.

Assessment
In outline the approach could be that realistic aspirations for improvement are set by discussion with people who use the service in the coming period of time (3 months or maybe alongside a care planning cycle). Action plans could be established by registered managers, as lead professionals, with care workers to make progress towards those aspirations and determine how that will be demonstrated. Evidence and analysis is carried on throughout and an assessment made at the agreed point by the same mix of people who use the service that set the aspiration. For the organisation they are seeking an upward spiral of service improvement. To meet the aspirations set the organisation is likely to invest in additional support activities such as finding practice based research to inform improvement, workforce development, key worker schemes and supervision practice plus planning how resources can enhance the care environment. As important as these support activities are they are always supplementary since the only achievement that matters is the evidence of the experience of the people who rely on the social care support in the care setting. 

The mark of excellence for the organisation is achieved by adopting the approach and showing assessment against aspirations set by the people who use the service. There might be a need for external facilitation and/or verification. This could be a paid role but best if managed by peer reciprocal support from other provider organisations or via existing trade and professional bodies. As a linked activity organisations providing services (maybe with commissioning organisations or Health and Well Being Boards) might want to set up local hubs that distribute and collect practice based research, act to advise organisations blocked in some way from progressing improvements and serve to ensure that information about the excellent service providing organisations is readily available (Directory/websites) to the public. Such a hub might also act to provide events that allow people to prepare for future care needs by considering the issues, options and support available before crisis.