Dr Laurence Clark Delivering Dignity in North Lancashire

The Project Collaboration between Lancashire County Council and the CCGs in North Lancashire which aimed to: – improve standards in the care and support of older people – raise awareness of dignity and embed a person-centred ethos across all settings. Delivered July ‘13 – March ‘15

What We Delivered An overview of the various definitions and understandings of dignity.. A provider audit questionnaire around person-centred approaches. A Delivering Dignity Launch Event on 16 July 2013 attended by 25 providers (although 31 booked to come).

What We Delivered 3 Appreciative Inquiry sessions, although more were planned and subsequently cancelled due to poor take-up. 3 coaching and mentoring cohorts were established. Each cohort attended a series of 6 monthly half-day sessions which explored coaching tools and person-centred approaches to bringing better outcomes for older people. Across the 3 cohorts 20 people registered their interest and 14 attended.

What We Delivered 3 Welcome Values workshops were delivered. The Welcome Values project recruits, trains and supports people who use services, family carers and staff from care providers to visit other people who use services and assess the quality of their care. Providers involved were the Lancashire In- house Provider, Lake View Nursing Home, Hill Croft Nursing Home and Care Watch Morecambe.

What We Delivered An end-of-project celebratory event was organised and subsequently cancelled due to poor take-up.

The Evaluation Based on: Notes from workshops & meetings Project delivery action plan. A one-to-one interview with a participant on the Welcome Values workshops. Bespoke questionnaire completed by both facilitators. Survey Monkey questionnaire identifying outcomes from the project completed by 7 participants.

Appreciative Inquiry “begins by identifying what is positive and connecting to it in ways that heighten energy and vision for change. …AI recognizes that every organization is an open system that depends on its human capital to bring its vision and purpose to life… The outcome of an AI initiative is a long-term positive change in the organization… AI is important because it works to bring the whole organization together to build upon its positive core.”

Appreciative Inquiry Numerous AI workshops were planned and cancelled due to poor take-up, despite phone calls, s etc. Enabled staff to meet with older people and family carers and learn from their perspective what matters, what’s working and how they want to move forward being included as a valued partner.

Appreciative Inquiry Older people told the facilitator that they had never done anything like this which highlighted that this inclusive way of working in partnership with people and families is not embedded in these services. The recommendation for each session was to involve families and older people in future meetings to ensure dignity continues to remain at the centre of all support.

Coaching and Mentoring Aims: to enable managers and supervisors to undertake structured, productive sessions with their teams using coaching and mentoring tools to provide greater understanding, motivation and encourage commitment to person- centred principles that support dignity in older people’s services to enable managers and supervisors to work in partnership with their teams to deliver dignity in care to older people and their supporters

Coaching and Mentoring Feedback from facilitator: “Feedback was that the sessions helped people learn new skills and confidence to make sure the people they support are at the centre of what they do, also, offered some solutions that we don’t do as frequently as we should because we focus on risk and systems that aren’t about people.”

Coaching and Mentoring Feedback from participants: “I learnt new skills in coaching the staff team, understanding them better and sharing information as part of appreciative inquiry.” “The workshops were excellent. Pauline delivered the information with passion and engaged me in all aspects.” “I signed up for the course with Pauline Doyle… Not Pauline’s fault but the course was a non-starter [as] candidates did not turn up; no commitment.”

Welcome Values The values identified in the workshops were: Zero tolerance towards abuse Respect Treating people as individuals Independence, choice and control Listening and supporting people to express their needs Privacy Feeling that people could complain without retribution Engagement with family members Assisting people to maintain confidence and positive self-esteem Need to alleviate people’s loneliness and isolation

Welcome Values At the end of the workshops 3 key themes were identified which can be celebrated: 1.There appears to be a lot of respect for people who use services. 2.People who use services are given privacy. 3.People who use services are in many ways at the centre of personal choice and control.

Welcome Values 3 things were identified by participants that need to change: 1.How people who use services are empowered to have more of a voice and be willing to complain. 2.How to ensure people are safe where they live, especially in relation to living safely and comfortably in large services with other people who may occasionally or regularly be upset angry and unpredictable and have an effect on the wellbeing of others. 3.How to ensure the least restrictive practices are used for people who use services.

Welcome Values Feedback from participants: “It enabled me to develop skills in delivering ‘dignity training’. The most successful to date has been an adaptation of the process we learnt which has been a "dignity focus at mealtimes" document rolled out for all our staff to monitor and improve delivery of care at mealtimes under the key "dignity values" areas. I intend to expand this over further specific areas of care within the home…”

Conclusions Workshop facilitators said: Workforce is aware of dignity standards but little evidence of how they implement those standards in every day practice. At the start of the project they overestimated the level of skills and knowledge around dignity and person- centred thinking within the workforce. People struggled to commit because there were other training courses on offer.

Conclusions Workshop facilitators said: In learning disability services the value and importance of including all stakeholders has long been acknowledged, however this is not the case with older people services. This created a barrier to delivering the project in an inclusive, participatory environment.

Recommendations There needs to be a serious review of systems that are not person centred in organisations. There needs to be a strong push to make sure that the voices of older people and older carers are valued and incorporated in developing future practice. There needs to be a serious review of person centred values for the workforce

Recommendations There is a need to change the model of care for older people with more personalised services and more personal budgets in health and social care. Basic values training needs to be delivered across the entire workforce. There needs to be a long-term strategy around developing new models of services and decommissioning old-fashioned, institutionalised services.

Recommendations Training on Positive Behaviour Support, physical intervention and least restrictive practices need to be delivered. The Welcome Values process needs to be condensed down to two workshops and a workbook to make it work for Older People’s services.