Martin Walker is the Policy Advisor for Personalised Commissioning and Self-directed support for TLAP. He leads on Individual Service Funds (ISFs) and over Social Care Curry a few weeks ago I was expressing my frustration that ISFs are still misunderstood and underused but potentially transformative for people and providers. Councils have a duty to offer Personal Budgets in all three of the specified ways under the Care Act, so why is this not happening? I asked Martin to help answer some questions about ISFs for this blog, and next week we are working together with NWADASS and TLAP to see if we can encourage and support people to use them more.
Last week Community Integrated Care won best care home at the National Dementia Awards for their specialist home, EachStep Blackburn.
We have been partners with EachStep since before it opened; both through our work integrating Community Circles, and with our Associate Gill Bailey spending a day each week there to coach and support staff to implement person-centred practices. You can learn more about the partnership in this short film clip.
This great news has given us an appropriate point to reflect on our journey, and I’d like to share three reasons why I think EachStep is a real winner.
This short animate describes how a Wellbeing Team supports Norma and Jean – but it is only half the story.
Wellbeing Teams offer a fresh approach to home care, that is different in two ways: how people are supported and how the team works together. The ‘wellbeing’ in Wellbeing Teams stands for both people supported and for team members, you cannot do one without the other.
For the team this means being self-managing. As Daniel Pink, in his provocative book about motivation called Drive, says
“Ample research has shown that people working in self-organized teams are more satisfied” than those working in traditional teams.
This blog describes eight ways that self-managing Wellbeing Teams are structured and supported, providing the other half of the story.
Dora was dressed in a purple cardigan and had a beautiful lilac tint to her hair. She is in her eighties, and her daughter was on holiday, and Geraldine was making sure that Dora had a mid-day meal. I was accompanying Geraldine on her visits that day, and chatted to Dora about her grandchildren, whilst she ate her cooked salmon and vegetables. Dora’s daughter had arranged for Dora and Geraldine to go out for lunch as her favourite pub the next day.
“Remember not to wear your uniform” were Dora’s parting words as we left.
Geraldine is a qualified nurse and wears a nurse uniform and smart jacket, her colleagues in Caring Hands also wear a uniform of a navy tunic and trousers. Last week we explored the issue of uniform with the new wellbeing team.
The wellbeing team was partway through their induction and had shared their personal histories, and we had explored what matters to each of us. One of the underpinning principles of a wellbeing team, is to ‘bring the whole self to work’. As we started our discussion about uniforms, we looked at the reasons why Caring Hands chose to have uniforms:
“families like us to look smart and professional’
“it is easy for people to recognise their carer”
We were clear that it is not a hygiene issue, often stated as a reason for having uniforms, as people are expected to wear disposable aprons and gloves if necessary.
In my early working life I was an occupational therapist and wore the familiar green trousers and white tunic on hospital wards. When I worked with people with learning disabilities, no one wore a uniform, as the medical model had been replaced with a values based model known as ‘normalisation.’
Sally Knocker from Dementia Care Matters is very clear that “a uniform is seen by many as a symbol of power and control, reinforcing a sense of “us and them”.
Uniforms can convey a professional distance that as James, one of the wellbeing workers pointed out, is at odds with our principle of bringing the whole self to work. It would seem strange to be encouraging the wellbeing team to talk about what matters to them, be prepared to share their interests with people and yet expect them to dress the same and hide that individuality.
We explored how we could still inspire confidence and look professional to families and individuals, without wearing a uniform.
Being a tribe and being recognisable
People like to feel like they belong, are part of a tribe or a group that stands for something. Part of me loves the seduction of smart branded cars and uniforms. I personally would prefer not having to think about what to wear in the morning, and this was a benefit of wearing a uniform as an OT.
My friend’s mum is supported by a premier home care company, who have colourful branded cars and uniforms. I asked her what her mum thought about it. She said,
“I don’t think mum would want to be identified as someone who is receiving services with a branded car or uniform. If she was out with the person she would prefer people to assume that they are a friend.”
I think this was behind Dora’s request to Geraldine not to wear a uniform when they went for lunch in the pub.
When I tweeted about uniforms last week, Sally made a point I had not thought of:
At the end of our discussion the question we were left with was:
Can we combine an easy way for people to recognise us, whilst also expressing individually and being warm and approachable?
We decided that having a smart dress code, but wearing our own clothes was important. We explored the poloshirt with logo idea – but this is simply a different kind of uniform.
We agreed that we wanted a jacket, that everyone would have, in the same colour with a discreet logo of the wellbeing team. This would be a way for people to recognise us initially for the first few visits as required. We would wear it between visits, but not if we were supporting someone in the community.
I am keen to hear what people think about uniforms and home care. Please share your views.
Skills for Care tell us that values based recruitment and retention is about finding and keeping people who have the right values, attitudes and behaviours to work in social care. As we started to design our workshop day to recruit the first self-managing team in homecare in Lancashire, I started to understand that this was more complex than I had imagined.
We needed to move from an implicit understanding about the principles and values we wanted to recruit to, to make them explicit and ‘live them’ throughout the whole recruitment process. We needed to consider two areas, how the team organises itself, and the work that it does. We are modeling the new team on ‘teal’ principles, and in summary these are self-management, bringing the whole person to work, and evolutionary purpose. These reflect how the team is organised, and the work that we want the team to do, is to work with older people in their own homes, to co-design their support with them, and deliver this in a person-centred way. What does all this mean for values based recruitment?
In traditional homecare the first conversation is usually called the assessment. The purpose is to find out what the person’s needs are, and to do a risk assessment before the service starts. The conversation will be dictated by the paperwork.
How can we change this conversation from needs and risk, to what matters to the person, and learning about their priorities? Can we have paperwork that is person-centred, and yet still fulfills the expectations of regulators? This is what we are exploring with the new team of Wellbeing Workers. We want the first meeting to be a conversation, and the paperwork seen as the record of a conversation, not a form to fill in.
Does this sound familiar? Jean was recruiting for carers for a homecare team. She shortlisted five people and invited them to come for interview. Out of the five, only one person turned up. The person who did turn up said,
“I don’t really want the job, but the job centre expects me to come for interviews.’
Like Jean, I was worried whether people would turn up. Yesterday was our recruitment day for the new self-managed Wellbeing Worker team we are establishing in Lytham St Annes, for Caring Hands. This is a new way or working in home care, and we have been trying a very different way to recuit people. Yesterday was the day to find out whether this had worked.
We have 60 people expressing interest, 30 people had a 15 minute telephone call with Geraldine the registered manager, to talk about the role and received recruitment packs and given the date for the recruitment day. Knowing that people not turning up is such a big issue we asked people to phone to confirm their attendance by 16th August. Ten people confirmed that they would come – but would they really turn up?
The day due to start at 10am, at St Anne’s Community Centre. With fifteen minutes to go there were only 3 applicants in the room. Then everyone else arrived – nine in total – carrying foil covered trays, and plastic bags – bringing their lunch to share. Bringing a lunch to share was not the only thing different about how we wanted to recruit people for this new team. This is what we were trying:
1) Recruiting for values
We intentionally did not ask for CV’s for people, or asked people to fill out application forms. We wanted to meet people as they are, and learn about them, and their values through the process of the day. One of the ways that we did this was to use the resources from Skills for Care, and created sets of ‘Values Cards’. We used these in small groups for people to share their answers and values with their potential team-mates – as well as us, listening in.
2) Focusing on Head, Heart and Hands
Ali Gardner explained in her blog how we are looking for people to use their head, heart and hands in this role, and therefore we wanted to reflect that in the recruitment process.
Head – We wanted people to tell us how they would ‘use their head’ to respond in different situations. One of the ways we explored this was through scenarios, explaining in turn what they would do if confronted with a particular situation.
Heart – Working in a self-managed team involves brining your whole self to work, sharing who you are and what matters to you. It is also about working ‘from the heart’ in a compassionate way with people we support – and each other. We wanted people to both feel comfortable sharing about themselves, and learning about each other too. We started gently with a warm-up exercise and built on this to ‘human bingo’, and then answering the values questions took the personal sharing to a deeper level.
One-page profiles are a key way to communicate what matters to you. At the telephone conversation part of the process, Geraldine explained how we use one-page profiles and we asked everyone to bring their draft one-page profile with them to the day (and provided information about how to do this in their recruitment pack). The recruitment pack included the one-page profiles of the recruitment team, so that people could ‘meet’ us through our one-page profiles before they came. All nine people bought their one-page profile, and during the day there was an opportunity for personal reflection, to add to their one-page profile and share this with the whole group.
We also wanted to see how people could, through conversation, learn what matters to the older people they would be supporting if successful. We used the ‘What Matters to Me’ booklet, and people working in pairs finding out what mattered to an older person (part of the recruitment team) through conversation.
Hands – As home care is a role that requires people to use their hands, two sessions directly explored this. When we were designing the day, we thought about people helping each other to eat as part of the recruitment process. Whilst we can see benefits to that, we were also conscious that you would know what the recruitment team were looking for, so could we approach this another way? In the end we decided on hand massage. We thought that expecting people to do something they have not done before (only one person had experience of hand massage), following instructions, and connecting personally through physical contact would help use learn more about people. People also used their hands to build structures from spaghetti!
3) Looking at team working
Being part of a self-managed team requires learning about team working in a deeper way. We covered this three different ways – in the scenario section there were scenarios related to being a self-managed team; we used the marshmallow and spagetti exercise, where people have to build a structure together in 18 minutes, and we had an exercise where people had to give feedback to another person. The concept of bringing lunch to share was also part of this – working together and sharing skills and lunch.
4) Thinking about this as ‘finding a match’
I explained at the beginning of the day, that we were looking for a good match between the role and people. To show that we were serious about this, we include a section where people interviewed me and Geraldine (the registered manager) about the role and what it entailed.
5) Co-producing the process and decision-making
We have a team of us organising and delivering the day, and making the final decisions. This included two older people, the registered manager, and the Community Circle Connector. We are setting up the Doncaster team in October, so Becky, the registered manager for the Doncaster team came along to see what the process was like. I asked my colleague Michelle to join us, as she leads on teams and organisations within H S A and used to be a home care manager herself. Caring Hands are working in partnership with Community Circles, to ensure that we can focus addressing lonliness and isolation as important elements of well-being.
The two older people – who introduced themselves to the group as Amy and Freda, were equal decision-makers in who was invited to join the team at the end of the day. Their role was particularly important in the session where people demonstrated how they would learn about what matters to an older person.
Today, five people from the group of nine are being offered jobs as part of our first Wellbeing Workers team in Lytham, the first self-managed home care team. People gave wonderful feedback about the process at the end of the day. This is not a surprise if you are being considered for a job of course, and our evaluation partner, Joe McArdle from Chester University, will be following this up so we can learn more.
What would have been different, if these same nine people had come for a half hour interview?
One woman, lets call her Maria, presented really well in all of the scenarios and values questions, but it was only in the hand massage, and the ‘what matters’ conversations that we noticed how she spoke over people, always had a ‘bigger story’ and struggled to listen. If I had been only interviewing her I would have given her the job, and then struggled to let her go through the probation period.
Two other people, lets call them Jo and Karen, expressed how they loved the concept of the self-managed team but were not sure how much hands on care they really wanted to do. We talked about this a lot during the ‘interview us’ section, and this helped them both realise that this role was not for them. If we had just done a half hour interview I think they would have decided to give it a go, and learned within the first two weeks that this was not really the role for them and left.
I am encouraged by what we are learning, but will everyone accept the jobs, and still be here in 3 months time? I will let you know.
PS 5pm Just heard that everyone has accepted the jobs. Phew.
Last week was Dementia Care Matters 20th anniversary conference. Gill and I were invited to give a keynote and I know it sounds cheesey, but it really was an honour. Not just that, it resulted in a significant change to my personal mission in relation to care homes. Before I say more about this, a confession. Gill is one of David’s biggest fans, and whilst I absolutely saw David as a kindred spirit in his values, and admired him, I felt in a bit of competition too. Now, I am most definitely moving from any sense of competition to collaboration. This is what has changed my views – four areas that matter and what this means to me.
‘Moving to teal was much harder than I expected,’ observed Michelle last week. I agree. I had assumed that as we already worked together as a person-centred team, and were self-managing in several ways, that it would be easy. However, stepping up to fully embrace self-management was still a big step, and a step worth taking. This blog describes our progress so far.
I am both excited and scared. In August we have a Workshop day to recruit the first four members of a new kind of home care team, inspired by the Buurtzorg model. The first team will be in Lytham St Anns in Lancashire, and the second team in Doncaster in the autumn.
The person specification is complete – and it is in the format of a one-page profile. We have called people Well-being Workers instead of carers, to emphasise that the role is to very different to a traditional carer. The job description is also very different. We explain that the team will be small (no more than 12 people), self-managing and flexible.