New research on vascular dementia

The Alzheimer’s Society has produced a spotlight on ongoing research into vascular dementia, the second most common form of dementia.

The spotlight highlights a number of ongoing projects working to understand how to prevent the disease taking hold. One such project, led by the University of Oxford, is testing to see whether surgical procedures undertaken to prevent the risk of a stroke has had a noticeable impact on the cases of vascular dementia in the test group.

Other research is delving deeper into causes of vascular dementia. One particularly interesting piece of work by Professor Roxana Carare of Southampton University is investigating as to whether conditions that drain fluid from the brain make vascular dementia more likely.

You can read up on all of these projects by clicking here.

Not long left for Skills for Care managers’ survey

Skills for Care’s Managers and Nominated Persons survey ends tomorrow. The objective is to find out what the daily life and tasks of a care manager or nominated person consists of, so that Skills for Care can make recommendations for improvements.

The survey is in part triggered by a lack of knowledge, but also by a growing awareness of the high staff turnover among this class of care employees:

For registered managers the turnover and vacancy rates associated with the role are 23% and 11% respectively, and we expect that as many as 10,000 registered managers may retire in the next 15 years. For nominated individuals, the CQCs plans to look more closely at strategic leadership as part of inspection may have an impact on that role.

You can find a link to the survey by clicking here.

 

Care home opens its doors to toddlers

A care home in London has become the first intergenerational facility in Britain by opening a nursery in its building. The move is expected to lead to both economic benefits for the care facility, and welfare benefits for the elderly residents.

The facility is an example of an innovative, intergenerational solution to Britain’s care ghettoisation that we described in our Future of Care Report. On a similar theme, the first mixed student and elderly residential development is expected soon.

Read more about it by clicking here.

Your work experience checklist

If you’re a residential or domiciliary care organisation taking someone in on work experience, there’s a big benefit to yourself and the sector as a whole. Hopefully, you’re getting someone who’s enthusiastic who may even end up working for you someday and making a real difference. However, it’s easy to forget the basics when it comes to work experience, so here’s your checklist to make sure you and the person get the most out of their work experience.

 

1. Get the right person

Normally, if someone is applying for work experience in your care setting then it’s because they want to be there, but not always. Find some way of vetting the person beforehand to make sure you’re getting someone who will put the effort in. There’s nothing worse in any work environment than someone who doesn’t want to be there.

 

2. Basic housekeeping

Make sure you give the work experience person everything they need to know on the first day. That means all the things you take for granted, such as expected working hours, where the toilets are, who to ask for help, how long the lunch break is, and where the first aid kit is located.

 

3. Don’t mistake anxiety for laziness

Most of the people you get on work experience will be young, and teenagers are complex creatures! Sometimes they may be giving off an attitude that can easily come across as sulkiness or laziness. Make sure, however, you prod a little deeper, because it could just be anxiety. Remember, it is likely to be there first experience of working life and outside of the comfort zone of the controlled classroom environment.

 

4. Ease them in

As stated above, this may be their first experience of working life, so don’t throw them in at the deep end. Make sure they get a full induction and tour, and maybe try them out on a few easier tasks before moving them on to more intense activities.

 

5. Give them a rounded experience

We all know that a care organisation is not just the front-line. There’s also the business management, finance and coordination sides, as well as others. Give the work experience person a full picture of your organisation and all of its aspects. If the person isn’t quite enjoying one aspect of the organisation, you can move them to another where they might thrive.

 

6. Give them a supervisor who will make time for them

The front-line of care can be hectic. It’s hard enough for your supervisors and managers to give time to full-time staff, let alone work experience people. Of course, we know that it is important that they do. Choosing the right supervisor for the work experience person can be crucial, so have a think about someone with the right personality traits and who has the time to dedicate to helping someone through the whole experience. You may even want to consider lightening their other duties for a period to ensure they have enough time for the person.

 

Do you have any other tips? Leave your comments below!

More than funding needed to change social care

Readers will be well advised to read a very interesting and provocative article in The Spectator on the need for reform in the social care system, concluding the system needs much more than just fresh cash.

The article, by James Mumford, who led a review of social care for the Centre for Social Justice, argues that funding is not the only answer for social care. Especially since, as implied in the last general election campaign, many seem unwilling to countenance a change in funding in order to fund those in need.

As Mumford points out, though, as we have consistently said on this blog, that lack of funding is not the only issue with our care system: “It is not a funding issue when a resident isn’t given a glass of water. It is not a funding issue when people in charge fail to deliver. And it is also not a funding issue that we, so often, look the other way or quite simply stay away.”

Mumford points out that when people are moved into a care environment, they are typically cut off from their possessions and their social connections, and are seldom given the opportunities to develop new ones. As a result, their mental well-being deteriorates along with their physical health. Mumford references a recent social experiment broadcast on television where children entered a care home and caused an increase in the physical health of residents, evoking a similar scheme in the US.

Mumford also echoes Advantage’s calls for us to think bigger and in a more imaginative way, citing the proposal from a New York doctor for smaller but more homely facilities for the elderly. Above all, he stresses the need to end the “marginalisation” of the elderly. There are no shortage of ideas to help with this. One idea mentioned in our Future of Care report called for housing schemes to be designed around the young and the elderly.

Increasingly, the mood seems to be that funding is not the only answer for care. Instead, we need radical and progressive thinking that recognises the need for a change of culture and mindset.

CQC report finds good care in mental health services

Although the media will no doubt focus on the negatives, a new CQC report on the state of care in mental health services has actually uncovered a lot of good news.

A study of mental health services conducted between 2014 and 2017 has found that 68% of core services provided by the NHS are good and 6% outstanding, while the ratio is 72% and 4% respectively for independent services. Among those services for which special praise were delivered were community services for those with learning disabilities or autism. Even providers labelled as requiring improvement have made “real progress”.

Unfortunately, the report also highlights a “substantial minority” of services where improvement is needed, and cited a number of familiar areas of concern, including staffing shortages, locked rehabilitation wards, poor quality clinical information systems, and the variation in the use of physical restraint and restrictive practices.

The latter is certainly a hot topic in the sector today, and the reason behind Skills for Care’s recent push on positive behaviour support. Clearly, services needed to embed the latest guidance in their training programmes more deeply to achieve change.

The full report and data is available on the CQC website.

Is the quality of care likely to improve?

Many pessimistic about the future of care

The results of an Advantage survey for a new report on the Future of Care show that many in the care sector are pessimistic about the future of the sector and the quality of care.

The survey asked respondents to rate their optimism about the future of the sector out of 10, with 10 being very optimistic, and 0 being very pessimistic. The average rating was just 3. Of those that delivered very low ratings, the main reason stated was a fear of demand outstripping supply and funding. Only 13% of respondents gave a rating of 6 or above.

A majority also felt the quality of care would suffer in the foreseeable future. Of those that answered ‘Other’, the general feeling was of stagnation.

Why did our survey respondents feel so negatively? What can we do to help our social care system prosper? Download our new report on the Future of Care to find out.

Did you know about Skills for Care’s Leadership Programme?

Skills for Care are ramping up the publicity on their Leadership Programme, which is open to applications.

Skills for Care have a raft of leadership programmes (with a discount for members) that many seem unaware of. Although it can be hard to take time out of an organisation, it’s always important to ‘sharpen the saw’.

If you’re a leader in a care organisation and you feel like you’re constantly under pressure, then this is an opportunity to work ‘on’ the business rather than ‘in’ the business.

You can apply to the leadership programmes here.

SCIE makes the case for intermediate care

The Social Institute for Excellence has published a new highlights paper on how intermediate care can deliver better outcomes for people in care.

The report has found that effective intermediate care reduces pressure on hospitals and on social care settings. For example, it has found that 72% of people who received intermediate care did not move into a more dependent care setting, and 70% who received intermediate care after a hospital stay returned home.

Intermediate care is designed to treat people to prevent the need to go into hospital or care. It is delivered prior to, or after a hospital stay, and aims to promote independence. Although it is not a new idea, it has received fresh attention with the drive to reduce pressure on the NHS and social care system.

However, it seems that there are a number of challenges to implementing intermediate care more widely, with the report citing effective leadership, integration, and unrealistic expectations. Of course, these seem to be challenges across the whole spectrum of health and social care.

What do you think about intermediate care? Do you think it is deserves more attention?

Person-centred approach – training and development

Earlier today, we posted about the new person-centred approach framework released by Skills for Health, Skills for Care and Health Education England. Within the document is a whole section advising organisations on how to embed these approaches using training and development. The framework recommends a number of "underpinning principles" to guide an organisation's approach to training and development on the topic.

 

Behaviour change

The most important of those principles is "behaviour change". As with the whole idea of a person-centred approach, this concept is now fairly old, but its implications have still not been felt by a vast number of organisations in the sector, and indeed across all sectors. Unfortunately, the framework is frustratingly light on how behaviour can be changed in a positive way, reflecting only that it is more successful than "isolated training". It does note, however, that any training geared towards changing behaviour will fail if the organisation's structure and processes reward an old, habitual behaviours rather than reward the behaviours enshrined in the framework:

Development of capability must simultaneously be supported with the right processes, system and opportunity together with locally relevant incentives, which build those intrinsic and extrinsic motivations.

 

Co-producing training

The framework also recommends that training is co-produced to a certain extent. This boils down to having the carer or even the service user contributing stories and reflections about their experiences during the course, or even during the planning of the course.

This shouldn't be new to any good provider or trainer. A good trainer will seek to engage the people on the course, getting them to talk about how they can relate to content of the course and whether they can think back to any relevant experiences. A classic reflection exercise is 'What would you have done differently?', getting the learner to retrospectively apply their new learnings to a previous experience.

Again, the framework highlights that the best co-produced training will have people involved in the planning stage without them even knowing it, with HR processes that continuously seek feedback from service users and staff.

 

Reflective practice

Again, we are all familiar with the importance of getting members of the team to reflect on what is working, what isn't working, and on the needs of others.

The challenge for many health and social care providers, of course, will be finding the time for members of staff (including managers) to engage in reflective practice. As resources become more stretched, it will become more and more difficult. One possible solution is to stress its importance during the induction period, to effectively train staff to continuously reflect 'on the job'.

 

Continuous improvement

The framework focuses on the structural element of continuous improvement - of managers consistently providing feedback to staff. The framework does not mention, though, the significance of a continuous improvement culture. The best companies in industry that practice continuous improvement have it as part of their culture, running through everything they do, encompassing HR, finance, production and service delivery processes.

Achieving culture change, of course, is difficult to accomplish and can take a long period of time. It requires concentrated effort and the full support of senior leadership. As any continuous improvement organisation will tell you though - and this includes the likes of General Electric and Mitsubishi - it is well worth it.

 

Value-based approaches

This part of the framework primarily refers to recruitment and retention. Unfortunately, the section seems a little too aspirational. The news this week has been full of reports about the huge number of vacancies with the NHS, with retention proving as much of an issue as recruitment. This is compounded by applications from the EU dropping off significantly in anticipation of Brexit and the end of free movement. Even a brief perusal of any job site will tell you that care settings are also continuously recruiting in a sector renowned for its high staff turnover.

Increasingly, health and social care providers are taking what they can get. Recruiting on the grounds of values and outlook, as the framework advocates, is simply not possible for those who cannot afford to go and do it. The emphasis has to be on training and induction. This is helped by having a strong culture that new workers can be embedded in to quickly.

 

Methods for delivering training

The 'narrative' section of the framework does not elaborate on this principle much, although content further down in the document does by discussing "permitted time for e-learning". As ever, the key is deciding which approach is most suited for each person and for each subject area. E-learning is often perfect for entry-level staff being trained in compliance topics where answers are often binary (i.e. yes or no, right or wrong). It may not be suitable for training that requires reflection and where judgement may be more subjective. 

 

Conclusion

Although the framework raises some great points, it does feel a little too aspirational and abstract at times. Many health and social care providers will feel that it doesn't account for challenges in recruitment and funding issues. If you take anything from the framework and this post, let it be these three points:

 

  • Culture, culture, culture: if behavioural change, continuous improvement and a person-centred approach are going to take hold, it needs to be embedded in your culture.
  • The method of training delivery needs to be suitable for the person and the subject area.
  • Train people to reflect on their work every day and 'on the job'. This embeds it into their behaviour, and means they are doing it even if you can't set aside specific time for them to do so.

 

 

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