Health & Social Care Provision |
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RESIDENT PARTICIPATION IN Health & Social Care Provision A Workshop Report Wednesday
19th April
2002, 10.00am ‑ 4.30pm
INTRODUCTION
The
future potential of Sheltered Housing focuses on the provision of health and
social care support to create 'a home for life':
Whilst
discussions take place at a national level between ministries and quangos
involved, and at the local level between care providing agencies, little seems
to be done to involve the recipients of care and support, and, in particular
residents of sheltered housing
In
our own previous Workshops, we have on many occasions discussed residents'
participation in:
We
have not previously discussed residents' participation in health and social
care issues; residents continue to be viewed as passive recipients of care.
Why should this continue to be so?
Support
and care provision is very personal and individual;
But
residents have a collective interest in ensuring that their own scheme (and
others provided with the same management structure) is, as far as is possible,
a 'home for life'; that as they grow more frail and dependent support will be
available to enable them, if they so wish, to continue to live in the scheme
rather than move to a residential care or nursing home (such a move not only
has financial implications but signals a marked loss of independence).
Residents
ought therefore to have a say in the type and level of support and care
available within their scheme and the manner of its provision
What
input might residents, therefore make?
Over 100
participants attended the Workshop, well over a quarter of them being
Sheltered Housing residents, with the majority of the remainder being scheme
or line managers. In the
morning session two projects were presented at length together with a third
brief presentation. The first of these described a large scheme offering a
wide range of care and support services, with substantial resident
participation; the second described a Best Value exercise; the third, shorter,
presentation outlined resident participation in the move towards
extra‑care provision.
PRESENTATIONS
"Empowerment
:
Myth or Reality" ‑ Angela
Bradford, Assistant Director The ExtraCare Charitable Trust, assisted by Derek
Chawner and Joyce Bough, residents of Berryhill Village ‑ a scheme of
nearly 150 units in Stoke‑on‑Trent
The
Extra Care Charitable Trust evolved 15 years ago from Coventry Churches HA; it
is a Coventry based organisation working in the Midlands to provide various
levels of support within a housing environment, though it also manages, today,
some nursing homes. Currently the Trust has 37 schemes, accommodating some
1200 older people, employing a similar number of staff and involving 1000
volunteer helpers. The Trust's philosophy is to offer services, up to the
levels provided within residential care and nursing homes, to older people in
their own accommodation so that they don't experience the trauma of moving as
their needs increase, usually marked by loss of independence. The provision of
care and support is backed with a wide programme of activities enabling
residents to contribute to the life of the scheme. A feature of ExtraCare
developments is the pre-planning that takes place before the opening of a
scheme. From a data base of over 9000 interested potential residents,
workshops and consultation days are set up in the selected localities (400
people attended a recent day in
Northampton). These events explore perceived needs, embracing design features,
activities welcomed, preferred tenure (at Warrington both rented and leasehold
properties are included) and the levels of care and support sought.
Such
pre-planning involves all aspects of provision of the type of meals to be
provided and their cost, the charges to be levied for various activities, the
charges of purchased domestic services. At Berryhill Village, for instance,
many of the activities were already ongoing before the residents moved into
their new home.
The
vision of the residents of what they expect from their scheme is co-ordinated
with those of other providers - Social Services, Health and Housing
Five
levels of support are identified: from a minimal need of domestic support to
the equivalent of nursing care. All flats within a scheme can meet all levels
of support ‑ one does not need to move if one's support needs change.
Flexibility enables a person to move both upwards and downwards in support
level; close collaboration exists with social services
Berryhill
Village has a staff of 30 embracing care and support tasks, housekeeping and
catering administration. Also included are a well‑being advisor, fitness
instructor and volunteer co‑ordinator. The aim is to involve all
residents in the management of the Village; 'street' meetings are held monthly
The
Well‑being Centre, including chiropodist, optician, dentist, is
available both for residents and also older people in the neighbourhood
At
Berryhill Village, a well being advisor has been engaged from fund raising
events; it is hoped that the PCT will finance the continuance of the project.
The advisor offers annual screening to identify health risks. In recent months
it was found that 20 Berryhill Village residents had diabetes ‑ but none
knew about blood testing or dietary needs; a special interest group has been
developed which has resulted in all those residents achieving acceptable blood
glucose levels. Similarly those with raised blood pressure, urinary infections
etc have been identified and supported. These support groups also serve an
important social function
Those
residents with the lower levels of support needs are able to access specialist
staff at all times
Angela
provided two case studies of residents who came to Berryhill Village after
very serious acute illnesses or surgery but who, through the support and
activity provided, achieved much greater levels of independence
Each
of the speakers emphasised the wide range of care and activities available to
residents. Any support plan is designed with the full agreement of the
resident and reviewed monthly, 3 or 6 monthly. Residents are strongly
encouraged to set goals for themselves (eg: to walk without a frame within the
month). The Village offers them opportunities to achieve their goals
The
ExtraCare Schemes demonstrate that, within a sizeable community a wide and
flexible
array of support services and activities can be offered. Individuals have a
wide range of choices open to them. Collectively they can oversee this range
of choices to ensure that it meets most of their needs "A Different Kettle of Fish" Sharon Mitchell, Business
Review Manager, Atlantic Housing Group
Sharon
Mitchell described the approach to Best Value adopted by Eastleigh HA, in
partnership with Fernhill Care Ltd, as part of a Housing Corporation BV Pilot
in March 1999 Labels, such as Investors in People, Quality Assurance, Charter
Mark, Crystal Mark are used as symbols of quality in the workplace. The label
Best Value connotes of the 4C's: Challenge, Comparison, Consultation and
Competition. One must see Best Value as an integral part of the process of
service provision ‑ not an add‑on extra What is extra‑care?
It encompasses frail older tenants, some of whom need relatively little
support, whilst others need higher levels of care and support to maintain
their independence. This project involved 117 tenants in two higher schemes.
Extra‑care aims to promote independence, dignity and choice and to
provide a home for as long as is wanted. Support is provided on site for 24
hours a day. Quality is assured through employment of staff with NVQ levels 2
or 3; all are already employed, with no casual employees. Care is bulk
purchased through a contract established via social services. Individually
tailored care packages can include washing and dressing, toileting and
bathing, food preparation and medication and tailored to meet individual needs
This is a very different type of service from that usually subject to review
‑ eg: property maintenance and repair. It is a 'soft' service in which
exact quantitative measurement is difficult; it is based on personal
relationships; performance indicators are not well established and there is
little or no comparative baseline information. In a fiercely competitive
market , information is tightly guarded and it is difficult for tenants to
make an input. There is a large number of stakeholders involved in providing
and using extra-care services Who are the stakeholders and how might they be
involved? This project's strategy aimed to support and facilitate the ir
involvement, recognising their complexity. A range of involvement options must
be adaptive and flexible, maximising the linkages to wider tenant
participation and community involvement A matrix was devised which mapped the
power and interest of the several stakeholders. One need not spend much time
involving quadrant A but one must target one's resources to those in quadrant
D
Mapping
Power and Interest
To
amplify: Different Stakeholders may be involved in different ways
...
For
Example
...
Other
agencies and community groups need to be embraced ‑ eg: Help the Aged,
Association for the Deaf, Cancer Relief, MacMillan Fund etc
There
are obstacles in involving some stakeholders in the partnership. Frail older
people are often unable to participate fully and wider views must be
incorporated through proxies. The very number of stakeholders produces
problems
A
variety of formal and informal techniques of involvement were used in the
project. 40% of the tenants took part in one to one interviews; three small
groups were established and 14% of tenants took part in focus groups. An
Advisory Board embraced key players; outside organisations formed a
Consumer Panel. Scheme Staff could not be used as interviewers but they were
made to feel comfortable with the process and were encouraged to cite
obstacles to development, opportunities for improvements What
Worked? Front end planning took time but provided a focus for the project.
Stakeholders, especially the tenants, drove the process. Good practice was
shared and linkages maximised. Family members and carers acted as advocates In semi
structured interviews people were asked to rank what issues they felt to be
important, and these were then compared with satisfaction levels
Focusing on What Matters
Performance / Importance
Matrix
A
series of Soft Pi's was developed
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