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:
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.