Here’s some news. A revolutionary idea. A life changing way of working that saves money and improves the quality of every day living for care home patients. A pilot scheme, a novelty that has and could transform the way people live, and reduce the costs of their healthcare.
This is traditional. Going back to what we did before managerialism and measurement happened. Individualising Care. Tailoring interventions to needs. Treating each patient as a person in their own right. Doing what we did before we had to do the same for everyone, at the same time, irrespective of whether they needed it or not.
I went to university in 1986. My institution had just built a shiny, glass fronted new building for a new department which looked futuristic and claimed to be the future. A new building for a new discipline, for new times. It was called Management Science. I remember not knowing anything about it and therefore not having any views on it, except mild envy that those students got the new building and those of us studying dusty old subjects got the dusty old buildings. But part of me liked the dust, the history, the sense of continuity through the centuries. Part of me knew even then that whilst the world and its buildings might change, that whilst I would see in my lifetime a number of charlatans keen to reframe the way we should see the world, that people were and would always be, broadly the same. Motivated by the same things, such as love, belonging, meaning and connection, working in the same ways, to the same ends as they had always done.
Now, looking back over 30 years at the professions I work with, the public facing helping professions, I see that whilst people’s motivations have remained the same, the ways in which they are forced to work have not. ‘Care’ has become something that has to be ‘delivered,’ teachers are assessed on their students’ results, and if you are burgled you get a crime number, not a visit from a police officer. And then society wonders why half of its public servants are suffering from mental ill health and the other half don’t engage with what they do. Engaging leads to frustration; frustration leads to emotional injury; emotional injury leads to mental ill-health. Easier not to engage at the outset.
There is a protocol for everything, a measurement for everything, a manager for everything and people managing people managing people…..I once overheard a senior manager say that it might be an idea to think about having a meeting to discuss whether or not anyone thought it would be worth considering holding a further meeting to discuss a proposed piece of work. Is this how things get “kicked into the long grass?” How many meetings have you attended that urged you to engage in some “blue sky thinking?” How many hours are wasted every day, of taxpayers money, to think about maybe discussing something? How many days are spent on appraisals to discover that most people are doing the best they can in a finite area with limited resources? How many months are lost to recording professional practice rather than doing it? And all the while the clipboard mentality, so beloved of the CQC and the HMI, urges us to standardise. Doing the same thing for the same people in the same way, so we can measure it, seems to be a groove into which we have become stuck.
Bolton recognised that this groove was not working and was actually costing more, in financial as well as wellbeing terms. So they experimented. They provide training for 41 Care home staff, across 16 Care homes, to develop them as Enhanced Care Coordinators (ECC). The ECCs were given “the training, the authority and – critically – the time to focus on improving residents’ health and wellbeing.” (https://www.theguardian.com/society/2019/apr/23/new-role-improving-care-home-residents-health.) It does beg the question, why are all residents not given such support, but the issues with care homes have already been well reported in the press of late.
So how does an ECC work with a patient? The answer is that there is a concentrated period each day. Not only does the ECC help the patient to get ready on a morning, spending up to an hour on that, helping the patient to face the day, but they also have the authority – and budget – to call in outside professionals to provide tailored therapy to help build strength and more importantly, agency in the patient.
Patients develop the physical and emotional strength to care for themselves, with some being able to manage their own medications, and others being able to develop the independence to move out of the care home. Even the ability of a patient to self dress, wash and toilet and walk to the dining room, relieves long term carer workload; a short but focused period of support can lead to longer term independence which overall saves money for the system and enhances the wellbeing and agency of the patient. It is hoped that more costly resources will be used less, such as ambulance call outs and hospital admissions.
Innovation? No. Rocket science? Certainly not. Good old fashioned care, based on individual needs and time, to develop the patient to be more independent, is not new. It’s what used to happen before everything was reduced to a checklist. Of course people will complain that to takes time, and to that I refer them to an excellent TedTalk which proves that 40 seconds is all it takes to show compassion for a patient. ( https://m.youtube.com/watch?v=elW69hyPUuI) And that, like the ECC project, shows the benefit is not just to the patient. Professionals and patients alike flourish when compassion, kindness and care are in evidence.
We all complain about learned helplessness, about patients, students, trainees wanting to be spoon fed. But how far has this one size fits all managerial culture created that desire?
By refusing to allow tailored care for each person, by adopting a protocol driven, mass policy for all, we have taken away the autonomy and agency of each individual, whether patient or learner.
Bolton are giving it back. Call it what you like, but those of us who have worked for long enough in these professions always knew that this is how to be, didn’t we?
Even before the great glass buildings arrived.