Compassion in Healthcare at Torbay Hospital

Last month Mum mentioned she’d seen a talk advertised in the library, it was being held at our local hospital and was being given by Sarah Tobin. It was on a Monday evening, a day I worked at home, Mum was curious and thought it might be of interest to me from a work perspective. So we agreed we’d go and I did a quick google to find some info and came across this. The event was the first attempt at a Health Science Cafe event being held at the hospital and most importantly they’d be free parking, a small but important manner. If you were to play a word association game with anyone who has had anything more than casual use of the health service I’m confident it wouldn’t take long before they mentioned parking – finding a space only being half the battle. Anyhow, I digress, this was an early evening event with free parking and Sarah Tobin, what was not to like.

Who is this Sarah I hear you ask? Sarah was one of the many professionals who provided support for my Dad, and all of his family, when he was first diagnosed and through his treatment for bile duct cancer. Specialist nurses are worth their wait in gold, they have intricate knowledge of what you are facing, have always made themselves readily available, always *always* return your phonecall if you have to make one, have the ability to unlock doors and generally give a sense of confidence in a quite daunting experience. I guess you could think of them as nursing sherpas who guide you through it all….we were lucky to have the support of several different ones and they all helped enormously.

Last Monday we arrived at Torbay Hospital, parked up and I checked in on Foursquare and was delighted to see I’d not been to the hospital in nearly six months. Dad died last November and until then I think I had visited at least every four months and in the latter stages of his life far more frequently, with a large number of visits as an emergency admission. The last time I’d been at the hospital was to drop Mum up to deliver thank you tins of chocolates to the staff who had cared for Dad. I still wasn’t really sure what to expect but off we went.

We were greeted by Helen, the Trust librarian who came up with the idea of the Health Science Cafe at Torbay. She had mentioned in the press release linked above that she felt it was important for people to have the chance to visit the hospital site for occasions other than just to meet medical need. One of my take home thoughts from the evening was how good it had been for me to return to the hospital that has played such a significant role in our lives over the last five years, with a positive reason. To drive up without the nagging doubts, the butterflies, the anxiety, the stress. To be honest it felt a little odd, after we’d parked up I had to remind myself that there was nothing to worry about!

The talk was very informal, there were about ten of us there although I think most people were previously associated with the hospital in some formal way. Sarah introduced herself, she now works 0.5 as a specialist nurse and 0.5 in teaching and education. She told us a little of her own personal experience, and indeed what fuels her interest in this area, and about her masters that focused on whether you can teach compassion and her current PhD studies in the same area.

She went on to talk about a number of key approaches adopted within SDHT (South Devon Healthcare Trust) to support work on compassion. These included:

Patient storytelling – this was introduced as a benefit to patients, where they are given the opportunity to share their experience. Their experience is tape recorded, transcribed and then shared with teams in a facilitated discussion designed to identify future improvements.

Observations in care – after a day long training session people are given 2o minutes to observe a ward/healthcare experience. Observers work in pairs, they note down what they see, hear and smell, purely as objective observations with no reasoning or judgement attached to them. They compare and contrast their notes after 20 mins and feed back to the staff members they have observed.

Schwartz rounds – this approach developed in the US at The Schwartz Centre and piloted in the UK by the Kings Fund provide a monthly, one-hour session for hospital staff to discuss difficult emotional and social issues arising from patient care.

Other approaches discussed included the development of a Leadership Programme for nurse leaders and ward managers, the introduction of the Friends and Family test, and Jeremy Hunt’s new requirement that nurses work for a year as healthcare assistants before training. The discussion was wider than just the steps taken to increase compassion, we also discussed the issue of complaints (90% focus on communication in some way), the changing shape of training over the years to include a greater focus on communication skills, the balance of positive to negative feedback (3:1), pride in nursing, how to gather feedback to get a hospital wide picture, the number of patients in hospital and their reasons for being there (80% of the surgery carried out at Torbay is now done as day surgery – this leads to changing methods of patient care, changing demographic of inpatients and so on).

Media Impact Mention was also made of the media and the negative expectations that many people have of hospital care, before experiencing it for themselves or those they care for. Initial analysis of the Friends and Family test feedback at Torbay commonly reports ‘it was loads better than I was expecting’. The local paper had been invited to advertise the Health Science Cafe and run a story on it, they had declined the opportunity. I can’t help but feel bad news sells more newspapers than good! Maybe they’ll get behind the later events, perhaps even send a reporter along to share with a wider audience.

Our discussion of the impact of the media also extended as far as two fly on the wall documentaries currently showing on TV, 24 Hours in A&E filmed at King’s College Hospital now in it’s third series, and Keeping Britain Alive: the NHS in a day filmed across the NHS on Thursday 18 October. I have a real interest in these documentaries, part morbid fascination with something new, part as an example of human behaviour and within that the compassion captured, part also as a reminder of how lucky we are to have a national health service.

While I imagine only certain people are interested in these programmes (best viewing figures for an episode of 24hours in A&E just top 3million people, Eastenders and Coronation Street routinely get double or three times that), that is still a large pool of people who do appear interested in this user generated content. One Born Every Minute, another Channel 4 documentary series now in it’s fourth series is set in an NHS Maternity Ward and clocks viewing figures of almost 5million; it’s not clear what exactly it is that people are interested in but I’d hazard a guess that it is part real-life stories that could as easily feature us and our family members as players that attracts them. Thinking about the three approaches Sarah had discussed one of the common features of them is reflected in this documentary approach, they all give a real-life focus and focus on the experience (of patients or staff) and allow for reflection on that experience as a prompt to identifying learning points, or building resilience, and also in humanising people.

This blog post was designed to share the experience a little more widely, partly because I was left with quite a few ideas and questions I’d like to think of further, so your own thoughts and experiences are very welcome. A lot of my thoughts were about how it’s possible to create a common team/organisation wide focus that focuses on an individual’s experience of compassion; how you define, or develop a shared definition of compassion; how you keep learning and reflections alive and tangible; whether there is enough focus on positive feedback as well as negative; how important and value laden compassion is – perspective being key; whether certain environmental circumstances are likely to reduce, or increase, compassion; and whether greater focus on staff members’s as individual’s could create behaviours among patients that increase their own chance of being treated compassionately (and vice versa)! What do you think?

Reaching critical mass? Social media at #NCASC

Last month I attended my fourth National Children and Adult Services Conference #NCASC in Eastbourne. The first time I attended in 2009 was to launch the resources from Safety Matters, an action research Change Project I’d been running at RiPfA focusing on adult safeguarding. We had a session in Harrogate presented by myself and a couple people from the project who worked in one of the local authority members in our network. The session, and resources, were really well received; the feedback was amazing and I left clutching a handful of business cards and a big fat grin of satisfaction! We followed up afterwards by email or phonecall with the contacts we had made. At that time I’d been using Facebook for two years, Twitter for just over one and LinkedIn for a mere six months but I wasn’t confident of the value of any of them for my working life.

Fast forward to NCASC 2010 in Manchester and l can share with you that there were three people tweeting from conference about adult social care, three of us, Vic @cpeanose, Mark @MarkWatsonKM and myself. I suppose there may have been one or two other exhibitors or journalists tweeting, and I think Jasmine @Jasmine_Ali was tweeting about children’s services but I couldn’t confidently name any more. There was no organised hashtag and very little online action, but I left convinced that social media had more to offer our sector. Last year we started to get a momentum building at NCASC 2011 in London; there was a veritable feast of tweeters, policy makers, journalists, exhibitors and at last an (unofficial) hashtag and engagement with people not attending conference. I shared some thoughts on it here:

This was my third time at NCASC and each year I leave exhausted with a lot more to think about (and a head full of more ideas) than when I arrived. I usually meet a few people in person that I’ve not met before, my favourites this year were @jaimeelewis @mroutled and @philblogs and I was also delighted to see far more real life networking inspired by twitter connections. [As an aside I do believe that the #socialcare sector is finally realising the potential of #socmed].

Ever the optimist, despite having my bid for a social media session rejected in 2011, like a dogged determined stubborn one woman show with a belief for something better, I persevered. This year I was successful in my bid to run a social media session at NCASC 2012. The focus was Social media as a tool for citizen and community engagement and three years after starting talking online about the value of social media, and two years since RiPfA had started to use social media to engage people with our work and coproduce content, we had the opportunity to talk to other people about it. I was given the foyer bar area, in a lunchtime slot, up against some brilliant alternative sessions including another RiPfA one led by @gerrynos and @rich_w talking about our joint work on user-led organisations. Let’s just say I wasn’t optimistic about expected attendance.

What happened next really surprised me, people arrived, and more people arrived and more people arrived until there was standing room only:

Even better people participated; I didn’t want a session on social media to involve me talking at people, so it was really rather important that people shared their thoughts and ideas. I was also at that point in conference myself where I thought if anyone else talked at me my head might explode; I’m quite a kinaesthetic learner who heavily relies on the left side of my brain, and there had been lots of words but little else at that point – good words mind, but lots of information broadcast. So I was delighted that the audience participated and also engaged people not in the room through using twitter. My slides are below:

Social media as a tool for citizen and community engagement #NCSAC 2012 Workshop from George Julian

I’ve had lots of great feedback following that session, lots of energy and ideas, lots of people sharing the value of social media for their roles as Councillors, Directors, Service Managers and Service Providers. Community Care profiled the session and some of the discussion with it here. I’ll put some more thoughts down about the session in due course but for now I promised to share the slides, so they’re up.

I know I said it last year, and I could always be accused of being overly optimistic, however, it does genuinely feel like social care is *finally* beginning to recognise, and hopefully realise, the value of social media.

The importance of feedback

A couple of weeks ago I made a momentous decision.

I decided to resign from my job.

Dear Colleague

It is with regret that I am writing to let you know that I have taken the decision to resign as Director of research in practice for adults, and move on from Dartington. I’ve worked for RiPfA for over six years, have enjoyed my time immensely and feel privileged to have had the opportunity to work closely with so many committed and passionate people across the adult social care sector.

I am extremely proud of RiPfA, the support it provides and the progress that it has made to support evidence-informed practice over the past seven years. I will remain in post until the end of November. We are using this opportunity to look at the leadership needs of the organisation over the coming years and we expect recruitment to start later this year.

Please don’t hesitate to get in touch if you would like to discuss or if you have any questions.

This was one of the hardest decisions I’ve ever made. I love my job and really enjoy the people that I work with, within RiPfA and throughout the social care sector. I’m sure in time I’ll blog some more about the decision, the learning and the stacks and stacks of ideas that I’m not likely to now see to fruition but I hope someone else will take and use. In the meantime the answer to the question I’ve been asked the most is: I don’t know. I have no concrete plans for the future, a stack of ideas, but no job or certain plans so do get in touch if you would like any of them and/or if you know of any opportunities I might be interested in.

The other point I wanted to make was just how lovely most people have been since I shared my decision with them. I have been blown away by the compliments, the support and the regard that people seemed to have for me, as well as for RiPfA.

It really has been a difficult but wonderful week.

So my final thought for now is that if you know someone who you think does a good job, then why not let them know next week. I suspect we all probably underestimate the power of positive feedback and as lovely as it is to hear things now I’m moving on, I probably could have done with hearing them (or believing them) before. Go on, make someone’s day.

Getting social care evidence into practice

There have been a couple of discussions on twitter and blog posts I’ve read recently that I’ve wanted to reply to, the most clear one came from @Ermintrude2 who wrote an excellent post about her struggles to keep up with research while working in frontline practice. Ermintrude, works as a social worker in an integrated mental health team, alongside NHS colleagues – she is an Approved Mental Health Professional (AMHP – pronounced ‘amp’ for anyone not in the know), a Best Interests Assessor (BIA) and a Practice Educator. She is also a prolific blogger and tweeter – she is likely the perfect opposite to apathy when it comes to social care practice.

In her post Ermintrude discusses the impact of work culture, of an employer’s attitude to research, and of professional attitudes to the importance of keeping up to date with research. She also talks about some of the sources she uses for information and keeping herself up-to-date, I was delighted to see RiPfA in her list, alongside other similar organisations who in one way or another are working to support people in social care practice to access and use research. I would recommend you read Ermintrude’s blog if you’re interested, the quote that made me chuckle into my coffee was this one:

One of the chief things I’ve learnt is that just because an article is presented in an academic journal, doesn’t mean it’s well-written or useful. We shouldn’t idolise academics as there is as great a variety in quality as there is in practitioners but there is no doubt that having an active interest in current academic research and debate is the next best thing to being able to be actively engaged in contributing to research.

I don’t think Ermintrude is alone. It appears to me that there is growing interest in the application and utilisation of social care research evidence and this interest is coming from several directions. There are those who work in social care practice, like Ermintrude and many of the people I saw on twitter engaging with that particular post, who care about their practice. Who want to be able to readily access research and use it’s findings. There is a considerable group of people who use social care services or who support someone who does, and I would argue an increasingly growing group of people who have yet to need to use social care, but who are aware that they may need to at some stage. Obviously there are social care providers, individuals or small organisations, alongside large national companies, who all want to do a good job providing social care and have an interest in efficiency and standards. Then there are those who work in social care training, development and education who to keep need themselves current with the growing evidence and knowledge to do a good job. Then of course there are academics and researchers who are producing research evidence, there has always been interest in what happens to the new knowledge that is created and there is a growing focus on research impact, I’m also hopeful that the focus on the Research Excellence Framework (REF) will go some way to turning attention to how research actually gets to those who need it.

So, all in all, there is potentially huge amounts of interest in getting social care evidence into practice and I’m really delighted to share with you the launch of a new project focusing on this very topic.  The project, Creating an Impact: Social Care Evidence in Practice is a collaboration between the LSE team from the NIHR School for Social Care Research, RAND Europe and of course, research in practice for adults (RiPfA) and the LSE Higher Education Innovation Fund have kindly agreed to fund it.

The project aims to look at three areas:

1. Exchanging evidence and practice around two key areas – the Care and Support White Paper and Long Term Care – these are deliberately broad topics so there should opportunities for most interested parties to get involved
2. Exploring best practice methods for exchanging knowledge, and
3. Making the case for research

If you’d like to know more you can read an outline of planned activities on the new project blog, which is in development and will be added to throughout the project. There isn’t currently the function to subscribe to the blog but hopefully there will be soon. If you would like to get involved with the project there are two immediate opportunities:

Firstly, there is still just about time to apply for the project coordinator role, this would be a great opportunity for anyone interested in the issues we’ve been discussing. Applications close on Wednesday 5 September so you’d need to be quick but please do consider applying and share the advert with anyone you know who might be interested.

Secondly, we’re looking for people who work in social care, you might be a social worker, an AMHP, a care worker, a provider, anyone who works as a social care practitioner, who would like to contribute to some media articles. We’re looking for people to comment, (anonymously if you prefer – we just need your generic job title and some idea of the region where you work) their thoughts about a) what does not work well currently and why relevant research is not feeding through to you, and b) your thoughts about what researchers need to do differently in future. This should take no more than five minutes of your time, if you would prepare to do this let me know and I’ll provide your details to the person compiling the contributions. Feel free to just add a comment to the bottom with your thoughts if you prefer – it would  be good to see what people think.

There will be lots of opportunities to get involved with the project over the coming weeks, keep 19 October free for the first unconference if having read this you can feel the fire in your belly burning a little brighter. Hope to hear from some of you and see some of you there.

(cc) Photo from Astronomy_blog on flickr - taken at the Dr Who Exhibit at the Wales Millennium Centre, Cardiff Bay.

Social media for social care – let’s not forget personalisation

This is going to be a short post, I promise, it’s also a little thrown together as I’m finding 140 characters just isn’t enough space to try and explain what I mean! This post builds on two previous posts of mine Social media is not the answer written in January, and a post from the end of October about measurement of impact Social media metrics: reach ≠ quality and three excellent posts all written this week, The role of social media in a social worker’s continuing professional development from @mgoat73, Use and application of social media in social work and social care education from @jaxrafferty, and Social Media and Social Care/ Work Education from @Ermintrude2. All of these posts discuss the role that social media can play and it’s relatives benefits and limitations. I’ll not repeat what they say here.

Before we go any further, do you know who this is? You’ll find out by the end of the blog if you don’t!

I just wanted to make one small point. For a sector that has spent the past few years struggling (and continues to struggle) with developing a personalised approach to support, those of us currently using social media to discuss social work or social care, seem to have forgotten (or be in danger of forgetting) about the need for personalisation. Social media can certainly be a useful tool, in my experience it has opened doors, formed and supported connections and relationships, provided a viewpoint I wouldn’t otherwise have, given useful context from many worlds I don’t regularly inhabit or have access to.

The benefit of social media as a support for broadcast or information share is well established, even in social care. Well maybe not well established, but it’s logical and easy to explain to someone, and I’m confident we could find examples of it being used in this way. I don’t believe we’ve even scratched the surface on its potential as a tool for collaboration or crowd sourcing, for creating content and sharing ideas across the sector.

I also have yet to see any evidence of social media making much impact as a support for those wishing to access and use services, I’m sure there are one or two notable exceptions, but I’d hazard that these anecdotes are just that. Those of you in the social care sector who are familiar with personalisation will almost certainly have heard the anecdote of the guy from the north, who bought a season ticket for the football/rugby/cricket with his personal budget*. Social care is full of these examples, genuine stories from service users that get borrowed by politicians or civil servants and before you know it they become part of the folklore, and yes I deliberately put in the vague notion of what the season ticket was for because I’ve heard it claimed as so many things in recent years, a classic case of Chinese whispers!

So my plea, because I promised to keep it short. Let’s not forget about the true meaning of personalisation, about giving choice and control to the end user. To do so that means a range of methods for learning, sharing and communicating. A range of approaches for doing our business and providing support. So let’s talk about the benefits that social media provides, let’s dream expansively about the possibilities, but let’s not claim it as a panacea.  It has huge potential, within a range of approaches, but let’s ensure our end users get to choose to use it, rather than those of us who are converted trying to convince them it is the most appropriate choice!

*The season ticket holder (shown in the piccie above) was Gary Croft from Oldham, you can read about his story here.

Abuse and Neglect – do we love animals more? The Sequel.

Back in June I wrote a blog post comparing the public response to two current news stories – the first about Winterbourne View, the scene of institutional abuse of people with learning disabilities, and the second about two Metropolitan Police dogs who suffocated when their handler left them for too long in a vehicle. These stories were both equally horrific, but the public response to the animal cruelty was far greater than to the abuse of people with learning disabilities.

Tonight when I checked the BBC news site I was appalled to see the headline story of a local woman who had abused a kitten. This story was reported this evening and has so far (at 21.30pm) been shared 2800 times.

The news story I was looking for was about a new report from the Equality and Human Rights Commission (EHRC) that has found home care for older people is so bad at times it is breaching their human rights. This story was the headline this morning, was reported on the site just after 8am and over 12 hours later has been shared 1300 times.

As I argued back in June, both of these situations are horrific. I’m not advocating that abusing humans is far worse or far better than abusing animals, I’m just surprised at our reaction to it. Still surprised.

Signposting

RSPCA Cruelty Line 0300 1234 999

NSPCC HelpLine 0800 800 5000 and ChildLine 0800 1111

Action on Elder Abuse Helpline 0808 808 8141

If you are concerned about a vulnerable person (adult or child) suffering abuse and don’t know what to do about it contact 999 if it is an emergency or a crime or contact your local council or police force for other concerns. Usually if you Google ‘reporting adult abuse’ and ‘the area where you live’ you will usually find what to do.

Another trainline fail

Booking train tickets is the bane of my life. I’m very lucky in that I have someone who can help book my travel if I’m organised far enough in advance to ask them to do so, however the reality is I’m not always as organised as I’d like – especially when I’m trying to juggle work travel with some sort of social life at home. This week I’m off to give a masterclass on research use in #socialcare practice at Kingston University. This makes my soul ache for numerous reasons, namely the eight hours travel (at least) on a Friday, the feeling of losing some of my weekend by being away from here on a Friday, the inevitable busy trains, the fact that Kingston is a good hour and a tube/bus/walk away from Paddington. Luckily, the subject matter makes my heart sing and I’m optimistic that the session itself will be good fun, and hopefully well received, and I was invited by Ray Jones who has been a staunch supporter of our organisation for years, so I’m delighted to be going, just less delighted with the travel.

Anyhow, why am I waffling on about this? Well tonight I decided to book my travel, and what happens:

I wasn’t allowed to book a ticket, the system didn’t tell me I couldn’t book, just that I couldn’t book accommodation – which I’m guessing means a seat. Please tell me the train companies are not allowed to now sell you a ticket without a seat? Booking train tickets has stolen so much of my life over the past few years I couldn’t face fighting the booking system. I decided writing this and appealing to the wisdom of twitter, was more likely to resolve the issue.

So any ideas for how to book my travel? Please? Or any offers of lifts door-to-door gratefully received!

Social media metrics: reach ≠ quality

I need to start this post by confessing that I’ve been wanting to use ≠ in a post for ages. For anyone who is thinking it’s a typo, it’s not it’s actually the symbol for *does not equal*, so indulge me with my quirk if you will and keep reading – anyone who got here already.

In fact let’s start right there – that’s me, that’s my quirk, that’s my indulgence. When I blog I tend to stay very true to me, it’s a personal blog, I write what I like and I don’t worry too much about who reads what. If I was blogging for work, or concerned about understanding or promoting something of mass interest, I doubt I’d start a blog like this, I’ve already lost at least half of you who stumbled here I guess. There is the point of this blog post – a reflection on social media metrics, and the challenges of measuring anything useful and the relationship between self and audience satisfaction.

50%

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I joined the #lgovsm chat this week and found it really useful, in fact I really enjoyed the fast pace discussion and challenge, you can read a write up of the discussion here. The bit that made it for me was hearing from new people, who only rarely fall into my social media path, and having some debate and discussion. I work in social care and in my opinion we’re a sector woefully short of social media influencers. In fact I’d argue those who may be considered to be such know very little about #socialcare – they may know about #socmed or about communications, but few seem to understand the intricacies of social care, and where they do they only occasionally have the opportunity to join in a lot of the social media discussions because their working lives doesn’t facilitate them sitting in front of a computer to participate.

At this point I  should declare (in case you’ve not noticed already) that this post is likely to be full of sweeping statements – I’m sure that’ll lose another 20% of you as I offend your own viewpoint, apologies.

70%

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Back to my last point, certainly most people working in #localgov social care are lucky if when they can access computer equipment, they are not on machines that are at least 5-10 years old, running IE6, without a sound card. Lots of residential care providers have been helped online through the Department of Health funded Get Connected project, but there is still a long way to go before most providers are active participants in social media. I’m not even going to consider those of us who use social care services, rather than work in them (and I know it’s not either/or) but I think that needs another post, another time.

Maybe this is the same in other sectors, or maybe it is particularly pronounced given how slow the social care sector has been to embrace technology more broadly, and social media as one vehicle within that. I’m not sure, but I’m sure there are some social media experts who will let me know. Which brings me on to the point of my post that could make or destroy it’s reach – working on the assumption that I’ve only lost 70% of the readership already. The blatant opinion, that is likely to upset those people who have the most social media reach. These are the people who have the largest networks, and/or the most followers, and/or the most ‘influence’ (as measured by social media metrics).

95%

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If you’d like to know more about metrics and their measurement then take a peak at the post written by @Ermintrude2 that you can read here and that post built on an introductory one from @ClaireOT which you can read here.

There are so many limits to social media metrics, I’m not going to get into the algorithms (because the posts above do) but I’m going to offer three tricks, as I see them, for anyone interested in increasing their influence and/or extending their reach:

1) Follow more – invariably those with highest influence scores follow thousands of followers on twitter, or facebook, or linkedin. There is a simple reciprocity bias at play here, the more you follow, the more follow you – and therefore the more people there are to share your wisdom and musings with the world.

2) Don’t talk to the little people – one or two well timed interactions, with other similarly ‘influential’ types will boost your scores, chat and discussion with those lower down the food chain won’t. So you get more influence for hanging with the cool kids than encouraging and welcoming new people into your social media circles.

3) Re-tweet (RT) as much as possible, or better still take someone else’s tweet, add your own hashtag and mention them at the end with a hat-tip (HT) if at all. This will allow lots of people who follow you to think you’re adding to the discussion, they won’t necessarily know that it isn’t your contribution and when it comes to them RTing they’ll end up RT you not the person at the end of the tweet (where you remembered to mention them).

I believe all of those three tricks will help increase your reach and influence. What none of them do though is account for quality, and there lies the rub for me:

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reach  ≠  quality

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It seems to me that one of the great successes of social media is that it enables us to turn broadcast on it’s head. It is no longer about cascading information, but about disrupting and debating and reframing and building and contributing to information. It is about a living, breathing entity. Therefore I’d like to see any social media metric measuring engagement and participation, and quality of contribution within that. Unless I’m missing something the metrics just aren’t there yet. So I’ll keep my head in the sand and keep relying on my favourite social media metric – a word of mouth recommendation, or a discussion with someone who bothers to engage with me. I know that I’ll bias my own network like that, I know that I’ll make my own judgements, which may well not be as reliable as the algorithm, however I prefer my own judgement of quality over quantity or reach any day.

Disclaimer: I know nothing about klout or other social media metrics, I’ve never visited their site or awarded any scores to anyone. I try to follow no more than 100 people on twitter and my facebook account is full of photos of my mates babies. I am  NOT an expert on this stuff – I’m just throwing my thoughts into the mix. I do NOT wish to offend anyone, merely to promote discussion and to that end I’d love to know your thoughts and views. If any of you read this – thank you – I can’t believe you reached the end!

My arrows came from here.

Reflections on #NCASC – let’s start with people

For the last three days I’ve been in London for #NCASC – the National Children and Adult Services Conference. A considerable focus of the conference was #integratedcare and the need for #health and #socialcare systems to work closer together, set within the current economic situation and reduction of resources. I think its fair to say that at times at conference you’d have been forgiven for forgetting that what we are all really interested in is improving life for people who need to use health and social care services. I guess that understanding is absolutely implicit, and the challenges are great at the moment, so much so that it would be easy to reach a state of being overwhelmed with the magnitude of the challenge, and disillusioned with what can actually be done.

So, I’d like to share a good news story.

While I was going about life at conference, back in sunny Devon unbeknownst to me (because my Mum didn’t want to bother me when I was working), my Dad was getting increasingly breathless. For anyone reading this blog for the first time, my Dad has cholangiocarcinoma (bile duct cancer), and he has a terminal diagnosis. Just over a week ago we had an appointment with his consultant (you can read the post I wrote the day before we went) where he told us that one of his tumours had shrunk slightly (and the reaction). This is great news as we’d tried to prepare ourselves to hear that the cancer had spread to his lungs given his difficulties to breathe and recover from the slightest of physical activity. We were told that Dad was anaemic, and the relationship between tumours needing blood supplies and the tumour shrinking was gently explained. More blood tests were taken, the possibility of an endoscopy floated, iron tablets and vitamins promised once the results were available.

On Thursday Mum decided they could wait no longer, Dad didn’t want to hassle (neither of my parents ever do) but Mum balanced up the possibilities of Dad’s health deteriorating sharply over the weekend (anyone who has had to rely on our health or social care systems knows not to get ill at the weekend) and the need to just gently nudge the system. One phone call from Mum to the Oncology Dept revealed that they had the results and someone would phone back with them. Hours later a chance inquiry into Dad’s health by their GP when dealing with my 93yo Grandad led to him getting involved and prescribing iron tablets and following up with Oncology too. A day later Dad has a course of iron tablets and a blood transfusion booked for Tuesday because his haemoglobin levels were so low. I’m confident that we have that outcome for two reasons, because my Mum didn’t wait until things got worse and chose to take action herself (in spite of how uncomfortable that makes her feel) and because our GP knows enough about my family to ask about my Dad when dealing with my Grandad. I’d like to think that his information recording computer system is good enough that when he looks at my Grandad’s notes he is able to see that he lives with his 91yo wife next door to their daughter and son-in-law who provide them with care and support, one of whom also happens to be terminally ill. I know I’m pipe dreaming but you know what I mean.

So what has this got to do with NCASC?

Well, as I sit here musing on Saturday, the words that made the most impression on me were from people who I know and respect, all of whom focused on people as part of the solution. These were Councillor Sue Anderson from Birmingham City Council who addressed a session on Health and Well-being Boards #hwb and focused on the need to focus on good relationships rather than bureaucracy. She wasn’t suggesting that the systems and strategy are not important, she was however stressing the need to start with relationship building and trust.

Next up on my thought provoking list has to be Richard Jones. The Director from Lancashire CC and former ADASS President took the floor in the Think Local Act Personal session #TLAP on the final day and challenged #socialcare to focus, arguing that we were getting caught on second order conversations about #integration and #resources and forgetting the people at the centre. Making it Real the new publication from TLAP will prove useful for anyone working on #personalisation to judge their progress against the end results that citizens have identified they need. Sue Bott also talked a *lot* of sense in the TLAP session, with a humour and personality to her delivery that few before her in conference had managed – she even got a room full of conference weary delegates to raise a virtual toast to Making it Real!

My final sense talker has to be Peter Hay, the Director of Adult Services in Birmingham and this year’s ADASS President who took the floor a number of times at conference. He joined the panel in the final session that focused on #integratedcare and the work of the Future Forum and again brought the focus back to those who use #socialcare services, reiterating a challenge from Lord Crisp at the conference opening to build services around #life not around #care or #health.

Isn’t that all a bit naive and over simplistic? 

I’d like to think not. We are without doubt in need of large scale system change, #Dilnot challenges us all to consider our own future and how we will provide for our old age or social care costs, whatever your view on the Health Bill the creation of Health and Well-being Boards present an opportunity, our demographics are changing, as is our technology, our family life and our expectations. None of this is new though, not really, the likes of @RichardatKF can tell you all you need to know. Surely, we have known for long enough what works and doesn’t work with regards to integration and we must know by now that people just want to feel well and live their lives as independently as possible. Maybe it’s just me but I’ve yet to meet someone who cares which budget their support comes out of, people just want to live their lives.

So what can we do?

This was my third time at NCASC and each year I leave exhausted with a lot more to think about (and a head full of more ideas) than when I arrived. I usually meet a few people in person that I’ve not met before, my favourites this year were @jaimeelewis @mroutled and @philblogs and I was also delighted to see far more real life networking inspired by twitter connections. [As an aside I do believe that the #socialcare sector is finally realising the potential of #socmed]. I’m sitting here believing that change can happen, we have clear evidence around these challenges, we have enough people with enough experience to move on some of this. Personally I believe that this requires commitment and leadership, from those at the top of government (I too struggle to see how bin collections are more important than social care) to match those from the sector who I’ve mentioned above. As much as I welcome any attempts to engage people on the future of care and support (6 weeks left to contribute) I do wonder whether what we really need is a commitment to action.

The one consistent in all of these discussions and system challenges is the person who is trying to live their life. Start with the person, they (and their carers or family members) are the lynchpins in all of these systems and services. Let’s start improving services now, we can’t afford to wait.

NB: Just a thought, #socialcare readers of this might be interested in an earlier post What is Service Design? – the comments and discussion especially may help unearth some thoughts for how we can move on such large scale system redesign, without forgetting the end user or person who uses them.

#JSWEC Social Work Education Conference

I’m up in Manchester for this year’s Joint Social Work Education Conference – this is the 13th year that it has been run but the first time I’ve attended. I’m talking about ChangeCards – what they are, where they came from and how they are being used in social care. I’ll post about my presentation afterwards, on the off chance any of you are interested.

In the meantime I found this tweet from last year’s conference:

This year’s programme is packed with brilliant sessions, you can see what is going on here.

I’ll be there, I’ll be tweeting and using the hastag #JSWEC. I’m sure I’ll not be the only one, whether we’ll succeed in quadrupling I don’t know – not sure how many people were tweeting last year, but I’ll do my best to provide highlights. I have a niggling suspicion that there wont be many people tweeting – in my experience social work isn’t a sector full of tweeters, but I’m hoping I’ll be proved wrong. We’ll find out tomorrow.