Debbie Sorkin shines a spotlight on why in social care, prevention is often better than cure
Moving towards prevention has been at the cornerstone of recent health and social care policy. It includes keeping people healthy and independent in their own homes – a defining principle of the 2014 Care Act.
It means encouraging people to take more control of their own health and wellbeing: a move that is being supported, if slowly and patchily, through the introduction of Personal Health Budgets. And it also means supporting people, whether in their own homes or in residential care, so that they maintain both their physical and mental health as far as possible, and for as long as possible.
This laudable aim is at the heart of NHS England’s Five Year Forward View, but it should be clear that it’s also been the settled practice of social care for many years. It’s intrinsic to the idea of care that we don’t allow the people we support to fall ill when they don’t need to, ending up at the door of the local A&E. We want them to be as well – in body and mind – and as comfortable as they can be.
But prevention – keeping people well, or nipping problems in the bud – is getting harder to do, particularly in relation to older people, where the social care system is struggling to cope. Six consecutive years of local authority budget cuts have seen 26% fewer people getting help, and no-one has a full picture of what has happened to those older people – around a million strong according to Care UK – who are no longer entitled to publicly funded care. The human and financial costs to them and those who care for them are mounting.
The position is not helped by cuts in other parts of the system. For example, District Nurses provide community-based health services that are essential to keeping people with chronic, complex conditions well enough to live independently and stay out of hospital. District Nurses also play a vital role in social connection, reducing the risk of isolation, loneliness and depression amongst people they see. Yet despite increasing demand, there was a 28% reduction in the total number of District Nurses between 2009 and 2014, and this trend has continued over the last two years.
So what do you do in these circumstances? You fall back on leadership. Partly this is Systems Leadership – working collaboratively with others (something social care staff are usually very good at); starting from where you are; and doing what you can with the resources available. Partly, though, it is leadership within your organisation, as demonstrated through everyone’s everyday behaviours, from social care apprentices all the way through to the Chief Executive and the members of the Board.
And keeping people well is built into The Leadership Qualities Framework (LQF) for Adult Social Care. To start with, it’s central to the section on Managing Resources, using resources effectively and minimising waste. Why would you want to have someone you support fall ill or lose some of their independence when they don’t need to?
It’s also there in the section on Encouraging Improvement and Innovation: leaders have a responsibility – played out at all levels in an organisation – to encourage improvement and innovation to create a climate of continuous service improvement. This means always being on the look-out for better ways to keep people safe and well.
There are numerous examples of social care organisations that have taken the prevention message on board and run with it. In the West Midlands, New Outlook, a small local care provider, has teamed up with Nehemiah Housing Association to place a greater emphasis on wellbeing amongst residents and service users. Both organisations are based in areas of high deprivation, but have banded together to operate culturally sensitive domiciliary care teams; improve the knowledge base of tenants in relation to health and wellbeing issues, including around dementia; offer a hot food service as standard; and offer a wider range of activities, including twice-weekly coffee mornings.
And it is having a real effect: although the programme has only been running for about a year, the number of emergency ambulance calls from the sites where the programme is operating dropped by 66% between 2014 and 2015. There has also been an increase in the number of tenants choosing to ‘buy’ additional time from the care team to support them with social events or medical appointments.
Social care is also engaged in prevention through training, often in partnership with local NHS services. Shropshire CCG has funded their Lead Nurse to go into care homes and home care services to train staff to spot early signs of deterioration in service users, with a view to preventing more serious problems. Many of the Enhanced Care in Care Homes Vanguards are taking a similar approach: in Gateshead, care providers have taken advantage of a ‘ward round’-based service that sees GP practices and community nursing teams aligned to care homes across the borough. In practice, this has led to fewer avoidable hospital admissions and better quality of care.
And social care providers have taken a real lead in prevention off their own bat. For example, Nightingale Care, a residential care home based in South London, has successfully negotiated with its local clinical commissioning group to get funded for on-site GP and allied health services, and has seen significant reductions in the number of A&E calls, far less admissions, since introducing the scheme. In Wales, the Royal Masonic Benevolent Institution (RMBI) has put in place direct connections with hospital consultants via video to decide whether or not residents actually need hospital treatment, or whether they could remain in their home with appropriate care.
So prevention doesn’t have to go by the board when funding is tight and times are hard. Whatever your role, it’s at the heart of your social care leadership.
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.
Debbie Sorkin is National Director of Systems Leadership at The Leadership Centre. Debbie.firstname.lastname@example.org @DebbieSorkin2