Climbing the mountain: Setting off for basecamp
29 October 2015
If you want to go-fast go alone. If you want to go far, go together
Why I wanted to make change
I have recently taken on a new role as practice development lead for dementia care at Abbeyfield Kent Society. The Society has 6 care homes, all supporting people living with dementia. I have been asked to support home managers and their staff to move practice towards more person-centred support.
So, where to begin. After years working in many different roles, including being a dementia care practice consultant and safeguarding consultant trainer, this is my first role where I have the scope and authority to instigate large scale change across more than one care setting. It has been hard to describe my emotions but I would say that a combination of intense excitement and visceral fear would come close. Excitement at the fantastic opportunity, the fabulous people I am working with and the passion I have met from staff eager for change. The visceral fear from the enormity of the task.
I know that person-centred thinking works. It works because both the process and the tools bring people together in a spirit of equality, reciprocity and mutual respect. The support at Abbeyfield Kent is based on the Christian principles of caring, compassion and companionship. Whilst our values hold true to those that underpin person-centred practice, they are not so easily discernable in the fabric of our organisation.
Spending time last year in Bruce Lodge, a care home supporting people living with dementia in Stockport, I saw first hand how people living with dementia can be supported to live enriched and fulfilled lives through personalisation. In the fabulous book, ‘Making Individual Service Funds Work for People with Dementia Living in Care Homes’ (2014) Sanderson and Bailey describe the outcomes, but importantly the journey of how personalised time is created and sustained. Person-centred care is no longer a bolt on, or something extra to be done when we have time. Person-centred care is essential as a bedrock to personalisation. The Care Act  enshrines personalisation and its imperatives in law. The new CQC inspection frameworks require services to evidence that they are delivering personalised services.
I want to bring person-centred thinking to Abbeyfield Kent, to move beyond person-centred care to a service that offers personalised support. One important difference between traditional person-centred care and personalisation through the use of person-centred thinking tools is the inclusion of the experiences of the formal and informal carers. Not only do we seek to understand the experience of the person living with dementia, but we show equal respect to the qualities, aspirations and needs of paid carers too. Kitwood reminded us that carers are people too. Across all 6-care settings I have met managers and carers who committed to doing the best for people they support, but who, at times, have not felt as though they are always treated like people.
What I tried:
But before I could bring the staff together to start to plan the strategy, I needed to get to know the service and the people within it. My initial plan has been to complete exploratory visits to all care settings, gathering information about the way that care is delivered, the views of the staff and the people we support to help me to have an idea of the care and support that is currently available. I have used a combination of direct observation, using Dementia Care Mapping™ and guided self-assessment tool from Progress for Providers – checking your progress in delivering personalised support for people living with dementia. I have completed through guided conversation with bother manager and care coordinators of each setting. I have found that the Progress for Providers tools are very powerful in themselves as they generate conversations and reflections about practice and help managers to really drill down into what good support looks like.
On all of my visits I have been excitedly talking to everyone about my plans to introduce person centred thinking tools and the good conversations that take place in the development of one-page profiles. I have shared as well that my ultimate goal, through some years away, is to introduce individual service funds for everyone living in the care settings.
What I have learned:
Across all Homes the Progress for Provider scores provided the evidence for our feelings, that we are only just getting started in working in a way that helps the people we support to have more choice and control in their lives.
What I am pleased about
There is a huge appetite for change across Abbeyfield Kent. When you talk to people about the power of person-centered thinking tools there is often a very common response, and it is usually along the lines of: but that is so obvious why haven’t we been doing this before”.
What I am concerned about:
In discussion with Michelle at Helen Sanderson Associates, as part of the ‘Personalised programme for managers- which is an approach that supports managers to deliver person-centred change and build personal resilience without leaving the workplace’, I reflected on my progress to date, and the challenges I thought I had ahead of me. At the same time as I have been reflecting on the first parts of my journey I have been reading First break all the rules (1999 Buckingham, M. and Coffman, C.). The authors ask 12 fundamental questions that employees ask of themselves, that great leaders need to answer if they hope to keep their employees motivated and engaged. In the book the journey is liken to one of climbing mountains. And this was an analogy I could relate to. When I started my new role my needs were basic, and encompassed in the first questions: do I know what is expected of me and do I have the right materials. Well yes, I thought. I have those. I know what I am doing, what I am bringing, where I want to go. Job done, deep breathe – on wards and upwards.
When I spoke to Michelle I shared my concern that there was so much to do, so many changes to make that I was unsure where to start
I had my baseline information. My qualitative and quantative data and my enthusiasm, but I didn’t know where to start. Michelle as able to help me to step back and look about me. I realised then that there was no one else standing with me at basecamp. Not because they didn’t want to go, but because I hadn’t shared with anyone that we hard started! As the proverb says, if you want to go far you have to go together. If you want to introduce person-centred thinking, you have to model it.
Based on what I know what am I going to do next:
I have developed three outcomes, statements of what success looks like, that give sense to the journey I am asking us to make. The statements link to our scores form Progress for Providers, and focus on making change in areas that will support a greater understanding for all. To support an understanding of what needs to happen to achieve that success managers and care coordinators across the company are now working through the SCIE e-learning resources Getting to know you and you tube videos https://www.youtube.com/watch?v=fnaKnVWFh44 : a great place to start to understand one page profiles and personalisation, and https://www.youtube.com/watch?v=-VYE9cVofTg a great short video about who to create one page profiles for people who don’t use words
And me? How can I show the power of the one page profile? I have printed off numerous copies of my one page profile. I carry them with me. If I want people to learn to share, I need to show them how.
I will let you know what the view is like from further up the mountain
Tanya Clover Consultancy Practice Development Lead for Dementia
Abbeyfield Kent Society
 Kitwood, T. (1997a) Dementia Reconsidered: the person comes first, Berkshire, OU press
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