A joint Iriss and Scottish Care Project: Inspiring outcomes for older people
In all of the 4 sites of the Fit for the Future project, members of the independent sector speak about wanted to be valued as ‘equal partners’.
In an attempt to capture what good partnership working looks like for the independent sector; in our first meeting with the Falkirk Providers Forum (residential) the group explored what ‘partnership means’ to them. Below are the principles of partnership working they want to align themselves with:
As I spend more time in Argyll & Bute (specifically Cowal), trying to understand the landscape for older people, I’m learning that there isn’t so much an issue with filling in the gaps as there is connecting the dots.
There is a range of community support available- groups, clubs, befrienders and lunch clubs. There are also a range of paid-for supports in the area, offering different services in the home and community. But these services aren’t always delivering holistic outcomes for an older person -they may only be meeting specific basic needs. I think this may be because support (paid and unpaid) can be disconnected. This may be because of
Isolation is a concern across Scotland, but can be even more so in rural areas like Cowal. Even more so for people who may have issues with mobility, may need support to leave the house and may not be able to use community transport. It is these people that services find it most difficult to reach.Ā Paid care at home staff are often the only people to see some of these older people through the day. Their houses may be older, difficult to renovate and harder to reach.
The local befrienders charity, Cowal Elderly Befrienders, have adapted their service model to try to connect the dots. They try to act as facilitators for older people to get together with each other, giving them the support, opportunity and transport to do so. Rather than visit home to home, they try to bridge the gap between an individual and their community.
Distance is also an issue- I had the opportunity to sit in with the carers club at Crossroads Carers in Dunoon. The women in attendance were talking about lack of accessible venues meaning that even groups made to support people with long term conditions were not accessible to those people. There was also mention of travel, specifically to and from Inverclyde for hospital, which was seen as traumatic and unnecessary. It is in these cases that reducing unnecessary hospital admissions must be even more of a priority.
Work in Argyll and Bute will be centred on delivering support which addresses these issues as much as possible – and links with older people and the community to understand these barriers.
I’d also like to develop stronger relationships amongst partners in the areas- to try to connect the dots to deliver better outcomes for older people.
This week’s blog is about by making small, immediate changes to systems in order to start a larger process of redesign.
Following Januaryās 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 ā but she wasnāt sure how that fit into her current model of support provision.
Wilma believes that the key to delivering outcomes isnāt about paperwork- but about staff attitudes and taking the āfearā out of outcomes.
Wilmaās solution:Ā Adding the simple question āwhat matters to you?ā to her current assessment form/person centred care plan
This question gives space for a discussion, which can inform the rest of the information Ā 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 reportĀ Exploring the relationships between evidence and innovation in the context of Scotlandās social servicesĀ 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 Ā “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?
I’ll be spending Monday and Tuesday in Dunoon working with Ardenlee care home to understand more about what it’s like to be an older person in Dunoon.
I’ll be speaking to residents of the care home and hopefully members of the community to understand the any challenges or opportunities of living locally.
If you would like the opportunity to chat about life in Dunoon or are supporting people locally, please feel free to get in touch at rhiann.mclean@iriss.org.uk
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,Ā 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 ToolboxĀ for a range of examples of approaches to outcomes.
Ā 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 Ā aĀ WEST LOTHIAN INDEPENDENT SECTOR DEVELOPMENT EVENT. This event will be held:
Time – 1pm for 1.30pm till 4.30pm approx.Ā
Venue -Studio room, Bathgate Regal Community Theatre,Ā 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.
Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā PROGRAMME
OBJECTIVES Ā
Session 1Ā
Ā Session 2
Ā Session 3
– A guest blog by Becca Gatherum,Ā Policy & Communications Officer with Scottish Care
As most people involved in the health and social care of older people will know, the current policy and delivery landscape is both challenging and changing.Ā April 2014 will see the implementation of the Social Care (Self-directed Support) (Scotland) Act, empowering service users to exert more choice and control over the services they receive and prompting services themselves to become more flexible and outcomes-focused in their delivery of care and support.Ā Furthermore, we move towards the integration of health and social care statutory services only one year later and in preparation for this, third and independent sector providers must be fully involved in the planning and delivery of local services.Ā Add to this the ongoing challenge of tackling negative public perceptions of some elderly care, a backdrop of diminishing financial resource, changing demographics towards an older population overall and recognition of the fact that the services we will require in the future are likely to be significantly different from those offered currently, and it is not hard to see how providers can become uncertain and anxious about what the future holds.Ā As the independent sector provides 88% of care home places, 51% of home care hours and 41% of the social services workforce, it is important that these uncertainties are addressed.
This is where the Fit for the Future project offers an exciting opportunity for independent sector providers to be proactive in preparing for the future needs of Scotlandās older people and responding to identified national and local service delivery priorities.Ā At the heart of making current and future policy and practice drivers a success, and improving outcomes for older people, is effective local joint commissioning. Ā Fit for the Future will support providers to respond to these local plans as positively and proactively as possible.Ā By looking both inwards at what a service delivers well currently and what it might do differently, and outwards as to what role it can play in the wider community, the project will support providers to maximise their engagement with the reshaping care of older people agenda.Ā By working with the wider sector locally, we hope it will also enhance working and community relationships with both the public and professionals, and will boost internal and external confidence in a serviceās ability to provide what people really want and need whilst remaining viable.
What is perhaps most exciting about this project is that it is not necessarily asking providers to make significant, sudden changes in a climate of austerity, where services can already struggle to alter delivery models and staff support mechanisms.Ā Instead, it asks those involved in the care of older people to be more creative in their thinking about delivery, to involve more people in making decisions, to address what small, perhaps temporary changes could support them to overcome a barrier or challenge to creating an even more positive experience for service users and staff.Ā It will be most interesting to follow how these new ways of thinking and doing manifest themselves locally, as differences in location, geography, service type and commissioning plans will all play a part in influencingĀ outcomes and experiences of the project.
Scottish Care is also positive about how this project can support both those services and areas taking part and the sector more widely.Ā By creating a āwashing lineā style of learning resources, others can access whatever parts of the project they feel will be applicable or beneficial to their own services.
By supporting providers to address what works well in their care and support provision, what the barriers or challenges are to delivering this even more effectively, and to understand how overarching policies and initiatives can be made meaningful in small-scale ways, the project should build confidence: confidence amongst staff, service users and families that a service is catering for the wants and needs of its service users whilst remaining viable, confidence that a positive caring environment is being nurtured, confidence amongst local commissioners that the sectorās services can respond to plans and priorities, and confidence that the sector really is fit for the future.
An invitation to all Care Homes and Care at Home providers for older people in Falkirk
Margaret McGowan, Scottish Care Development Officer to Falkirk is working to support the independent sector in engaging with RCOP agenda by ensuring that theĀ independent sector providers are better informed about the Reshaping Care for Older People programme and are fullĀ partners through contributing to shaping relevant policies, decisions and programme activities.Ā This event will give us a platform to discuss how we can support the independent sector and fill in the gaps in moving forward. It is also an opportunity to discuss Fit for the Future and the direction the project could take in the area.
Event details:
16thĀ December Ā at Unit 6 The Courtyard, Callendar Business Park, Callendar Road, Falkirk FK1 1XR
Carehome managers/representatives are welcome to attend at 11am
Care at home providers are welcome to attend at 1pm
The following partners have agreed to attend and meet with providers to contribute to this learning:
Hope to see you there!
Last week was a very interesting week in West Lothian.
We met with 4 care homes in West Lothian, each with a different idea for innovation or improvement that they would like to test in a lab setting.
Proposed ideas included anything from a dementia carers group to a communication tool for staff! Some homes wanted to use the tool to test a radical change in a safe setting, whilst others wanted to explore an experience and have space to reflect.
We were overwhelmed at the feedback and are now in the process of getting to the core of these ideas and choosing the one that best serves the Reshaping Care for Older People Agenda and can be shared with other providers.
I was also able to attend a social service lab in a day centre in North Lanarkshire – as a participant and as an observer. While the full evaluation of this day will come later, I personally felt it was a really interesting way to work differently and I have high hopes for labs in West Lothian!
For more information on labs in general please visitĀ IRISS’ Social Service Labs Website.
Stay tuned for more details!