This post was written by Laura Dobie, the Living Well in Communities Knowledge and Information Skills Specialist. You can follow Laura on Twitter at @LauraKnowledge.
On Friday 21st October I went along to Scottish Care’s new models of care workshop. It was a really interesting day filled with discussions on the future of care delivery, which highlighted examples of innovation and good practice in care from across Scotland – and further afield.
Legislative and policy context
Donald Macaskill, CEO of Scottish Care, facilitated the workshop discussions and gave a summary of the myriad policy publications and legislation which are having an impact on the care sector:
- The Public Bodies (Joint Working) (Scotland) Act 2014
- Audit Scotland’s forthcoming review of self-directed support.
- The Carers (Scotland) Act 2016, which is influencing partnership working.
- The Human Rights Act 1998, which is being used to challenge practice.
- The Community Empowerment (Scotland) Act 2015, which has already seen examples of local communities buying out care homes.
- The Mental Health 10-year strategy, in which older people’s mental health will be a priority.
- The Review of primary care out of hours services. What is the potential of care homes in meeting out of hours care needs?
- The National Clinical Strategy, with its emphasis on multidisciplinary teams and, where possible, co-location.
- The Palliative and End of Life Care strategic framework for action, which raises the issue of training for social care staff, who need to have an awareness of, and the ability to deliver, palliative and end of life care. How do we do this without over-medicalising care homes, which are people’s homes?
- The third dementia strategy has a focus on advanced dementia and palliative and end of life care.
- The National Care Standards.
There was also the uncertainty of Brexit, and the possible impact that it could have on staffing and funding. The National Living Wage implementation, NHS cost efficiencies, the reform of the care home contract, reform of care at home and housing support, reform of NHS boards and local government elections in May 2017 will all have an impact on the sector.
Donald also discussed the Chief Medical Officer’s report, Realistic Medicine, which stresses the need to reform clinical practice and focus on preventative medicine and approaches to care, and self-management. The report highlights the need to reduce variation and inconsistency, reduce harm, reduce waste, and the need to better manage risk.
It is clear that all of these factors are influencing the delivery of care and will shape future provision.
What will social care supports for older people look like in five years’ time?
Participants then had the opportunity to discuss the future direction of care and determine what should be the core principles in redesign. There was much interest in intergenerational models, such as a model from the Netherlands in which students live rent-free in accommodation with older people and spend 30 hours a month caring for the residents.
Participants also advocated holistic care across professional bodies, and a community hub model with professionals close at hand in local areas. They stressed the need for greater efficiency in information sharing, and to support risk enablement, rather than risk aversion. Participants also observed that staff need to be competent and confident in delivering palliative and end of life care, indicating a possible need for training. People felt that there should be an emphasis on enabling people to remain at home, and that there needs to be true partnership in reablement, including the third and independent sector.
There was a general consensus that new models and solutions need to be person-centred, and that individuals need to have real choice when it comes to care.
Participants shared examples of innovative models of care from across the country. We heard about My Life, My Way, a pilot project delivering self directed support in care homes in East Renfrewshire and Moray, which aims to offer people more choice and control over how services are delivered. This includes options such as staying in a care home part time, or residents bringing their own carers. I highlighted examples of hospital at home services from across the country, and the Buurtzorg model of care in the community, which the Living Well in Communities team at Healthcare Improvement Scotland is supporting health and social care partnerships to test.
There’s also a test of change underway in Dundee in respite care, in which an individual’s usual carers provide care for that person in the care home. Participants also discussed an enablement model for care homes and care at home from Aberdeenshire, in which people are encouraged to do as much as they can for themselves to maintain their independence. Other innovations included night staff wearing night clothes to provide people with dementia with environmental cues that let them know that it’s night time, and an advanced nurse practitioner coming in to care homes to reduce pressure on GPs and reduce hospital admissions.
What would you like to see?
Some of the developments that participants would like to see in care homes and care at home include:
- Adequate funding for care.
- Extending supported living to a bigger community.
- People being able to receive proper support at home.
- Moving to a care home being seen as a positive decision, rather than a last resort.
- A joint IT system that everyone can access across health and social care.
- A better trained workforce.
- More opportunities for career progression.
There was then discussion of the barriers to innovation, which included budgets, regulations, resources, culture, attitudes and staffing levels. Co-production was seen as both an enabler and a barrier.
Participants felt that it was easier to introduce new technology than to change people’s mindsets, and that it was difficult to find the time to reflect and develop an innovative culture. A lack of nurses was highlighted as a challenge, and some considered that grading and quality ratings in inspections promote risk aversion, rather than enablement. Restricted access to quality education resources was also a problem, and participants felt that there was a need to demystify the term innovation and build confidence in change leaders.
Sharing what works
Margaret McKeith, National Project Lead – Partners for Integration, observed that the independent care sector in Scotland is good at delivering at high-quality care, but not so good at sharing it. She discussed the work of Scottish Care’s Innovation and Improvement Group, which aims to showcase good practice and offer a resource for providers looking to do tests of change.
This will have a presence on the Scottish Care website and will include examples of improvement models, evaluations, innovative practice and tests of change. I’m looking forward to seeing the different examples of good practice and the variety of media that are being produced once this resource is launched.
The workshop was an action-packed and engaging day which gave everyone a chance to share their knowledge of new models of care and innovative practice in their areas, and to get up to speed with developments across the country which could shape the future delivery of care.
Concluding the discussions for the day was a vision for care communities beyond villages, where people only need to tell their story once; for care that is based on equity, flexibility and a sense of home. This vision succinctly summarised a day of thought-provoking discussions and participants’ aspirations for care which is truly integrated and person-centred.