Sue Robb of 4Children talks to Julie Laughton and Alison Britton from the Department for Education about the role of childminders in delivering the 30 hours free entitlement.
Improving people’s experiences of social care
Alice Maynard, chair of the guideline committee at the National Institute for Health and Care Excellence, discusses new social care guidance and how to provide a positive care experience
Social care is very personal. People have their own care needs and we must understand those needs to ensure people receive the best possible care, delivered in the way and at a time when they need it. Care must be tailored, personalised and most importantly be centred on the person who’s accessing it, otherwise, how can you actually give someone a positive experience? This is why, as a part of my role on the guideline committee at the National Institute for Health and Care Excellence (NICE), we’ve developed a new piece of guidance which looks at people’s experiences of social care and recommends that adults who need social care should be able to shape the care they receive so it fits around them and enables them to be the person they want to be.
It’s hugely important that people have a say in their own care. Everyone is unique, we all have things we like or dislike and having our preferences respected, understood and met is what truly makes the difference when we receive care. This was a key element of the guidance. It fundamentally recommends that people accessing social care services are treated with dignity, as human beings who have their own history and experience that shapes who they are. Sadly, we know at times this doesn’t happen, so having this guideline in place is vital for people to live a life that reflects their individuality. Professionals assessing people’s needs must look at the person’s history, recognise their preferences and really understand how these can be factored in to the care they receive.
For example, when an older person goes into a care home, it’s important to understand who they are and how care can be tailored for them. They might have lived their life as a dancer or an economist so may want to attend a tea dance or read a certain paper for example. The same applies to other groups too. So, a young disabled person might be an avid football fan and want to go to all their team’s matches like other fans. If professionals don’t make the attempt to find out who people are and what they need and want, they can’t deliver high quality care. It may seem like a basic thing to do but it has a huge impact on the person receiving the care.
Experience of care
When we developed this guidance we had a clear aim – to help improve people’s experiences of social care. Being a person who uses social care myself, I know how it feels to be on the receiving end. Often, it’s people who don’t receive care who make decisions on social care frameworks, processes and protocols, yet they may not understand the impact of their decisions. Our guidance is here to change the way social care is delivered in two main ways. Firstly, I would like social care providers, local authorities and health providers to read and take into account the recommendations of the guideline to improve people’s experiences of social care. We also need to make sure people who receive services feel empowered. It can be very challenging as a social care user to know what standard of care you should be expecting. Should you let someone treat you a certain way which you might not think is right? Or can you say ‘please can you do it this way?’. This is important to give people the control to live their lives their way. By doing this, it will encourage providers to look at someone as a person and actively listen to them. Sometimes I don’t think people like asking for something they have a right to, and that’s why it’s important for people working in health and social care to offer a good standard of care where the person is central and their wishes valued.
To make sure people are cared for properly, health and social care must work effectively together. But there are so many challenges the system is facing. Between 2010-2013 we saw Local Authorities’ total spending fall by eight per cent and this is projected to continue falling. Just last year, the Health Foundation found that by 2030/2031 there will be a funding gap of £9.2 billion for adult social care, a total of 40 per cent of the projected budget. Bearing this in mind, bringing these two systems together is now more important than ever before.
Ultimately, working together will mean those people accessing services receive the best quality care regardless of where that care comes from. Often people will access both health and social care services, so the quality of care in both areas needs to be consistent as well as ensuring counterparts from both sides are aware of a person’s history. The guidance encourages social care practitioners to consider how the processes they use for assessing people’s needs and planning and delivering care can be tailored to individuals. People don’t always fit the processes that an assessor is using, which makes involving people who receive care in the design and development of those processes even more important. The committee felt that this could result in a better quality and more cost effective outcome as people would receive the care that they needed to feel in control of their lives.
The committee worked carefully to find and examine the evidence, ensuring our recommendations were fair, honest and focused on actually improving people’s experience. The committee members included professionals working in the sector, people accessing social care services and people with caring responsibilities. People came from a range of backgrounds, including people with local authority experience, those employing personal assistants and people with experience of living in residential homes. Hearing their perspectives was eye opening and hugely important in shaping these recommendations.
Shaping people-centred care
In my capacity as chair I was also able to tap into my own experience as a person who accesses social care. I have a portfolio career that includes working in social care over the past 25 years, predominately within training and consultancy. I was also until recently chair of the disability charity Scope, which provides care services, so I had experience from that role which also helped me with this work. As committee members we all brought our knowledge and experience to guide the development of these recommendations, but we also engaged with people about our work too. During the consultation process we heard people’s views. They thought the work was hugely important but could be challenging to implement. Of course, we recognise that but the prize is vastly improved care for those who rely on it.
We’ve put people who use social care at the heart of our guidance. We want to make sure that people’s thoughts, views and opinions are heard so they can shape the care they receive. It’s really important that those involved in social care services listen to people’s views. We all have a right for our wishes to be respected when it’s something as intimate as the care we need for daily living. What we need everyone to understand is that, for this to happen, there has to be a change in culture and that’s something that will take time and focus, as providers adopt our recommendations. I’m just hopeful that, by using our guidance those providing social care services will be able to make a real difference to people and ensure their experience of receiving care is a positive one.
Setup in 1999, NICE produces evidence based guidance, advice and recommendations for health, public health and social care practitioners. You can find out more about the work of NICE on their website, keep updated with their work by signing up to become a stakeholder or follow them on Twitter @NICEcomms