Rosemary Hurtley, Founder, Elizabeth Care
Are we putting the needs of older people first when equipping the workforce to deliver best practice for people with long-term conditions? Receiving person-centred care is a fundamental feature of healthy cultures in health and social care organisations. A key contributing factor is education and its fitness for purpose in the workplace in which we now live, move and ‘have our being’. Sustainable good organisational cultures are made from striving to achieve the shared purpose to deliver person-centred outcomes to the individual, from their perspective.
I am talking about work-based learning, based on what older people in our care homes need. Clinical Commissioning Groups (CCGs) are realising the need to upskill care home nurses (and care assistants). Anxiety about health domination has affected people’s experiences of care. It’s left many providers with an underdeveloped workforce, missing out on developed understanding of how to deliver person-centred socio-therapeutic, complex care; an essential prerequisite. For example, CCGs are expecting care homes to deliver ‘enhanced’ medical or technical skills to help increase early discharge and reduce hospital admissions.
Without staff offering a good experience, we will return to a medical model of delivering tasks without relationship-activated principles. Staff need opportunities to learn on the job, supported with coaching and work-based supervision. It need not require more resources but a different way of thinking and behaving. It enables exponential acquisition of skills and behaviours and the attitudes that people have a right to expect. A person-centred philosophy integrated into an organisation is the best way of ensuring that neither a medical model nor a social model dominates. Socio-therapeutic care requires a multi-disciplinary and integrated collaboration and co-operation that focuses on what older people with long-term conditions must have. Doctors are knowledgeable about medical intervention but not necessarily about caring. Nursing is about professional caring for the whole person and, despite exemplary practice in many care homes, professional practice has been underdeveloped.
A fear of the medical model taking over, however legitimate, has unfortunately played down healthcare needs in many social care settings, diminishing the nurse’s role. In some cases, healthcare professionals’ decision-making is undermined by other social care professionals who have limited understanding and education on the healthcare needs of older people with complex conditions.
When health and social care was split – it was about money, and we were left with no clear definition. Social care felt it didn’t need to know much about healthcare and vice versa. It was thought that, for example, in a residential home we can just call in someone when we decide it is needed. But who takes responsibility for this decision and for the ‘patient’ when the health professional leaves? People are left vulnerable as care staff can’t always recognise early signs or determine when health needs arise, change or need to be responded to differently. We need more knowledge, critical thinking and skills in-house.
To combat the pressure, we can’t afford care assistants to be treated as nurses or treat nurses as enhanced care assistants. We need clarity about roles, levels of legitimate authority, responsibility and accountability to deliver care in a socio-therapeutic way. This must involve the individual, their families and access to a wider range of specialists across health and social care.
Programmes, such as Elizabeth Care®, are emerging to provide a more multidisciplinary and evidence-based picture of what is needed, worked into a carefully thought out, enriched role for nurses, other registered professionals and ‘carer practitioners’ with enhanced roles in socio-therapeutic gerontology practice that is not ‘medicalised’. They can lead to foundation and work-based degrees giving a clear career pathway. An alternative to taking the most promising staff down the management route. A work- and skills-based education would deliver the care needs fit for a growing, ageing population and develop experts and specialists in caring for older people. Staff need an innovative mix of knowledge, skills and practice that currently sit in a range of disciplines. Development at senior level must be offered at the care delivery end to provide the right care experience for residents and relatives and equip staff properly.
Care homes are understandably defensive and justify themselves about the quality of their care as they are unfairly targeted, underdeveloped and misunderstood. We must take the initiative to be seen as equal partners along the care journey. We must take strategic ownership and drive our own future to equip our workforce and provide a worthwhile career pathway, creating our care homes as centres of learning, attracting people to work with us. We must also have a larger share of resources from Health Education England as older people in ‘social care’ settings have the same rights for quality care as the rest of the population.