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
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 of the framework 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.
Person-centred approaches in healthcare
A new framework is being launched by Skills for Health, Skills for Care and Health Education England to put people-centred approaches at the heart of the health and social care sector.
The framework builds on a long-running trend to put people and their needs at the heart of health and social care, replacing the traditional top-down approach of yesteryear. Although to many this may seem like old news, there are still a number of health and social care settings who do not fully understand the implications of adopting a person-centred approach.
The framework, according to Skills for Health, was created by drawing on the experience and knowledge of professionals in the sector, and is designed to take person-centred principles and apply them to the current landscape. It is designed to help health and social care workers – or rather their managers, in reality – “put person-centred approaches into practice and to create sustained behavioural change”.
You can read the new framework here. As ever, although the thought must be applauded, drafting a framework and implementing that “sustained behavioural change” is the real challenge, and it isn’t clear from the framework how that is to be achieved in a realistic context. Much of the framework – as is clear in the central diagram – is based around conversations with service users. In health and social care settings where human resources are increasingly stretched, finding the time to have these conversations is easier mandated than done.
A more detailed analysis of the section on training and development will be posted shortly.
Choosing the perfect care home
BBC News have published an article online today advising people on ‘how to choose the perfect care home‘. We liked the article because it included a checklist from Age UK on what to ask potential residential or nursing homes before you or your family member moves in.
The list is useful for providers though, too. Very often we focus on complex issues and forget the basics. This checklist is great for bringing us back down to earth, and ensuring we have the fundamentals of care right:
- Can residents choose their daily routines?
- Are senior staff on duty at all times?
- What is the ratio of staff to residents?
- What is the annual turnover of staff?
- What dementia support is available?
- Do GPs visit the home?
- What is included in the fees?
- What meals are provided?
Caring for an elderly person is not an easy task. It is exhausting and takes up a lot of time, which we often lack. That is why professional services for the elderly at home come to the rescue of people in such situations and help them in coping with such a task as care of the elderly in their own homes or care institutions which are proposed for taking care of senior people and serving them in all kinds of ways required by them.
In home care services include housekeeping duties – like sweeping the floor of any room where residents rest and keeping the premises clean and well-organized; providing hygienic conditions related to everyday routine cleaning and use of purificators and the wardrobe in which the patient stores his/her clothing and other things).
Entertainment activities which allow their participants to forget about their disability at least for a while and spend some quality time which can alleviate the symptoms of such illness and help in the process of aging slower and finally allow elders to spend more time with their children and their grandchildren etc.
Senior citizens and disabled people lose their autonomy most especially when they are in their last years of life due to various reasons: for example having illnesses which require the use of life support equipment which takes too much physical strength from the patients and thus makes them unable to care for themselves independently for a long time (like heart problems severe dementia etc… In order to spend more time with their relatives in this hard period of their lives elderly people and their children have to hire people who take care of elderly at home and provide them with the necessary assistance in a daily basis.
If you’d like to get more information about different senior caring options, be sure to visit websites like carltonseniorliving.com/life-at-carlton/.
Is DoLS set to be replaced?
This may have slipped under everyone’s radar. A report that received little attention in the news from the Law Commission has recommended scrapping the current Deprivation of Liberties Safeguards, which it describes as “in crisis”, and replacing them with a new Liberty Protection Safeguards system.
Although this may seem like semantics, the new system is notably less onerous that the current safeguards. Although this may prove much more beneficial to a courts system struggling to deal with the massive increase in DoLS cases since the 2014 Cheshire West ruling, some will highlight that it poses a risk to the vulnerable. One notable change is the scrapping of ‘best interests’ assessments for all cases.
Law Commissioner Nicolas Paines QC has argued, however, that the current system is failing families because of the backlogs it creates: “There are unnecessary costs and backlogs at every turn, and all too often family members are left without the support they need.
“The Deprivation of Liberty Safeguards were designed at a time when considerably fewer people were considered deprived of their liberty. Now they are failing those they were set up to protect.”
New report shows the importance of basic skills
The biggest problem with training, and what you can do about it
The best health and social care resources
Finding up to date information on health and social care can be hard. If you're in a position where you're responsible for providing training into the sector, it can be time consuming trying to keep track of regulation and best practice changes, as well as keeping your own CPD going.
So, to give you a helping hand, we've assembled some links to online resources that will help you keep on track. Get them bookmarked!
1. Skills for Care/Skills for Health
Granted, they're not the easiest websites to navigate, but they're a must read if you want to keep track of the latest best practice. The best thing to do is to follow the blogs, which should make sure you're capturing everything important.
2. CQC
When researching regulations, you may as well go straight to the source. The CQC have a number of interesting resources available on their website. They publish the majority of the research and surveys they undertake, allowing you to form your own opinion on the findings. There's also the latest guidance easily accessible for providers across the sector.
3. SCIE
The Social Care Institute for Excellence (SCIE) provides a wealth of resources on every topic imaginable in the sector, including explanatory videos on a lot of them. It's all helpfully arranged by region and letter too!
4. CareTalk
CareTalk is an online magazine that covers the care sector. We like it because it's often upbeat and emphasises the good things going on in the sector, which is refreshing when you consider what usually makes it into the mainstream news. Definitely worth following!
5. Care Industry News
Exactly what it says on the tin. If you can get past the garish background, there's some really good content that is regularly updated. In fact, if you get our newsletter, you'll see that we link to them a lot.
No stop for health and social care integration efforts
The head of NHS England has signalled that there is no intention of ending plans to more closely link the British health and social care systems.
A report from the National Audit Office earlier this year suggested that health and social care integration was not being carried out effectively enough to deliver the desired results, although where it was done well there were undoubtedly benefits.
Addressing the NHS Confederation in Liverpool, Simon Stevens reiterated that the course had not changed, and said that his priority was to end the “fractured” health and social care system, with nine areas covering 7 million people to be targeted as priority areas for integration.
The integration at a local level will be driven by ‘accountable care systems’ (ACSs), which will bring together local NHS organisations with voluntary groups and care organisations. The intention is to build on those local areas where successes have been made, which has had a particular impact on hospital admissions.
Although many will, without debt, criticise some integration efforts, but the evidence from the NAO’s report does suggest that there are benefits when it is done well. Experimenting across different localities may not always be pretty, but we can all acknowledge that our care system needs a shake-up, and we should welcome any moves that improve welfare whilst alleviating burdens on overstretched public services.
A look at Teeside’s ‘outstanding’ care home
Nunthorpe Care Home in Middlesbrough has just received the highest rating possible from the CQC of ‘outstanding’. How did it do it?
According to its residents and the CQC report, a “homely” feel, stimulating activities, and a passionate workforce.
Take a closer look by clicking here …
