Hightown Housing Association provides housing, care and support services in Hertfordshire, Buckinghamshire and Berkshire. Our registered care homes support people with learning disabilities and mental health needs, with many of the residents having moved from long-stay hospital institutions.
The current funding challenges for local authority commissioned providers is well documented and Hightown has not been immune to this pressure – having to find savings while continuing to provide caring, safe, effective, responsive and well-led services. Funding pressures inevitably mean recruitment pressures, with filling vacancies and staying on top of rotas absorbing managers’ time.
Hightown’s senior management are keenly aware of the importance of its registered managers and understand that, for even the most highly-skilled managers, the demands of the job can sometimes be extraordinary. It is a day-to-day expectation that registered managers can run complex operational services while prioritising competing demands from care managers, commissioners, the Care Quality Commission (CQC) and their own head office. Each shift must be well-organised and attuned to individual service users, who often have complex needs specific to their learning disability or autism. To make a real ‘home’ for the people that live there, managers also aim to create experiences that go beyond being fed and looked after in a safe way, organising trips, events and the marking of celebrations – elements of caring that no provider wants to see diminished.
Investing in initiatives
Like many organisations, Hightown has invested in a formalised wellbeing programme – using the government-endorsed ‘five ways to wellbeing’ from the New Economics Foundation (NEF), with activities over the year that link to at least one of the following:
- Be active.
- Take notice.
- Keep learning.
Resource for this has come from Hightown’s Learning and Development Team within Human Resources, as well as a team of ‘wellbeing champions’ – staff volunteers who have received mental health first aid training. ‘Connect lunches’ specifically for staff in care and supported housing have brought this work to life by making the wellbeing champions available to speak to and to generate conversation around topics such as mental health. Holding these lunches at locations convenient for care staff, rather than head office, has been key to their success. The champions have reported that these events help them to enjoy their role, rather than seeing it as an additional job.
However, as Hightown has sought to understand the key sources of potential stress for registered managers, it has become apparent that the positives from wellbeing initiatives will only go so far where staff are affected by certain structural pressures of the job.
Hightown is committed to a long-term programme of improvement addressing three key elements of the job:
- The care home and office environment.
- Employee relations, procedures and line management.
- Support and change initiatives from head office.
Improving the environment
Hightown has around 60 office sites, including a mixture of those designed and furnished for their use and converted rooms in residential houses and bungalows. Historically, some furniture has come second-hand, chosen to fit in the spaces available and additional filing cabinets fitted in over time.
To help registered managers make their site offices places that are conducive to their positive mental health, two approaches are being taken:
- A digital filing system facilitated by an interactive ‘manager’s dashboard’.
- Targeted replacement of furniture and furnishings.
Hightown has invested in a digital filing system that prompts staff to attach documents at certain time intervals. These documents are then retrievable via a manager’s dashboard. For example, managers are prompted to attach staff supervision documents at least once every six weeks and the attached documents are stored in a ‘Staff snapshot’ section of the dashboard.
Contracts, leases, TV licences, fire safety documentation and so on can all be filed electronically in this way. For Hightown, this means that the number of paper files in offices can be reduced. For some care homes, this is a significant step in making the office environment more manageable, more pleasant to work in and more welcoming to those who visit.
Registered managers oversee high-frequency tasks that must be executed accurately, such as medication rounds. The nature of these activities means that there will be occasional errors, and managers need to be able to assess how and why these have occurred and consider future mitigating actions and lessons learnt.
This process of review and learning sometimes happens alongside employee relations (ER) procedures that potentially put individual staff under investigation. Hightown reviewed the consistency of approach taken to these ER cases and realised that different stances were sometimes being taken, with some registered managers commencing formal investigations for small errors due to concerns about what the CQC and local authority would consider a robust ‘response’. However, proceeding with investigations in response to human error had put additional pressures on the team and line management relationship, and had potential consequences for the mental health of all involved.
To help, Hightown has clarified the internal position on thresholds for ER action and has introduced weekly one-to-ones for all registered managers, providing a face-to-face forum with their senior manager. These have been successful in helping registered managers feel better-supported by facilitating input into, and backing for, on-the-ground decisions they are making in response to events, errors and incidents.
Support from head office
Semantics can sometimes be very important. Hightown’s Quality and Contract Compliance team recently changed its name to simply ‘Support’, emphasising that this team is there to support registered managers get the quality outcomes they are working for.
The Support team offers early intervention ‘back on your feet’ days – a day’s support available to managers who might be behind on management tasks, whether due to staff vacancies, particularly complex case work, or an unforeseen event. The aim is to prevent a stressful backlog of tasks and the consequences this can have in terms of rota planning, staff relationships and morale. In addition to requests for these visits, officers from the Support team regularly visit services in a supportive capacity to establish where there may be rising pressures.
Messages to registered managers about changes being driven from head office are also being delivered in new ways, to capture attention and help managers engage with the policy content or digital system change. For example, interactive videos starring staff from the Support team have been created in-house, adding audio and visual communication, and a sense of humour, to what could have previously been simply an email.
Top three simple measures for quick results
Although some of the measures taken by Hightown have been enabled by investment in ICT, there have been some simple measures taken that have had a significant positive impact on registered managers and required no new resources:
- Attention to the office environment
Some of the most effective improvements to Hightown’s office spaces have not come from spending on new furnishings or digital filing, but simply paying a bit of attention to layout. Layouts too often are due to historic decisions about where to plug in a device or the presence of a filing cabinet that is heavy to move. Removing archive material, a spring clean and reorganisation of storage has achieved a real improvement of space in some of Hightown’s schemes.
- Weekly one-to-one opportunities
Even if only for half an hour, these have provided the space needed for senior managers to be responsive in supporting the on-the-ground decisions of registered managers. Although both the senior and registered managers initially felt this would be a time burden, once implemented, managers realised they were saving time otherwise spent drafting emails or attempting to contact each other. They also preferred this guaranteed face-to-face contact and felt it has improved the line management relationship.
- ‘Back on your feet’ days
These have relieved some stress from managers by letting them know its fine to raise their hand and ask for help at key moments of pressure when normally manageable tasks have slipped.
Looking on a national level, we would welcome practical resources and guidance from national bodies on promoting organisational culture that supports the mental health of registered managers. For example:
- Sector-specific guidance on practices that promote learning by looking at errors, incidents and pressure on standards in the context of the system rather than individual culpability.
- Practical tips and examples of positive learning exercises from across the sector.
- A narrative about learning that doesn’t use the language of failure and abuse.
- General principles for how and when to take disciplinary action that won’t reverse organisations to defensive states.
- A Government-endorsed health check on organisational culture that executive and leadership teams can use as a self-assessment.
The big next step for Hightown is investment in a new training programme for registered managers and managers of supported housing. By Winter 2019, Hightown hopes to be rolling out an in-house programme of training that gives managers time to reflect on the nature of their line management relationships with front line staff, and practical tips for how to get the most out of their staff teams.
Hightown will also continue to invest in its wellbeing initiatives linked to the five ways to wellbeing and hopes to bring more of that work out to its registered care settings.
What initiatives have you used to support your registered managers? How can others implement your ideas to improve mental health across the sector? Share your knowledge and provide feedback on this article in the comments section below.