Debbie Sorkin talks about how in social care, we’re all in it together
This issue of Care Talk coincides with Carers’ Week, which takes place from 12th – 18th June. It’s sometimes forgotten that informal carers constitute the largest single group of people in social care, with some 6.5 million people across the UK supporting a loved one who is older, has a disability or who is seriously ill. The figure has grown by 20% since 2011 and is forecast to rise to 9 million over the next 20 years. Informal carers are also doing more hours of care per week and are, on average, getting older, with more than one in five carers now aged 65 or over. And they make an enormous contribution. Estimates of the value of informal care range between £55 billion to nearly £100 billion a year if the replacement cost of all informal care is taken into account.
Carers are vital to understanding the needs and preferences of people using care and support services. They make meaningful choice and control a reality.
At the same time, their voice isn’t always heard as clearly as it might be. So if you’re a paid worker in social care, how do you play your part to ensure that this doesn’t happen? This matters especially if you’re a Registered Manager, as your teams will take their cue directly from you.
Well, one way is to make really hearing and including informal carers part of what you do every day. It comes down to how you behave in ordinary situations. In other words, it’s part of how you demonstrate good leadership in adult social care.
You start by grounding your leadership in your values. As the Social Care Manager’s Handbook states: ‘The values that underpin social care have developed through recognising that the very best practice comes from the highest standards of personal and professional integrity, and the commitment to deliver a service that centres on and responds to the people who use it….attributes such as compassion, sympathy, empathy and caring roll up into a genuine, purposeful and kind resource that takes practical action…[and] treating people with dignity and respect will run through your service like a golden thread.’ So this applies to people in the round – the people you work with and support, and their carers and family members.
You express that leadership in very practical ways. This goes whether you’re an Apprentice, a Care Assistant, a Registered Manager or a Director – whatever your role, you can do something to improve and develop what you do and how you do it.
It starts with building and maintaining relationships. In The Leadership Qualities Framework (LQF) for Adult Social Care, this is part of how you show good leadership in the way you work with other people. So good leaders listen to others and recognise different perspectives. They empathise and take the needs and feelings of other people into account. They gain trust and support. And they communicate effectively with individuals and groups to promote the needs of people who use services, and to ensure that they, and their carers, understand what is happening and can co-design that care.
As a corollary, they encourage contribution. You’ll have a much better idea of what constitutes truly personalised care and support for someone if you bring their carer into the conversation right from the start. So this is about encouraging people to engage in planning and making decisions; respecting the knowledge and expertise that carers bring to the table; and aiming for true co-production.
And good leadership means working with carers to encourage continuous improvement in care and support, encouraging dialogue and debate – you don’t have to agree about everything. If you’re a Registered Manager, I think this means supporting others, including at front-line level, to innovate, try new things and to keep standards high. At more senior level, I also think it means making this ‘how we do things around here’, putting a development and improvement cycle into place that makes exchange of ideas commonplace and puts carers at the heart of developing services.
One initiative that has focused on continuous improvement and innovation has been NHS England’s New Models of Care, especially those focusing on Enhanced Health in Care Homes. This programme has involved six places around the country – in Gateshead, Nottingham, Airedale, Wakefield, East and North Hertfordshire, and Sutton in south London – bringing the NHS and social care together in new ways, in order to support people living in care homes.
They’ve recently published a Framework highlighting what’s worked and how they’ve gone about things, and this contains plenty of practical advice about involving and working effectively with carers.
The central role of carers is enshrined in the founding idea of what makes for a successful enhanced care model. To have truly person-centred change, as well as putting the needs of the resident or person with care needs at the centre of any changes, the principles state that you need to support carers and families as well as those with care needs.
The thread continues throughout. For example, if you’re moving towards having multi-disciplinary team support, with co-ordinated health and social care, this doesn’t stop with paid staff. It includes helping carers, as well as individuals with needs and professionals, navigate the care system. For an integrated community multi-disciplinary team to work, ‘the resident, their family and their carers are kept at the centre of the MDT’s decision-making process at all times’, as the model below illustrates:
Taken from The framework for enhanced health in care homes, NHS England, September 2016.
© NHS England
And many of the places show just how they’ve put carers at the heart of their strategies. In Airedale, a dedicated ‘gold line’ phone service provides a single point of contact for residents and their carers for help and advice, 24 hours a day, seven days a week, to support people in their preferred place of care wherever possible. In Wakefield, Connecting Care Hubs support carers by bringing together social care staff, District Nurses, GPs, Occupational Therapists and a range of other services in the same place to improve access to care and speed up getting help in place. And in Nottingham, the reablement service has developed a personalised approach, focusing on prevention and working alongside carers with people needing support in the community and those in care homes. The overall aim is to have services ‘wrapped around’ an individual and their carers, so that they are connected to and supported by their local community, with proactive care becoming the norm and carers able to access support more easily when and where they need it.
This year, all the New Models of Care will be focusing especially on ways in which they can share, and spread, their learning, including about how to support carers. So why not get in touch with them, and start thinking about the small things you could do, that would – in the words of Dame Denise Platt – use the power of social care ‘to transform people’s lives’. As always, it’s about taking up your leadership role, and having an identifiable, positive effect on the quality of someone’s life. And if you do that for a carer, you’re likely to have a positive effect on the life of the person they care for. We’re already good at caring in social care: more than 90% of services are rated as good or outstanding for caring by CQC. Let’s do a bit more of it for our carers.
If you have examples of great leadership in your service, please send them in to www.caretalk.co.uk or contact Debbie.email@example.com.
Box out: Debbie Sorkin is National Director of Systems Leadership at The Leadership Centre. Debbie.firstname.lastname@example.org @DebbieSorkin2
 See The National Audit Office, Adult Social Care in England: overview, 2014: https://www.nao.org.uk/wp-content/uploads/2015/03/Adult-social-care-in-England-overview.pdf
 See The National Audit Office, Adult Social Care in England: overview, 2014
 The Status of Adult Social Care: Dame Denise Platt, 2007: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_074218.pdf