Is a new dawn in social care delivery about to, well, dawn? It appears that it may be in some parts of the country. New types of social care workers in adults’ services have been trained to undertake new tasks in 28 Skills for Care-funded pilots that kicked off in 2003. A further 50 projects launched this year.
“New types of worker” is a term in the white paper Our Health, Our Care, Our Say. And these new workers are needed, says Jim Thomas, head of the Skills for Care pilots programme, because “in adult services, we’re good at redesigning services, but not so good at redesigning the way care is given”.
Thomas explains that since policy now requires the increasing involvement of service users in the design and delivery of their care, workers will need new skills and original roles will have to be developed.
So far this has meant much imagination from care providers consultation with service users about the content and delivery of their care packages negotiation between agencies to develop new joint working procedures and training to give more skills to frontline workers so they can do different, more sophisticated tasks.
The pilot project in Leeds combines health and social care delivery. Someone with a critical illness being cared for at home might have an assistant home care worker come in to help get them out of bed, dressed and given breakfast. They then might have to endure the disruption of visits in the afternoon from several health care staff to address their various medical needs.
But if the care worker had been trained in administering that kind of medication, it could have been sorted in one go in the morning, says Margaret Pease, resources manager for community support services in Leeds.
The pilot began by training 20 home workers in elementary healthcare skills up to NVQ level two, then pairing them with district nurses who initially closely supervised them as they carried out basic clinical tasks. Once the nurse was satisfied as to their competence, they were permitted to perform those tasks unsupervised.
“When you talk to users, they’re not interested in whether you work for health or social care, they only care if you’re competent,” says Pease. She believes that improving the skills of care workers, many of whom might never have held a qualification before, makes sense in terms of reducing continuous daily imposition on service users and gives greater job satisfaction and status to the workers involved.
A cynical view might be that reducing vulnerable service users’ time with highly qualified nursing staff allows a money-saving bonanza for councils. An alternative view, says Pease, is to see this as a way of making best use of the resources you have.
Another example of new workers offering new solutions includes the six “assistive technology” staff at Norfolk Council. As social services’ focus shifts to enabling people to live as independently as possible, and as technological advances promote this aim, so service users and their carers need to be alerted to the tools that can help them.
But people’s nervousness about what they perceive as unfriendly modern equipment has to be considered, says Bernadette Olley, one of the assistive technology support workers based in Great Yarmouth.
“When you mention technology to the older generation they think of computers, and it’s all unfamiliar territory to them. I might have to spend a fair bit of time explaining how a passive infra red system works to detect movement, and showing a carer how it can alert them to their partner getting out of bed in the night, so they can help them to the toilet safely.”
Not falling down the stairs on a trip to the bathroom could equal not breaking your hip, so that an older person remains physically and mentally healthy for longer, resulting in huge savings to the NHS and social care budgets.
Changing the way service users are viewed so they can become service providers is another example of how new types of worker are being encouraged. Mental health service users, for instance, if well supported, can offer professional skills and personal insight that are invaluable to people with mental distress, or buckling under the strain of being a carer.
At the Service Users Complementary Project (Such) in Taunton, Somerset, “holistic helpers” are people who are or have been mental health service users and have been trained in complementary therapies including aromatherapy, Indian head massage, reflexology and one-to-one listening skills. These services are then offered to mental health service users, as well as people with physical conditions and carers.
Holistic therapist Maggi Rowan started the project on a voluntary basis in 2002. Since receiving Skills for Care funding, she has trained in management skills, and she and the other four members of staff have been able to be paid. Taken together, this has enabled Such to extend its service provision so more people can benefit from the team’s unique skills and perspective.
“It is a big help that the people working here have an in-depth understanding of mental health” was one service user’s comment, and it’s a sentiment echoed by many others in the project’s evaluation report.
Without benchmark data it was difficult to measure the overall effectiveness of the initial 28 projects, says Ian Kessler, reader in employment relations at Oxford University’s Saïd Business School, who carried out the first-stage evaluation.
But despite the limited number of employees involved, he says “we found there was a genuine attempt to develop new roles, and they reflected real changes in what people did and in their job titles”.
“At their best, they were having good effects: there were shorter waiting times and feedback from users was that they felt they were getting more of a specialist service.”
But in terms of sustainability, there was a mixed picture. Some new roles finished when the initial pilot funding ran out, especially in the voluntary sector.
The pilots that succeeded best were those that had explicit buy-in from those at the top. “If people who are championing change and innovation in social care are not properly supported by senior managers then the change does not work,” Kessler says. “Some have worked brilliantly, others haven’t worked as well, but you have to allow for failure, and then learn from that.”
More on the projects and the Skills for Care programme
This article appeared in the 10 April issue under the headline “Pilots on parade”