One-page profiles and home care – the impact on people and staff

The last time we were in Dumfries and Galloway we finished off our training and focussed on Person Centred reviews. Gill is back in Scotland over the next few weeks meeting with the team leaders, supporting them to carryout some person-centred reviews and checking how things are going.

On the last day we were together as a group everyone shared some examples of how using a person-centred approach and one-page profiles was already making an impact for their staff teams and for the people who they support. We are going to share some of those stories with you in the participants’ own words which we think speak for themselves.

Impact on people

“We work with a gentleman called George, George is 93 and any form of formal interview to create a one-page profile probably wouldn’t have worked well for George because of his hearing, it’s difficult for him. What we felt would be best was build on what we already knew with George and go in and continue to ask more questions of George, about his life, his aspirations still, about himself, which we did over the course of a few weeks. We collated all of this information and created a one-page profile for George. As a result of this we thought nothing more of it, we cleared it with the office, they were impressed, we put it in George’s folder at his home. His relatives visit George very regularly, twice a week, and they have access to his folder, occasionally they write in his daily log notes to us, and they saw George’s one-page profile and contacted Marianne directly (we’ve given them our phone numbers just because George is so old and they worry about him) so they actually phoned my colleague and told her they’d read his one-page profile and they couldn’t believe what was in there and they actually even said we couldn’t have done it better ourselves. They’re in their 80s and have known George all of their lives and we’ve managed to draw things out of George for that profile that blew them away.” Andy

“One of the service users just thanked us for letting them tell us what they like and what they dislike and enabling us then to change the care that is getting provided. The woman, she likes a towel just being put down anywhere regardless of whether it’s on her bed, or on the seat, or whatever – she likes to be sat on top of a towel at all times. And it’s wee things like that that carers maybe just don’t have the time to find out on their own. So now that it’s in there she says it’s brilliant, she’s getting to sit on top of this towel all the time or lie on top of a towel, it’s just a comfort thing with her and she really likes it so she thanked us for that and she said that it really helped” Kymm

“I have the one example of a doctor that we support, he’s on a new package so it was part of the meet and greet process and he said in all his years, he’s worked 60 plus years as a doctor in a hospital, he said something like this would have been absolutely wonderful. He was really, really enthusiastic, both him and his wife say ‘it’s marvellous, it’s just wonderful that you’ve got the time to sit here and hear about us and what we want’ they felt as if they were being a bit of a burden with me sitting there and once we’d got over that they just kept saying how great it was, so that was really, really positive.” Vicky

“We’re getting to know the service users better, getting to feel a wee bit of an understanding before the initial meeting and greeting so the staff are loaded with information and we’re not going in blind as such, we’ve got the information from the profiles to prompt conversations and discussions over what the service user’s going to like” Heather

Impact with Staff

“I would say since we’ve done it with the staff it’s built up better relationships because we could maybe phone somebody and say ‘is there any chance, we know you’re already working but could you pick up this visit on Sunday?’ ‘Oh but why can’t carer such and such do that?’ it showed that they actually have commitments outwith work, that they can’t always, like the carer that teaches rugby to the kids on a Sunday morning so now that people know that, they understand the reason as to why she can’t assist us on a Sunday morning and she will pick up other times when she is available” Kymm

“One of the things they got from one of the staff profiles was, none of us knew because she’s quite a quiet member of staff, is that she’s got extreme talents when it comes to drawing and art so we’ve started using her in the day centre when it comes to arts and crafts afternoons so we’re using a strength of hers and passing it over as like a learning tool for our service users” Heather

“They like the fact that they’re being listened to and valued as individuals. It gives the staff a chance to put across what they can offer to others and what they need in return to feel supported and with that they feel because they’re getting to know each other and know their strengths and weaknesses and how to support each other it’s good team building, it’s a good team building exercise because a lot of them are lone workers they pass you know or they don’t know each other so it gives them a bit of common ground there” Vicky

“The staff are a wee bit more willing to open up and share through the one page profiles and we’ve actually got to the stage where our staff are coming into the training room and looking to see whether there’s any new one page profiles up so they’re eager to see other people’s profiles, how they’ve developed them, what they’ve been like and whether there’s a common denominator. It’s more involvement and depth for team leaders for supervisions and staff development” Heather

These stories are just a start as it’s been only a few months since our first session at the end of March. As the months go on and providers are able to develop one-page profiles for more and more people, we expect more and more examples of the difference they are making to people’s lives.

Emily McArdle & Gill Bailey

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Connie: using 21 hours differently to move from ‘task and time’ to relationships and well-being.

We are working with the Commissioning and Contract teams in Flintshire County Council, in a programme to transform their home care from time and task to what matters and wellbeing.

Here Nicki Kenealy and Lyn Morris, from the contracts team, describe how this is progressing and we share an example that illustrates the process we are using:

“We want to tell you about the work that Flintshire Social Services is undertaking in partnership with Helen Sanderson Associates and all of Flintshire’s domiciliary care providers. This was day 3 of an exciting programme of change that we are implementing in readiness for the Social Services & Well-being Act that will come into force in April 2016.

Today we have been working with our Providers on some real life examples of the practical implications of changing our approach away from ‘task and time’ to delivering “what matters most” for people and achieving personal outcomes.  We have to tell you this morning we were all quite apprehensive about how we could manage things differently but by the end of the day we know that it can be done and we have a model to help us look at individuals situations differently.  We found that this new approach really is about working in a person centred way and unlocking each individual’s circumstances rather than apply a “one size fits all” approach.

Providers told us that this approach was creative and inspiring and that they could see how their staff would also benefit and enjoy greater satisfaction, a win – win!

This is only the beginning in Flintshire but we will continue to tell you about our success and our pain as we move forward, through these blogs.”

On the day that Nicki and Lyn mention, we worked with eight provider managers looking at how we could offer a very different service, with different outcomes, but using the same amount of time. One of the examples we worked through to explore this was Connie (a real person, but her name has been changed).

Connie

Connie is in her eighties and lives in Flintshire. She has homecare support from a local agency for 21 hours a week. Typically she has four visits a day:  one for breakfast; a second at lunchtime; a third for her evening meal; and the fourth to help her go to bed in the evening. Connie’s outcomes are that she lives safely at home; that she is physically healthy, and that she is clean and well-dressed. We had permission to roll up her hours to a weekly or monthly amount, that could be used creatively to achieve the same outcomes. This is how we approached it:

We started by looking at what matters to Connie.

We know that music is important to her, and she has the radio on most of the time. It’s also really important to her to look well-dressed and wear her jewellery. We know that Connie enjoys her garden, lilac is her favourite colour, and she loves to dance. She used to love poetry as a child, and still quotes quite a lot of poetry now.She’s a bit unsteady on her legs, and walks with a frame so making sure things are out of the way so she doesn’t trip or fall is important to support her well.

We started the process by looking at what matters to Connie, and then started thinking about her relationships and community connections. When we completed her relationship circle, we saw that she has a daughter, who lives two miles away, and grandchildren. She doesn’t know any of her neighbours very well but recently one of the neighbours was having some work done to the house and popped a letter into her letter box addressed to Diane, her daughter, to say he hoped it wouldn’t be of any inconvenience so there is a small amount of contact.

When we looked at Connie’s community map, she used to go to a day centre quite a long time ago before she went into hospital, but that isn’t happening anymore. Other than going to her daughter’s twice a month for Sunday lunch, she doesn’t leave the house at any other time.

Now that we understood a bit more about Connie, we wanted to see if we could use her 14 hours differently, so still achieve her outcomes, but more towards increasing her well-being by thinking about relationships, community connections and contribution. Could we help Connie in the 5 ways to Well-being – through opportunities to stay active, keep learning, connect, give or take notice?

We started by looking at how the family contribute and if there is anything that can be changed? Her daughter, Diane see’s Connie on alternate Sundays when she comes home for Sunday lunch but also pops in twice a week during the afternoon for an hour to chat with Connie. The first possibility was to have a different conversation with Diane. At the moment Diane cooks all the food for Connie and leaves it frozen, then carers get it out and reheat it, and sit with Connie as she eats. Connie finds it really quite difficult to stay focused on eating so the 45 minutes they spend with her at lunchtime are spent encouraging her to eat and chatting.

Firstly, we wondered if we could talk to Diane about how she used her time, and ask her that rather than popping in in the afternoon whether she could possibly come and eat with Connie twice a week. Because if Diane could do that, that would free up about 45 minutes to an hour in Connie’s ‘budget’ (her hours) for her to use differently.

The second possibility is with her grandchildren and great-grandchildren are in contact with her, and pop round to see her. We wondered whether it was possible to arrange for them to have tea together once a week, which again would free up about 30 to 45 minutes of time we could use differently.

Having both Diane and her grandchildren go round to see her would help Connie achieve her outcome of being physically healthy and eating at lunchtime, and taking her medication. It would also mean that some of that time could be used more flexibly.

We also wondered if we could extend the two visits that Connie has at her house on Sundays to include tea as well, which would save about an hour and 15 minutes of budgeted support twice a month – time which could then be used more flexibly.

Just by making small changes, we would have freed up about 2 hours and 20 minutes to use differently with Connie to help her achieve her outcomes. Here were some of our ideas about how this time could be used to build connections and contribute – as part of focusing on her well-being as well as her outcomes.

We looked at what we could do to strengthen and build Connie’s relationships with her neighbours, hoping that we could support that to become something that felt reciprocal. This helps with ‘connect’ from 5 Ways to Wellbeing.

One of Connie’s carers said that it was almost as if the neighbours wanted to be in touch with Connie, but didn’t quite know how to do it. The neighbours would have seen lots of carers coming in and out of the house, and the carer’s worried that the neighbours thought that they might not want to interfere.  So we looked at ways Connie could make the first overture, or start to connect with her neighbours. One possibility is that because Connie does spend so much time in the house, one contribution she could make would be to take in any parcels or letters that would come for her neighbours.

Because Connie isn’t able to cook herself, we explored how cooking could be much more of a sensory and supported experience for Connie.  We wondered if Connie could help to ice the cakes the carers might make with her, and then offering those to her neighbours as well. We were looking at ways that Connie could make contribution rather than just being the person who was cared for as well as potentially connecting further with her neighbours.

Knowing that Connie loves her garden so much, and that it is important to her, we thought a carer could go with Connie to a garden centre to have lunch there. One of Connie’s mealtime visits has a little extra time and so we thought that we could use that time to facilitate her trips to the garden centre.  We also thought that it might be possible to set up a herb garden with Connie, maybe on her window ledge, so she could grow herbs to share with her daughter, or even with her neighbour as well.Once we looked at potential contributions, it is clear that Connie could be a great neighbour and connect with her neighbours in a different way.

Then we looked at community, and what opportunities there might be for her to go out and feel more part of a community and follow her interests.

We know that Connie used to love to dance, and now she sways happily to music with her frame. We explored whether there was any possibility of Connie using some of her time to go out for a light meal in the evening and then go to a tea dance. The freed up hours from the slight changes to the family visits would provide for this support.

So within the community we are focusing on Connie’s love of gardening, her enjoyment of dance, and if there might be a luncheon club Connie could be part of.

Finally, we looked at how we could get the best fit between staff and Connie.The first thing we did was look at the staff that live in or know Connie’s area, and who could do a better job of connecting Connie locally. Most importantly, local staff would decrease the amount of travel time involved in supporting Connie and her visits. Then we thought about the kind of personality that would get on with Connie. So we looked at what kind of people Connie gets on with, and where we have people with similar personalities who would give Connie the best support (from our best guess). We looked at whether we had any staff with shared interests — particularly people who like gardening, poetry or dance — so Connie would have her own team of people she could really get to know.

Based on Connie’s outcomes and what matters to her, we have been looking at using the time that Connie has for her support in a more effective way, that will continue to provide the same amount of support but to a greater benefit. Specifically, we are looking at trying to extend the number of people in Connie’s relationship circle, potentially with her neighbours. and she would also be able to meet people if she was able to go to a tea dance regularly.

By thinking differently, by rolling up hours to have a budget that could be spent flexibly to meet Connie’s outcomes, and by her family making the same time contribution they’re already making but in different ways means that Connie could get a lot more out of her 21 hours.

This is an illustration of what could be possible. Next month we are using this process with two older people supported by two home care organisations in Flintshire, with the person, their family, the manager an the councils Reviewing officer. As Nicki and Lyn say at the beginning, we will keep sharing what we are trying and learning, and whether we can move from these ideas to delivering them in practice.

What does success look like in care in the home for Dumfries and Galloway?

During the election I saw a tweet that suggested that the public don’t really think about social care provision until they or someone they know and care about have a need for it. I’m not sure who said this or if it’s entirely accurate. However, I have to admit that I only really felt the need to get immersed in in personalising home care when it became something that directly affected my family.

My Aunty Edie was 96 and still living in the same 2 up 2 down terraced house that she had been born in. She was a kind, independent and proud person who had always had a role caring for others. She supported her husband Jimmy who’s years in the coal mine had lead to problems with his lungs and mobility and her elderly sisters (including my Nana) who all lived to a ripe age, but who needed her practical help and support (I hope I take after this side of the family).

Aunty Edie had always remarked that the only way she would ever leave her home would be in a wooden box! When ill health and a fall resulted in her needing homecare she was grateful for the fact that this prevented her from going into residential care. She was incredibly appreciative of “the girls” as she called them and often said that they couldn’t do enough for her. However, when family members visited we could see that not everything was going well. This wasn’t because the carers didn’t care, they did! I think it was because they didn’t really know what mattered to her or how to support her in a way that made sense to my Aunty.

Developing her one-page profile was a logical solution and provided much more information that the care plan did. As a result, the care and support that Aunty Edie received improved.

In Dumfries and Galloway, several homecare providers are taking part in the Care at Home pilot and are currently practicing developing one-page profiles for both customers like my Aunty Edie and for their colleagues, using specific person-centred thinking tools to further personalise the customer experience and to focus on building resilient, person-centred teams.

I’ve been working with the leadership team who meet after each stage of the programme to analyse progress, celebrate and build on successes and problem solve anything that is getting in the way. I’ve been struck by the motivation of the homecare managers and am impressed by their practical, no nonsense approach to implementation. Despite the daily challenges experienced by the homecare staff, they have managed to not only deliver on the goals and targets that they set themselves, but have exceeded them. One of the things that I think has helped with this was developing a shared one-page strategy right at the start of the work. This showed what success looked like from these four different perspectives:

People using the services (customers) Staff and managers The provider organisations The commissioner

It identified how this would be delivered and how it would be measured. Each provider was asked to set their own targets; ones that felt realistic to them given their knowledge of their services.  These are the success statements that all 6 providers and the commissioner have co created and are working towards. In Steven Covey’s book ‘The Habits of Highly Effective People” habit 2 is Begin with the end in mind, which helps us to focus on what and where we want to be and do in order to be successful. I think early indications suggest that this was a great place to start.

Please click on the image for a larger version.

Success

Michelle Livesley

One-page profiles and their use in providing personalised care in the home

In our work together with homecare providers in Dumfries and Galloway we have been paying a lot of attention to one-page profiles as a core tool in personalising support for people who are cared for in their homes. One-page profiles are a person-centred thinking tool that supports the transition from people using services being passive recipients of care to enhancing the amount of choice and control they have over how their supports are delivered. At our last two training days the participants heard Hilda’s story.

Hilda

Hilda’s Story

When Hilda needed home care support at the first meeting there were conversations about what made a good day & what made a bad day for her, What was Working (WW) & What was Not Working (WNW) for Hilda and also from her families perspective. Looking at Hilda’s good days and bad days provided rich, detailed information about what was important to her, and clues about what support she wanted and needed.. Asking different questions led to different conversations that led to a thorough understanding about what matters to Hilda and how she wants to be supported. This in depth information about what is important to someone is what we need to ensure a person’s support is tailored to their needs and aspirations – the very bedrock of personalisation. Family members are a mine of rich information about their loved one and it is vital that they, and other people who know the person well, are involved in sharing this for their ‘top tips’ around providing great support. If you were to meet Hilda through her care plan, you would learn about what she struggles with and needs help with. You rarely read in care plans the positive, valued characteristics of the person, the rich detail of who they are – their important relationships and connections, passions, hobbies and interests – in so much detail that you know which newspaper matters, or what their culture or faith means to them, other than a tick box about which religion they follow. Looking at Hilda’s one-page profile, you get a real essence of who she is.  We can do this with everybody regardless of whether people use words to speak or communicate typically –  because we listen more carefully to what people are telling us in other ways & also the rich contribution family have to make.

What we are learning about in Dumfries and Galloway

Historically we know that services pay great attention to what is important for people focusing on what it takes to keep people healthy safe, whilst what is important to someone is often seen as something we do if we have enough time or enough staff. Personalisation brings this back into balance – people are the experts in their own lives and we must know and pay attention to what matters to people and deliver support in the context of how people want to live their lives.

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The homecare providers in Dumfries and Galloway have spent a good deal of time working on developing their skills to have the different kinds of conversations needed to develop one-page Profiles. The focus of the last two days has been on one-Page Profiles for the people they support. We also spent time thinking about how the initial conversation with a new customer might happen and this led to a penny dropping moment for some of the participants. They told us that until they had practiced developing a one-page Profile with someone they had never met, they always had the service already offered at the back of their minds. The new kind of conversation they were practicing started from the person not the service!

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Because participants have been able to learn skills across a number of weeks, with time to reflect in between, they are really starting to think about every conversation being an opportunity to gather rich information for a person’s one-page profile. Another participant said that as she’s talking to someone she is making mental notes about what’s important to them and what best support would look like.  The other thing that was very clear over the last two days spent with our homecare providers is the level of detail and clarity in the information they are capturing on their one-page profiles. This new way of thinking, talking and sharing information is going to make such a difference to the staff and people who they support.

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One-page profiles are fundamental to the planning process and they help us ensure that people, like in Hilda’s story, are consistently supported in a way that makes sense to each of them, truly enhancing their choice and control on a day-to-day basis because those supporting follow the one-page profile. We can’t decide on outcomes to be achieved without thinking about then in the context of what is important to the person and knowing how best to support them from their perspective.  Without this information, people are likely to be treated as a clinical condition and their disabilities will always be seen first. One-page Profiles get us moving away from those care plan boxes that often focus only on a person’s physical needs without also paying good attention to learning what matters to people – our quality of life is determined by the presence or the absence of those things which are important to us and so we have to take this into account when providing support.

Gill Bailey, Emily McArdle

When the weather is bad… a glimpse of the future?

Blog by Geoff Mark

I think Billy Connolly once said that in Scotland there is no such thing as bad weather, just the wrong clothes…

I don’t think we have a blueprint to transform care at home overnight and for what it’s worth, I’m not sure there is one. However, it seems obvious that simply working harder at getting more out of our current approach won’t be the answer as I have observed that the things that produce good results seem to happen almost in spite of our current approach rather than because of it. A new approach is needed to be able to connect what is most important for people. A new approach is also needed for the staff who support them so that they can recognise, value and make the most of the capabilities of themselves and the people that they support, using resources flexibly to create incentives to make the most of wider support networks and communities.

I can see that it all might sound a bit idealistic. However, I see most of the potential for a new approach in situations when it is obvious that our traditional approach won’t work and this is usually when we have severely bad weather. It happens 2 to 3 times a year and I’m always impressed by how services and communities respond. Care staff go above and beyond, walking across the fields in the snow, providers negotiate provision directly with service users and families, communities rally around, farmers clear roads and so much more. It happens time and time again.

I’m not suggesting for a minute that we could sustain all this indefinitely or that there are no risks in these situations, but there is something about recognising the commitment of care staff and care providers to the people they support. We need to make sure that this commitment is valued and reinforced by enabling staff to directly respond to what’s most important for the people that they support, while facilitating engaging wider networks of support. Equally, wider support networks and communities are more likely to respond if there is a clear opportunity to make a difference to the people who require support.  If this were in place perhaps we could sustain better outcomes and if more resources were available, we would be more likely to use them effectively.

So there’s the challenge – can we find a way to focus on what produces good results in the context of the challenges we face? I don’t think it will be easy because if it was easy, we’d be doing it, but I do think there must be a better way of approaching the whole thing.

The journey continues with Dumfries and Galloway…

We are currently working in Dumfries and Galloway on a programme that aims to support team leaders from five external home care providers and one in house provider, to develop and implement new skills to embed person-centred practices into the customer journey.

The theme for our third day together was the team.  It makes sense that in order to deliver great person centred support team members need to be person centred in their relationships with each other. A person-centred team is a team that has a clear sense of purpose, knows what’s important to and how best to support team members and identifies and uses team members’ gifts and strengths. The goal of a person-centred team is not just to get along however but to be aligned and through that get results.

A Clear Sense of Purpose

If you don’t have a clear direction of travel any path will do!

Person-centred teams have a clear, compelling and shared sense of purpose that is closely aligned with the mission of their organisation.

We started by asking team leaders to think ahead & if their services were truly personalised what would they look like?  What if person-centred thinking tools were embedded as typical practice & all reviews were person centred reviews, leading to outcomes people wanted to achieve? What would your service look like, what would the stories be?

We did this using an exercise called Front Page News which got our team leaders to imagine their organisation had made the front page of the newspaper in three years time. What is the headline that will make people stop & pick up the paper? What are four stories that describe what’s happening and what are people saying about their organisation? This helped them to visualise what success would look like and how the future could be.

Team leaders also referred back to the one-page strategy generated by the leadership team right at the start of this process.

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Identifying success moved onto developing a team purpose. A team purpose is a statement which affirms who you are and what you stand for as a team, a statement that will be inspiring and uplifting for the team and keep the energy focussed on helping people get better lives. A clear sense of purpose is the foundation for team members knowing what they want to achieve and is more likely to lead to exceptional performance.

We asked our participants to start with timed talk. During this activity they worked in pairs giving full attention whilst one person talked uninterrupted for 3 minutes about what they thought was the purpose of their team, then to swap roles for another 3 minutes and then finally to discuss together to come up with a shared purpose statement in 3 minutes. This can be a useful tool for team leaders to encourage all team members to have equal opportunity to share their thoughts and ideas.

The act of co-producing the teams’ purpose helps its members to buy into ownership of the ensuing work and outcomes. The team purpose is a grounding element that should remain constant and team leaders can then rely on the purpose statement to refocus the team during confusing or chaotic times.  When making decisions the team can check will the decision move us towards or away from our purpose.

Knowing what’s important to and how best to support its team members

Last time we met, the team leaders spent some time developing their own one-page profiles. We also asked them to start the process of developing one-page profiles with members of their team and today they quality checked these. This meant checking that the information on each one-page profile was specific, detailed and useful. To find out more on one-page profiles and getting them right, click here for a poster that explains more.

 

The team leaders then practised using information from their one-page profiles to put together a team one-page profile. We used a team foundation poster displaying the team purpose and information about each participant. This is a visual summary of the team’s individual one-page profiles that captures each person’s top 3 appreciations, important to and how best to support statements. The team one-page team profile records what people appreciate, like and admire about the individual team members enabling colleagues to consider the gifts and strengths of each other as they go about their everyday work and allocate roles and tasks based on these. We then capture what is important to us as a team.

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The groups then developed a set of team agreements, things that everyone in the team will sign up to so as they work more effectively together.

We finished the day by working through the Stress and Support tool. This is a particularly useful tool in supervision sessions and requires each person in the team to reflect on the following questions: What makes me most stressed? How do I usually react to being stressed? What helps: What can I do? What I would like you to do.

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So over the next three weeks the team leaders will be focussing on developing person centred teams by developing their team purpose together, creating a team foundation that reflects what’s important to the team as a whole and using this to develop agreements/ground rules for the team to best support each other.

“Alone we can do so little; together we can do so much.” Helen Keller

Our new Care at Home project

We want to share our experiences with you over the next few months. We are working with representatives from Dumfries and Galloway Commissioning Unit as well as support home care provider organisations in Dumfries and Galloway to explore how we can develop, implement and deliver a truly personalised service to people using home care services. The work that we are doing together aims to support team leaders to develop and implement new skills to truly embed person-centred practices into the customer journey.

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The programme is being led and co-ordinated by a leadership team who co-developed the design of the project with us. We met in early March 2015 to create a one-page strategy. For an example of a one-page strategy that we previously produced with Dimensions, see here.

At that meeting, the team clearly identified what success looks like for customers, colleagues and the organization. This helped to identify which person-centred practices will help to achieve this, and to put a system in place that will help to track how well we are doing. A simple system of writing the quality measures on a whiteboard so that they serve as yardstick, and as a place to start the next meeting from, was put into action. There are also plans to begin working on a communication strategy at the next meeting.

This week we began working with team leaders from the home care providers and commissioners and spent two days together. We spent time sharing the overarching vision developed by the leadership team and communicated through the one-page strategy, so starting with the end in mind – our vision of success

We began introducing some of the key person-centred practices, as identified on the one-page strategy, which we believe will help everyone to deliver success. Feedback from participants was that they felt supported and empowered that the leadership team would be updated on progress as we go along, as leadership team meetings were set to happen at regular intervals between training for the team leaders.

As we collect feedback on how things are progressing for the team leaders, the leadership team are going to be responsible for:

  • Problem-solving issues that are stopping team leaders from being successful, for example anything is policies or procedures that are getting in the way.
  • Celebrating success and communicating this internally and externally.
  • Measuring progress (We will feed into the leadership team how many one-page profiles that meet quality standards are in place so as have clarity in terms of how we are delivering and measuring in line with the one-page strategy).

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So what were the person-centred practices that were identified as being key to success?

Firstly, we looked at one-page profiles and explored how they are developed through good conversation with all those working in the organisation, and also people using the services and their allies.

We also looked at how we use one-page profiles to enhance the choice and control people who use services have around deciding who will provide their support. Given the single most powerful thing we can do if we are to improve a persons quality of life is to ensure they are supported by a person they connect with and who connects with them, the team leaders embraced this idea and acknowledged we have to better pay attention to this even though we may not be able to do it to perfection.

The team leaders loved the idea of having rich information that the organisation will have around each person they support, which is co-developed with the customer and their allies especially:

  • Their one-page profile – to help them get to know the person well, and know how they want to be helped
  • The ‘what you must do’ list for each visit, and a list saying what it would be really good to do if staff have time
  • Using one page profiles for matching

The second day of training was spent focusing on supporting managers to build their capacity, competence and confidence using five different approaches to developing one-page profiles with staff (see Helens blog for more info on the 5 ways). We then explored together how this would support making this happen at scale in their organisations and simply become typical practice. All of the team leaders threw themselves into this and discussed how this idea of good conversation can be a real help in terms of shifting cultures.

While we were there, we made a short video of the time that we spent with the team leaders:

We will let you know how the team leaders get on between now and our next day together on the 14th April. Each team leader now has their own one-page profile which meets quality standards and they are each going to support two of their colleagues to develop their one-page profile and come back to let us know how they went on with that.

We look forward to sharing the learning!

Gill Bailey & Emily McArdle

An exciting new project…

This blog is by and for commissioners and providers who are interested in using person centred practices to transform the experience of home care for individuals and staff. Blogs are by commissioner Geoff Mark, Helen Sanderson and guest bloggers from the providers we are working with.

A blog by Geoff Mark

I’m excited to be working with Helen Sanderson and six of our care at home providers to find more personalised and sustainable ways of delivering care at home. I am hopeful that we can find a way to improve the experiences of the people we support. We have co-developed a new vision for what person-centred care at home can look like, and the work we are doing together is to implement it within six organisations, and within their existing resources.

Here is a graphic of the process:

RLOpersonalisinghomecaregraphic-page-001

I think it’s fair to say that excitement and hope are not the emotions that I’ve commonly associated with care at home services in the last three or four years. In 2012, our strategic plan concluded that care at home services were becoming increasingly unsustainable. A combination of increasing demand, limited budget and decreasing workforce, and the day-to-day experience of everyone concerned with care at home, is more challenging than at any time I can remember. Watching the news on television, I can see that we are not alone and while I’m still optimistic that we have avoided the worst, realistically, I can’t be completely confident that things are as I would like them to be. This project is the first opportunity in several years where we have been able to invest in finding a new way of doing things, and that in itself is quite exciting.

I am hopeful that we will make progress because I know that the care providers and their staff are committed to the people we support.  Care at home is a challenge and it is difficult to think of how it would work at all without the commitment of those who are involved. In the last 5 years, we have had little to offer them in terms of increased resources and better terms and conditions. However, regardless of how hard these negotiations have been, there is a solid core of good people who have the interests of the people they support at heart. I’m not naive about this, most of the serious complaints end up on my desk and I can’t pretend things never go wrong, but most of the time I’m reassured that we all  want to be successful in making a good contribution to people’s lives, and there are always the hope that we can do better. I was worried that providers would be too busy keeping their services running and under too much pressure to engage with this project, but I’m happy to be wrong. When providers got a sense of an opportunity to improve things, they all signed up.

Just in case your geography is a little hazy…

This project is taking place in Wigtownshire, the most westerly district of Dumfries & Galloway in south-west Scotland. If geography is not your thing, here’s how to find us: Go to Carlisle in the East, just below the Scottish border, turn left and follow the Solway Firth out to the Irish Sea. Dumfries & Galloway is the region to the north of the Solway from Gretna Green in the East to Stranraer in the West. Wigtownshire is mostly made up of the two most westerly peninsulas:  “The Rhinns of Galloway “ (the long, thin one sticking out into the Irish Sea) and “The Machars” (the larger triangle sticking out into the Solway Firth).

Care packages, delivering parcels or delivering good outcomes.

I have a map of our region on my office wall and I have stared at it for numerous hours over the years, trying to find a solution to all sorts of issues. These days, when I imagine the effort expended by 1500 or so, low paid care workers, rushing about in 10-year-old cars, trying to make their specified visit times to support those 2000 older people, the majority of whom are in their 80s and 90s, I increasingly can’t think of how we will keep it all going. Especially in the context of a limited workforce and financial resources, we need to find a very different approach.

If I imagine I had pinpointed each service user on the map and stretched an elastic band between them for each care worker’s journey to and from each person they support, I can get a sense of how complex it is. The day-to-day experiences of service users and staff being pulled in different directions seems so obvious, especially if I remind myself that this also occurs in 4 dimensions as each visit has a time. Beyond this, it is a dynamic picture, never static always changing, with new service users arising and some no longer needing a service, while some staff leave, new ones are recruited or some are off sick or on annual leave.

From this perspective care at home seems like “logistics”. I’ve just looked up that word. The Oxford English dictionary says it is

 “the detailed organisation and implementation of a complex operation.”; or “the activity of organising the movement, equipment and accommodation of troops; or “the commercial activity of transporting goods to customers.”

The first definition seems fine, supporting people who have needs which require personal care to be delivered in a consistent and reliable way throughout the day involves the detailed organisation and implementation of a complex operation. I’m not so sure about the other two? The other day I recall saying ”I don’t have a private army of home carers to sort this out” and there are times when most people involved in organising home care would say it feels like a military campaign. However, surely this is more about the challenges we currently face than the day-to-day business of supporting people to live their lives? The tendency to think of it like delivering parcels has been around for a long time, we have commonly talked about “delivering care packages.” after all! Undoubtedly we need to take whatever will help from other sectors in terms of technology and communications, I personally like the texts that you get from delivery companies saying that “’Charlie’ will deliver my parcel in 20 minutes” – it has to be part of the future given how much of our lives are conducted on the web these days.

But all the technology and logistics in the world will not be enough.

When Charlie gets to my door all he has to do is give me the parcel and all I have to do is sign for it. I think we know good care and support requires so much more. I think we know that good care is delivered by motivated people who are committed and pay attention to what is important for the person they care for, and are valued for what they do. It also depends on the trust and confidence of person who is supported in the commitment of those who support them, and the opportunities they have to make the most of their own capabilities and assets in living how they want to live. We also know that really good outcomes often include significant contributions from family, friends, neighbours and communities. These are the things that this project is about, in the middle of all the challenges, finding ways to connect what is most important to the people we support, with what is most important and satisfying in the working lives of those who support them, so that we can make the most of both.