This week’s blog is about by making small, immediate changes to systems in order to start a larger process of redesign.

Following January’s outcomes event in West Lothian, I caught up with one care home in the area to discuss how outcomes have become part of practice in the home.

Wilma, registered manager at Peacock Care Home, has been attending many national and local events that have been stressing the importance of outcomes – but she wasn’t sure how that fit into her current model of support provision.

Wilma believes that the key to delivering outcomes isn’t about paperwork- but about staff attitudes and taking the ‘fear’ out of outcomes.

Wilma’s solution: Adding the simple question “what matters to you?” to her current assessment form/person centred care plan

This question gives space for a discussion, which can inform the rest of the information  that is gathered about a resident’s support needs. It also gives staff permission to have this discussion as a part of the process of getting to know somebody.

A small change that is the start of a much larger journey. Implementing it quickly and in a small scale in existing systems gives staff the opportunity to test and feedback on the question – shaping how to progress next.

This incremental approach, as detailed in IRISS intern Jodie Pennachia’s recent report Exploring the relationships between evidence and innovation in the context of Scotland’s social services in which she details the value of “incremental or additive innovation”. This approach could be seen as more practical for the sector, particularly as it does not “disrupt and transform practice” but rather  “sustain[s] and add[s] to what is already there (Van De Ven, 1986; Leadbeater, 2010; Mulgan, 2013).”

It’s great to see people taking action based on learning, and taking initiatives within a residential setting. The question is: can incremental innovation get residential support where it needs to be for the future? or at some point will a more radical approach be needed?

 

By: Richard Rutter

 

Here is just a small sample of the actions people took away from our outcomes session in West Lothian – we are hoping these post card reminders will keep people accountable!

It’s extremely easy for managers in direct service to be snowed under by day to day operations. We wanted to make sure that the learning from the JIT outcomes event on 8th January wasn’t left behind!

Over the last few weeks, outcomes have been a focus of the project. We have noticed a tension between an outcomes focussed approach (which many providers embrace and believe in) and the current commissioning system which measures in time spent, and tasks done. We want to explore this tension further through the project, but are cautious to become too focussed on the ‘barrier’, as joint commissioning and self directed support will have an impact on this current system. But understanding the difficulties in transitioning from one ‘way of doing things’ to another is vital.

 

 

 

 

 

Yesterday’s outcomes session in West Lothian raised some questions for providers about how to make outcomes part of everyday practice, particularly with such limited time and resources.

I believe that there is no one-size-fits-all outcomes approach or outcomes ‘tool’, but there is a body of evidence and examples that can be shaped and changed to fit context and have most impact for people who access support.

For examples of outcomes tool, please visit the Outcomes Toolbox for a range of examples of approaches to outcomes.

 

 

 Happy New Year from Fit for the Future!

To start the year on a positive note, tomorrow the Joint Improvement Team, IRISS and Scottish Care will be hosting  a WEST LOTHIAN INDEPENDENT SECTOR DEVELOPMENT EVENT. This event will be held:

Time – 1pm for 1.30pm till 4.30pm approx. 

Venue -Studio room, Bathgate Regal Community Theatre, 24-34 North Bridge St, Bathgate, West Lothian, EH48 4PS

 

The event is open to all independent providers of support for older people (residential and community based) in West Lothian.

                                                          PROGRAMME

OBJECTIVES  

• To receive an overview and update on “Reshaping Care for Older People” and proposals for “Integration of Adult Health and Social Care”. 
• Review and consider the greater focus on outcomes in delivering care, including development of a personal outcomes approach.
•  Learn more about the changes to working practice and commissioning that will impact on your services.
• Provide an opportunity to hear more about the joint IRISS and Scottish Care project Fit for the Future.

Session 1 

• presentation and discussion on reshaping care for older people , Health and Social Care integration and Joint Strategic Commissioning– led by David Pigott , Associate JIT

 Session 2

• An outcomes based approach to design and delivery of services including use of talking points – led by Chris Bruce JIT Strategic Lead on Outcomes

 Session 3

• The joint IRISS and Scottish Care project Fit for the Future. 

Here at Fit for the Future HQ, we are hoping that our bright and breezy stand and retro sweeties have brought more people in the independent sector to our project blog!

Welcome!

At the recent Scottish Care Annual Care Homes Conference, Exhibition and Awards 2013, we asked delegates (owners of care homes, managers, suppliers, visitors and support workers) two deceptively simple questions.

• What will your service of the future look like?
• What do you need (tools/information/support) to get there?

We had lots of people actively engaging in the conversation and putting their ideas up on our ‘ideas tree’

We took the answers and made them into word clouds – with the most common words the largest.

What will your service of the future look like?

The main suggestions from delegates centred around the quality and approach to support. People felt it needed to be person centred, include families and value things like health, dignity and independence.

People also recognised that their services would be integrated with health support and that they hoped that there was more of an ‘open and sharing culture’ amongst providers.

What do you need to get there?

Investing in high quality staff was a very common theme. People felt their staff should be paid more, that they needed more access to training (and funding for training). This was something that was highlighted by Scottish Care’s own Ranald Mair at the event.

There was one delegate who wanted to remove the ‘artificial boundaries’ from the transition from hospital to home or a homely setting ; it’s all the same person and all the same ‘pot’ of funding!

Interesting conversations on the day centred around the Liverpool Pathway- abolishing it, reframing it, training for it. What I took from this is that dying well is something that residential support services are exploring.

One delegate also wanted better ways to engage with families and older people themselves, with active participation at the centre of change.

Fit for the Future is dedicated to supporting the independent sector to make these positive changes, and as a group we will be discussing this feedback and how our project can deliver on some of the ‘things we need’.

 

 

At this year’s Scottish Care Annual Care Homes Conference, Exhibition and Awards 2013 we are asking providers in the independent sector to look to the future..

The theme of the conference is:

“The Future of Residential Care for Older People in Scotland”

The Fit for the Future stand will be asking delegates to think about

1. What their service of the future will be

2. What tools and information they need to get there

In return, we will reward you with sweeties.

See you all there!

 

This week has been an interesting experience (and a first!) for me.

We spent some time designing a title and brand for the project.

IRISS’ creative in residence, Andy, sketched up some initial titles. We voted on our favourite idea within the project team. Then Andy and Kate got to work on making the design come to life!

I made sure to keep a record of the magic!

 A big part of the work that Andy and Kate did was making sure the hand drawn images kept their authenticity, and Kate resisted the urge not to make them too neat and perfect. We wanted to keep it nice and energetic!

Kate then got to work adding colour to the sketches- using Scottish Care’s theme Reshaping Care logo colours and making it bright and bold!

 And the final result? A bright, recognizable and friendly logo!

 We chose ‘inspiring outcomes for older people’ because it got to the heart of what the project is really about – the lives of older people.

If you’re lucky enough to be attending Scottish Care’s Annual Care Homes Conference, Exhibition and Awards 2013  this Friday 15th November , you can get your hands on these little cards – and hear a little more about Fit for the Future.

 

– Rhiann McLean (IRISS Associate)

Right now, the project work I’m focussing on is taking stock of where we are now to help frame the changes that providers need to make to be (dare I say it?) Fit for the Future. I’m getting my head around our current national context, as well as local commissioning landscapes. In the next few weeks, I will begin the scoping stages of working with specific providers; looking at what works, and what could be improved to deliver better outcomes for older people.

The more time I spend with IRISS’ Innovation and Improvement team (https://blogs.iriss.org.uk/innovate/), the more I understand that context and environment are huge factors in change– and can be both barriers and facilitators for innovation. It has been useful to spend time recently mapping this landscape to get a real sense of the challenges and opportunities that providers in the Independent Sector are facing.

Providers often tell me that their achievements and progress sit under the ‘grey cloud’ of current media coverage of services for older people.

 I’m spending some time next week analysing a week’s worth of newspapers (Scottish National) coverage of support for older people to capture the national image of older peoples services.

I hope this will help us, as a project, and our partners, understand a little about the ‘grey cloud’… and how we can get out from under it and change the conversation!

… watch this space!

A very productive meeting with Robert Telfer, Development Officer in West Lothian has highlighted a really salient point: that care homes are really homes.

Ultimately, while residential care is a ‘service’, it has a different feel and different boundaries, because it is also home for its residents. Any changes to this setting need to carefully consider the impact on residents and their comfort. It must also involve them in design and decision making throughout…

After all:

“Home is existential and experiential. It is where domestic lives are played out. Home is a myriad of things: a set of relationships with others, a statement about self image and identity, a place of privacy, a set of memories, and a social and psychological space.” (Oldman 2002: 230)

* Oldman, Christine (2002) Understanding Care, Welfare and Community: A Reader edited by Bacigalupo, V., Bornat, J., Bytheway, B., Johnson, J., Spurr, S.