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Health and wellbeing: at the heart of social care

Debbie Sorkin National Director of Systems Leadership

Debbie Sorkin on how promoting wellbeing in the broadest sense is what social care is for
For this month’s Care Talk, I want to look particularly at the health and wellbeing of people using social care, and at what you can do, in practical terms, to support these aspects of people’s lives.

Because health and wellbeing are fundamental to people’s quality of life. And they’re not just, or even mainly, about medical interventions. Wellbeing is about being comfortable, healthy and happy. So it’s about not being lonely, and having social connections. It’s about being supported to live as independent and fulfilling a life as you can. It’s about feeling secure and happy in your own home – by which I include residential care. It’s about being properly safeguarded, so that your human rights and wellbeing are protected. And for many older people, or people with complex needs, it’s about not being on a merry-go-round of trips to hospital.

The medical profession is still catching up with this idea of wellbeing: in the words of Atul Gawande , moving from asking “what’s the matter with you?” to “what matters to you?” But social care has long seen wellbeing in this wider sense, and is increasingly recognised for its innovative approaches.

For example, residents of Nightingale, a care home in south London, had long received visits from children at the nearby Apples and Honey nursery. In September of this year, however, they took a further step to strengthen the inter-generational connection, by having the nursery co-locate on the same site. This move, a first in Britain, aims to tackle the ‘age apartheid’ that increasingly keeps generations apart, with old and young taking part in activities including singing, cooking, gardening and story-telling, and with these activities embedded in the nursery curriculum. As one of the Nightingale staff said at the time: “You could feel something different in the air with all these children running about. It just made it really happy. It just lifts the mood and brings life into the home.”

Anchor, England’s largest non-profit provider of housing for older people, is going down the same route. For example, three times a week, children from a Busy Bees nursery in Hampshire get together with residents in a nearby Anchor home specialising in services for people with dementia. The visits have proven so beneficial on all sides that Busy Bees, Britain’s largest childcare provider, wants to replicate it across all its sites.

Linking up with housing associations has proven another way to retain and improve people’s wellbeing. In the West Midlands, domiciliary care provider New Outlook has made connections with Nehemiah Housing Association that have now developed into a formal partnership to deliver services, with outcomes that have included better satisfaction levels, more take-up of services and calls to emergency ambulance services dropping by 66% over the last two years .

The Enhanced Health in Care Homes Vanguards have also focused on the benefits that accrue from keeping people out of hospital when they don’t need to be there. They have a wealth of experience and evidence, and are happy to share what they’re doing .

For example, the Wakefield Connecting Care Vanguard has set up a number of network hubs, looking at different service mixes and trying out new ways of operating. So one network has a particular focus on working with a community geriatrician, with weekly GP visits to residents with complex neurological problems in specific homes. Two others involve Advanced Nurse Practitioners acting as Care Co-ordinators for residents identified as high-risk, with regular pro-active care visits and better links with GP practices. A fourth has prioritised better collaboration between primary and secondary care, and Age UK, with better use of video links and access to shared care records.

As a corollary, there has been more emphasis on skills development for care home staff, funded through the Vanguard, so that staff can deal with more complex medical needs and prevent emergency call-outs. They have moved towards using multi-disciplinary teams across health and social care, often with the Registered Manager being the pivotal figure, and working with a range of health and social care practitioners including district nurses, Social Care staff, pharmacists and specialists in palliative care. The teams use a screening process to identify care needs which, if not met, may lead to residents needing to be admitted to hospital unnecessarily. The team can then support the care home to meet these needs that reduce reliance on hospital admittance and improve people’s quality of life.

It’s having a really positive effect. Outcomes from the pilots include a 25% reduction in ambulance calls; 30% reduction in A&E attendances, and at least 50 weekly visits to care homes by GPs – a significant increase. And as a result of care reviews, 53% of residents saw changes in their medication, often with less medication required.
The Vanguards have published a Framework , setting out what they’ve been doing, and how they’ve got started, along with contact details. It’s worth taking advantage of what they’ve learned; they’re a great source of insight and support.

But you don’t need to be a big organisation to change someone’s life for the better. You can make a difference at individual level, through respecting people’s personal preferences, lifestyles and care choices, so that they feel independent. In one non-residential setting I’ve come across, one Service User described the outcome of the support as making them feel they could fly: “I can do anything and everything”. Another described their support workers as ‘seeing my abilities not my disabilities’, and giving them the confidence to go for independent employment and even to run marathons, raising thousands of pounds for charities. And there are many examples of managers who have set up projects in the community for young adults with learning disabilities, so that they could develop their skills to live independently.

All of these are examples of how, in the words of Dame Denise Platt, “social care, when delivered well, has the power to transform people’s lives.” But how do you do this, especially when resources – time, money, attention – are tight and you’re not sure where to start?

One way to start is by seeing enhancing health and wellbeing as part of your leadership role. The Leadership Qualities Framework for Adult Social Care shows how leadership is founded on everyday behaviours – what you do as part of your normal work. It follows that leadership is for everyone, no matter what your role.

For health and wellbeing, it starts with one of the key dimensions described in the Framework: building and maintaining relationships. You can’t start to enhance someone’s wellbeing until you know what matters to them, through the relationship you build with them. So good leaders develop their listening and feedback skills; gain trust and show understanding; and communicate effectively to promote what people need and want.

It also means developing your networks, so you hear about new ways to support wellbeing. Good leaders identify opportunities where working across networks can bring new benefits; create opportunities to bring people and groups together; promote sharing of information and resources; and actively seek out other people’s views.

It’s worth giving a bit of thought either to the networks that you, your staff and your services users already have, or to the ones you might look at. If you have a local care association, or you’re a member of organisations like Care England, the National Care Forum or Voluntary Organisations Disability Group, they’re a good place to start: many have networks for specific groups such as HR and Finance people. Skills for Care has Registered Manager Networks around the country that can be a valuable source of emerging good practice and insights .

And look at online networks like the Academy of Fabulous Stuff – for health and social care – which has a wealth of information and garners thousands of views alongside direct queries. As I write, there are 27 new ideas posted on the social care page alone, covering issues from preventing deconditioning in older people to building social and sporting collaborations.

This goes together with a focus on continuous improvement. Again, ‘Improving Services’ as one of its seven key Dimensions, and this includes critically evaluating services to identify improvements and create solutions; ensuring the safety of people who use services; and actively encouraging improvement and innovation. All of these can have an impact on health and wellbeing.

So whatever your role, you can build enhancing the health and wellbeing of people using services into your everyday work. You’ll be joining others in social care who are leading the way in improving people’s lives. Let’s celebrate this and show just what social care can do.

If you have examples of great leadership in your service, please send them in to www.caretalk.co.uk or contact Debbie.sorkin@leadershipcentre.org.uk. Debbie Sorkin is National Director of Systems Leadership at The Leadership Centre. Debbie.sorkin@leadershipcentre.org.uk @DebbieSorkin2

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