Podcast Episode: Fit for the Future
Category: Adult social care
What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.
MD - Michelle Drumm
RM - Rhiann McLean
MD Rhiann McLean, Project Lead on the Fit for the Future project, was happy to speak to Iriss.fm about the project and progress to date. She firstly gives an overview of Fit for the Future and explains the main objectives.
RM Fit for the Future is a partnership project between Iriss and Scottish Care that is aiming to support the independent sector to embrace the challenges and opportunities in transforming support for older people, as laid out by the Reshaping Care for Older People Agenda. We are working across 4 different partnerships - North Lanarkshire, Argyll and Bute, West Lothian and Falkirk - funded by Change Fund monies, and we are working at each of those areas with the appointed Scottish Care Development Officers who have really good links to the independent sector locally, as well as strategic links with the local authority to understand the commissioning overview of each area.
Initial stages of the project were really about getting to know all the of areas we were working in, and in particular understanding some of the challenges that the providers felt they were facing and also understanding, from a joint commissioning perspective, whether there were any obvious gaps or needs in service that could be met by the independent sector and what our role could be there. Once we had identified our providers, it was really then about developing practical strategies and tools to work closely with them to reshape their model of care.
The outcomes of the Fit for the Future project are an increased capacity in the independent sector to manage the challenges of reshaping care for older people. We also want to develop effective strategies and tools, to disseminate those to the independent sector, to inform and inspire other changes. We would also like, in the end, to have enhanced outcomes for individuals receiving care and support from the independent sector.
MD She goes on to tell us about the work in West Lothian.
RM In West Lothian we are working with a company called Prime Care Health who came forward because they really wanted to specialise their services more and gear towards dementia, and this was in a recognition that they were having more and more clients staying at home in the community who had complex needs and dementia, and they really wanted to make sure that their service model was geared up for that, and that more importantly, their staff were trained and empowered to be able to work closely and productively with people with dementia. So really we are looking with them at reshaping the way that they approach outcomes, staff training and engagement, to deliver better outcomes for people with dementia and their carers'. It is close partnership work which will include people with dementia and their carers who access the service currently, so that they can have an active decision making role in terms of deciding what the future service will look like and really influencing with their experience. And that is really key, I think for Prime Care, because they wouldn’t consider moving forward without that expertise on the working group. So far it has been a great take up with Prime Care - a lot of staff are extremely interested in being involved - it is a commitment from them, so the fact that so many have come forward and are quite interested, to me is a really positive indication that this change is due and also that Prime Care is doing the right thing in terms of engaging their workforce and engaging the people who access their support in early stages.
Also in West Lothian we are working on a Care Home Lab. We have selected a care home who really wants to improve the way that they deliver outcomes, again for people with dementia in a care home setting. We are building on previous research and knowledge that has been done around outcomes in residential settings to really test out what tools can facilitate conversations and also, I suppose, what skills staff need and how it is best for them to build their confidence so that they feel that they can go forward in the future, having very outcomes focused conversations without that much management supervision. Really what we would like is for outcomes to be part of everyday operations, but to get there you need to test out exactly what it is that staff are going to find challenging. The Care Home Labs are also really interesting because they will include the people who use the care home and live there and their families as well, so it’s not just on one side saying “how can staff work in an outcomes focused way” - because we do have a lot of evidence around that, but it is also looking at how can we build relationships and make sure that people with dementia and their carers' are part of those conversations and feel comfortable being part of those conversations.
MD Rhiann says a bit about recruitment and retention of staff and the work in North Lanarkshire.
RM Our project has also chosen to address issues around recruitment and retention of high quality staff. Early in the projects we learned across all 4 sites that the recruitment and retention of staff was a challenge within the independent sector - as well as other sectors within support for older people - and we really wanted to look at how we could build values into our recruitment process to make sure that (a) we were recruiting people who had values that aligned with providers and values that aligned with people who accessed support, but also looking at the ways that values can actually add to the experience of being a carer, and really kind of through the whole process of retention, that carers can also feel valued as part of an organisation, which is going to help with the retention element, and also just create a much more positive working environment. There was a real recognition with a provider we are working with in North Lanarkshire that quality of care and support at home is really determined by the staff, and particularly keeping a consistent staffing team so that people always know the person who is coming to their door to help them at home, really have a relationship with them. So to put that in place they are really exploring different models of values based recruitment.
Also in North Lanarkshire we are looking at modelling alternative respite, so moving away from a typical building based respite model towards a kind of - how can you use space flexibly in order to keep caring relationships healthy in the long run? And that is including North Lanarkshire Carers Together, Scottish Care, Iriss and the provider. And they have been really great at trying to kind of move beyond some of the historical issues with respite and particularly how it is commissioned - to think creatively for solutions that are supporting not only the cared for person, but also their carer.
MD We hear about the work in Argyll and Bute.
RM In Argyll and Bute we are working closely with a care home to look at differentiating some of their beds, and that is a move towards, I suppose, making sure that residential facilities don’t fall into the trap of only having one function, particularly in remote or rural locations where you want a residential home to be able to fulfil a whole range of needs. So they are looking at implementing set palliative care beds, also they are exploring possibility of planned respite and community links within that respite. One of the issues that they have encountered is often people who enter respite can be in an emergency situation, and the care home doesn’t currently have great links out to the care at home providers in the community. Someone might enter the care home for respite in a crisis - the care home can support them to regain some of their independence so that they can go back home again, but the care home doesn’t have the links and the information to be able to pass on to care at home providers what they know about the individual, how the individual likes to be supported in some of their outcomes. So building those community links is really important to the care home because they don’t want to be seen as an island - they want to be part of the overall process of someone staying in the community for as long as possible.
This care home is also exploring on a very slow basis, what it would be like to open up more to the community and to have more people who are isolated living at home and maybe don’t have access to day to day activities - being able to access their facilities. I think it is really early stages for that conversation, in particular because there are a lot of barriers around a care home being someone’s home, and that is something we really need to consider. But it is an interesting concept that feeds on the My Home Life evidence we have from the Joseph Rowntree Foundation around what makes living in a residential facility a positive experience, and at lot of that is again not being isolated and being part of the community you were always part of when you were living at home.
MD Rhiann tells us about the work in Falkirk.
RM In Falkirk we are exploring intermediate care in a step-up, step-down model to reduce hospital admissions that are unnecessary and also to improve hospital discharge as a process. This is a really interesting area of work in Falkirk, particularly because it involves so many different partners - and when we look at the Reshaping Care for Older People Agenda, really partnership working is at the core of that. So really this is involving the local authority, the NHS, voluntary partners and the independent sector to work together to deliver a package of support that could make the difference between someone going home and staying home, and the difference between going home and heading back to hospital within days. So it’s actually a really important exercise in terms of understanding what the barriers are there and what tools help facilitate that process.
MD She tells us about the successes and challenges of the project to date.
RM So far in the project we have had a lot of successes and challenges. I think our major successes so far have been in building networks - the Scottish Care Development Officers have been really key in helping me access and get to know a lot of providers across all the sites. And really feeling like you are a trusted member of those groups, and that people can be open and honest about their experience has been overwhelmingly positive and has given us a wide range of information to draw on.
Once we found the right partners in each area, it was really clear what direction we should go in. The early challenges were around engaging with our partners and finding people who wanted to work quite intensively towards improving outcomes for older people. Finding those willing partners was a challenge in and of itself as well - in some areas there were two or three people who wanted to be part of the project and we had to make some really challenging choices. In other areas there weren’t as strong networks in terms of providers groups that we could feed into, so we were actually kind of, in the early stages, on the hunt to meet people. But once those early stages were over, really getting to know providers and what they wanted out of it - the choices were clear.
The great success for me is in the partnership working - how easily people have come together, shared their ideas, shared their experience, and how well I think the current working group set ups we have are working, particularly when they are in partnership with people who access services, which to me is a key element of the project. But watching those relationships flourish has been great.
I think a major challenge for the Fit for the Future project is that actually this is a time of transition and a time of a lot of unknowns, and trying to motivate the independent sector to be proactive and make changes, when there is so much that isn’t clear in terms of the future, it has been a challenge. But once people have moved away from the mind-set of being risk averse and towards thinking about their business plan as not just spanning the next 3-5 years, but the next 10-20, they actually have been able to step back from some of those anxieties and really look ahead and think about what older people in the future are going to need. And from there they have been able to come up with some really interesting, innovative ideas.
MD On the learning so far she told us …
RM The learning we have had so far in the Fit for the Future project is definitely for me, start where your partner is - I think if we had launched into each project area with a set project plan of exactly what we wanted to do, we probably would have failed at this point. For me, it’s important that we started where our partners were, understood the area and really worked with whatever resources and ideas they had to begin with. I think it has built a lot of organic relationships, and it has also meant that interventions that we are doing and the projects that we are running are not large, orchestrated, theoretical ideas, but are really based on day to day practice. And I think in terms of the final output, that is going to mean that we will have tools that are applicable in real day to day practice, that within larger theoretical models will have that practically grounded experience of what it means to work when resources are tight, when staffing is tight and when everyone’s time is under constraint, and when there are so many unknowns - and having real experience of that will mean that the outputs from the project will be able to apply in the same setting.
Another really important piece of learning has been about, I suppose, moving beyond speaking terms of barriers - it can be quite challenging, working with a group who feel that they are outside often of partnership working, and it has been a really difficult but rewarding experience to kind of work through those issues, understand exactly what those barriers and challenges are, but also to take that next step which is to acknowledge those barriers, but work to change the way that we work. So inspiring action rather than dwelling on those difficulties has been a really interesting process. And I think it has really come from the time and trust and the relationships, but also I suppose from this imperative that things have to change and they really need to change now. So moving beyond that barriers approach to actually look at solutions and different ways of working has been a massive shift for a lot of our partners, but it has been a really rewarding shift for a lot of them as well. I think they can be weighed down by a negative approach, and really opening those doors to possibilities has been exciting.
MD To finish, Rhiann tells us about the next steps of the project.
RM The next steps of Fit for the Future are really about working with each of our dedicated partners in each area to develop different models of support for older people, and through that gather the information and develop the tools we need to share that towards the end of the project. The current development stages are really about working closely in partnership and putting things into practice as well to make sure that we are not, again, sitting round a table with ideas, but that we are genuinely able to look at things and say “does this work in practice”?
I would hope that by the end of the Fit for the Future project we are going to have a whole range of strategies and tools and stories and learning from across these four sites. The other providers, independent providers in the sector, can pick and choose what is relevant to them in their situation, see what has worked in other areas, understand the process of that and what is involved, and hopefully make their own changes based on them.
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