To improve quality in social care, it helps to understand what the best possible quality looks
like, over and above the standards required by law. SCIE brought together the best available evidence
to help identify the key ingredients of excellent care and support. SCIE’s review of the evidence
concluded that excellent services put people who use services in control, help them to sustain
good relationships and to spend time on activity that is meaningful to them. In this film we
brought together a panel of experts, including people who use services to discuss what
excellence means in a supported living setting.
First, let’s meet the panel. Ann Netten is a Professor of Social Welfare who helps define
excellence for the Social Care Institute for Excellence. Dr Julie Beadle-Brown is a Reader in
Intellectual and Development Disability at the University of Kent. Dorothy Runnicles uses social
care services and is a campaigner for older people. And Pat Charlesworth, a self advocate
and champion for people with learning disabilities. Today our panel will analyse a series of
clips of social care in action, all taken from the Social Care TV archive. And
they’ll discuss examples of excellence.
When I went to assess Marjorie at her previous care home, I saw a lady who was sitting quietly
in her own room. She didn’t engage much with me in conversation. Her son had told us that she
used to play the organ at the local church and had a lot of pleasure and music had been
a very important part of her life.
- Have a go, have a go. - Ooh.
[sings] Have a go, Jo. Have a go.
We then decided that we would try and sit with her for a very short period each day and see if
she could pick up tunes again. So we would sing a hymn to her and she started again picking up those
tunes and playing some of those favourite hymns. It’s given her back some of her dignity.
This afternoon she’s actually going out to a concert with a volunteer and we think that
she will really enjoy that. It would be very easy for us to forget that our residents
are individual people with their own personal history and their own background and their
own things that they’ve liked to do and that they’ve been proud of.
[concert music]
- Are you enjoying it? - It’s good, isn’t it?
If I were ill, or if my mother was ill, I’d want people to remember who she was, what her
background was, the things that she used to like to do. And that’s very important for us here at
Val House. Indeed, the whole process goes much more smoothly if we treat people as individuals.
[music ends, clapping]
The clip leads the panel to discuss person centred care.
They actually recognised that she had a previous life, that she wasn’t just a number
in a room somewhere. And I wondered how often this lady would be taken out. Because that’s
what excellence is about, is sustaining a better practice, not just a one off.
Family background is really important, to keep the link with the families. Otherwise you
just don’t know where people have come from.
But then they had to find a way of resourcing that, and actually so they
found - they managed to find a volunteer.
The volunteer was really enjoying the music as well, which is great.
So it was a shared interest, it was something which she was enjoying. And for volunteering
things to work, then finding people who’ll enjoy the same things is important to do.
One resident who posed a dilemma for the staff was Des. Des had come to the home
on a high dose of anti psychotics because of challenging behaviour.
He was very unsettled, very angry with life. And he used to pick up the furniture, pile
it in the middle of the dining room and talk about fire. He was just so angry and upset.
And the first instance from staff was oh my goodness, we can’t keep him here.
In Des’s case, the care workers made a remarkable discovery about his
habit of piling furniture high.
We looked at his life history and we found that he was a painter and decorator. And in fact what he
was doing was preparing to decorate. He would cover up televisions with sheets, strip off his bed.
And so when we looked at that just understanding what he was doing helped the staff and we’d
have a meeting and sit down and say ‘OK, how can we help this gentlemen?’ We had paintbrushes,
and a roller, and just some water in a tin. And he was just so pleased to be able to
have some sort of meaningful occupation. And it’s an important part now of his life.
The panel discuss the importance of meaningful activity.
You could see the wider impact that the empowerment of that gentleman and finding out
about his history would’ve done. The mere fact that he is now happy, you can imagine how that
would spread to other people. Because an angry person in a home is not easy to live around.
And if you think about where it ended, we don’t know what happened next for them.
But an interesting next step would be to see how far you could take the decorating activity
for this man. He was relatively able, it’s possible that actually he could have engaged
in real decorating when it needed to be done.
It also requires the encouragement of staff to do that and to have their wits about them
in terms of what they can do to empower and enable. And somehow to acknowledge the
individuality shown by the worker who found that route and be prepared for that route
to be continued so that it becomes part of the culture of the others in the home.
In Surrey, 40 year old Lisa has a history of challenging behaviour. Lisa has now learnt
to use a language of signs and symbols, which enables her to communicate to support
workers like Yann, her basic needs and desires.
So Lisa’s just signed that she wants a cup of tea, in her book, so we’ll
have to go and get you one, won’t we?
Learning this technique makes a huge difference to Lisa’s wellbeing and ability to cope with life.
It means a little bit of independence for her, she’s joining her social group, it’s better
interaction with peers. It also means that she can get what she wants, she can show her choice
in all aspects of her life, whether it be an activity or whether it’s something as small as
choosing her breakfast cereal. If you put the communication in and make sure that she
knows exactly what she’s doing at any given time in the day, she’s a lot easier, she’s a
lot calmer, she knows what’s happening, it reduces the anxiety straight away.
The panel discuss the importance of communication when working with people
with severe learning disabilities.
For far too many people with learning disabilities, medication is used to control
people’s behaviour. Like walking around like a zombie, basically. That’s not good, that’s
not living, you know, that’s just existing.
Communication is such an important thing for all people with disabilities and deprivations
of various sort. And how possible it is with someone who doesn’t speak. And that is not
usually acknowledged we talk about getting their stories from their carers, or talking with
their family, but in fact you can communicate with people who don’t speak. That’s excellent.
And it’s a good example of knowing, of using their way of - giving them some technology,
some means by which to communicate, and to make choices, to be able to show what they want,
what they want to do. And as they said, even the small things like which cereal
to have for breakfast, or which larger activity they want to do, if you put the
communication strategies in place it has a whole range of benefits in terms of
meaningful activity as well as choice and empowerment I think.
Jan knows all about challenging behaviour. Her fourth child, Andrew, suffered brain damage
during his traumatic birth. As Andrew reached adulthood his mother Jan decided the best way
to safeguard his future, was to take control. Using direct payments, she recruits, trains,
and manages his entire team. She has studied Andrew’s triggers, and over time, has
developed a guide which outlines the style of life that suits him best.
This is Andrew’s Essential Lifestyle Plan. It tells us what makes Andrew happy, it tells us
what makes him upset. And it tells us what his important routines are. It’s a living document.
It helps Andrew by providing good information to the people that support him. Information that he’s
not able to share himself because he’s not able to talk. And he doesn’t necessarily - well I guess
he does know what makes a good day, because he’s going to be happy. But if you’ve not seen
him have a good day, how are you going to know what makes a good day? There has to be a
way of recording all of that rich knowledge and experience and that’s what this plan is.
We’re going to go up to town aren’t we?
Andrew’s brother Gary helps out whenever he can.
If we ever get up to the chemists and back in time.
- [Laughs] - If! Yeah.
Every Friday, Andrew eats out at a local Chinese restaurant, where he
has his own menu to choose from.
- What would you like today, Andrew? - What do you think you want?
The sweet and sour.
Thanks to Jan and other members of his team, his lifestyle is busy. And his
challenging behaviour, usually manageable.
- [Exclamation] - Yeah, Its a bus.
The panel see excellence in Andrew’s social interaction and communication.
I think - one of the things that was very powerful about that clip was about this plan,
this living plan, that point that was made about a living plan. And that isn’t dependent entirely
on it being in that particular circumstance, that living plan could happen in a care home,
could happen in all sorts of different circumstances, and it’s a very good way of people
communicating about exactly those different preferences and so on. So that empowerment comes
through that kind of communication between different people involved in the care home.
And you know, if Andrew doesn’t use spoken language, that’s not the be all and end all.
No. I think you do see that he has quite a lot of communication skills, because you - he is
understanding, both I think through rapport and through situation. What I thought was the nicest
thing was that the waitress didn’t ask the brother or anybody else, she turned to Andrew and she
asked him, ‘what would you like today Andrew?’ So obviously she knows him, it’s a familiar
environment, and then he showed on his picture menu. So he had a special menu of the things that
he liked, and he made a clear choice of what he wanted that day. So again you see both
relationship, you see choice, you see community kind of inclusion, the waitress in the restaurant
knows him, and actually she interacted with him.
On one occasion when I went into the small ward that he was in, one of the nurses said,
he’s having his bath, do you want to come in and help. So in other words here was a recognition
that even in the most personal aspects of Michael’s care, that I was involved. I mean,
I’d been bathing him for months before, so why shouldn’t I continue with that now. And they
recognised that. Things like that really made us feel that we were being honoured and respected,
and accepted for who we were in relationship to each other. So when he died, and that moment when
he died, and I always remember just pressing that buzzer and they came in. And I remember the nurse
saying, you’ve just been wonderful. Sorry, it doesn’t usually hit me like that. But she said, you
were there for each other. And that’s how it was.
I think that’s the most important clip that I’ve seen in recognising the end of life care
requirements and needs for excellence to come in. And we’ve got a long journey there, but
there are signs, that’s one of them, they know what they’re trying to do in involving
the closest and nearest to that, into that process, and that’s really excellent.
The fact that this person’s sort of closest, the person closest to him, was able to be
involved both in his care, and in his life remaining, actually has implications for
everybody, whether you are in the ageing environment or whether you’re somebody
with a learning disability.
In order for that relationship to continue to be as good as it was, it was partly
about the excellence of care that allowed that to continue to happen.
And here kind of you know different sort of groups of people from society, having different
needs and needing those acknowledged and respected, and that’s a very good illustration of that.
When I was given the opportunity of managing my own care budget, one of the great things that
came with that was the offer of additional hours of care support wrapped up in that budget which
I would be able to use for purely social purposes. There was a recognition if you like that my
needs had grown and what mustn’t be ignored as well is the - being able to go out and do things.
What managing my own budget has enabled me to do is to continue to attend things like theatre
performances, concerts and so on. I’ve even gone to the Coliseum, to English National Opera
with my carer. Not only was I getting out and about and enjoying something but I
was also feeling as if I was still part of a world to which I once belonged.
This clip exemplified the idea of service users being in control as part of an
excellent approach to care.
He didn’t just have the needs of his physical disability, but that he had the needs that were
about relationships and social inclusion for example. And so the fact that he was specifically
allowed to have some support to do activities like going to the concerts, going to the Coliseum
etcetera, was clearly very important for his overall wellbeing and overall quality of life.
The two if you like really most important things for people actually are around feeling in control,
which is what we’ve been talking about, and feeling in control of your life, but also spending
your time doing things you value and enjoy. Yes, I think I mean a personal budget, especially
when you’ve got somebody as capable as he clearly is to manage his own budget and do things exactly
the way he wants is a very good way of achieving that sort of control. But it is possible in
other sorts of settings and it’s a question of making sure that you take into account
people’s own views and the way that the services are put together or whatever particular
package of support is put together.
The panel conclude that excellence is achievable, if people working in social care
treat people as individuals, try to give them control and work on good relationships.
I think one of the key things that comes across, across all these videos is the
need to focus on the individual and to know about the individual, whether it’s
their history and what’s important to them, or whether it’s what they like here and now.
I think the thing that came through to me particularly was about the diversity of ways
you can give people control. You saw people from a wide variety of different situations,
abilities, levels of communication and so on. And in each instance people were being
given a way to reassert control.
If it really changes for better, and people’s lives, you know, get better,
then - that’s wonderful.