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Bullying and harassment in the social care workplace

In the past few weeks there are not many of us who have escaped media coverage on sexual harassment and bullying. The Harvey Weinstein affair and the behaviour of members of our political institutions has done much to concentrate the mind. This is not an issue however that is confined to the rich and famous. It does happen in the workplace and no doubt in the social care industry. ACAS are an organisation that I greatly respect for their guidance and expertise, and in this blog I provide a short review on their guidance to managers on bullying and harassment.

What is bullying and harassment

Bullying and harassment means any unwanted behaviour that makes someone feel intimidated, degraded, humiliated or offended. It is not necessarily always obvious or apparent to others, and may happen in the workplace without an employer’s awareness.

Bullying or harassment can be between two individuals or it may involve groups of people. It might be obvious or it might be insidious. It may be persistent or an isolated incident. It can also occur in written communications, by phone or through email, not just face-to-face.

Examples of bullying / harassing behaviour could include:

  • spreading malicious rumours, or insulting someone
  • exclusion or victimisation
  • unfair treatment
  • deliberately undermining a competent worker by constant criticism.

Under the Equality Act 2010, harassment is unwanted conduct which is related to one of the following: age, disability, gender reassignment, race, religion or belief, sex and sexual orientation and is therefore unlawful.

People do not always feel able or confident enough to complain, particularly if the harasser is a manager or senior member of staff. Sometimes they will simply resign. It is therefore very important for managers to ensure that staff are aware of options available to them to deal with potential bullying or harassment, and that these remain confidential.

What can staff about being bullied or harassed?

If staff are being bullied or harassed, they should take any action you decide upon as quickly as possible. It is always best to try to resolve this informally in the first instance as sometimes a quick word can be all it takes. However, if this fails there are a number of options for staff to consider:

  • see someone that staff feel comfortable with to discuss the problem, perhaps someone in HR or company counsellor
  • talk to your trade union or staff representative
  • keep a diary of all incidents, record: dates, times, witnesses etc
  • keep any relevant letter, emails, notes etc.

Why a manager should act against bullying or harassment?

Bullying and harassment create an unhappy and unproductive workplace, that has:

  • poor morale and poor employee relations
  • loss of respect for managers or supervisors
  • poor performance / lost productivity
  • absence / resignations
  • tribunal and other court cases and payment of unlimited compensation.

What can be done to prevent bullying or harassment taking place in the service?

There are a number of key considerations that should help to prevent this behaviour:

  • develop and implement a formal policy: this can be kept simple, but you should consider involving staff when writing it
  • set a good example: the behaviour of employers and senior managers is as important as any formal policy
  • maintain fair procedures for dealing promptly with complaints from staff
  • set standards of behaviour with a service statement about the standards of behaviour expected; this could be included in the staff handbook.

Is workplace bulling getting worse?

A study in 2011, by public sector union Unison, reported that six out of 10 public sector workers in the UK had either been bullied themselves or had witnessed bullying in their workplace. The findings also suggested a strong link between the increased incidence of bullying and the economic downturn, with one in four workers believing that staff cutbacks had been a direct cause of workplace bullying.

The majority of those polled in the Unison survey – 53% – said they would be too scared to raise concerns over bullying in the current climate, compared with just 25% two years ago.

Individuals on the receiving end of unwanted behaviour described conduct such as being yelled at, eye-rolling, verbal abuse, being ‘talked down to’ in a humiliating way in front of colleagues, as well as more concerted patterns of ill-treatment such as ostracism (‘being sent to Coventry’).

Issues raised often centred on ill-treatment by direct supervisors, frequently building to the point where individuals dreaded going to work, and where their home and family life had been affected. Many were on leave or had recently taken leave to ‘escape’ the workplace, to allay the work-related stress and anxiety they were experiencing.

Summary

Harassment and bullying in the workplace may not receive the attention it deserves. To those who suffer the consequences, they find so stressful that it leads to them giving up their job. This is not only damaging to the individual, but the service. To prevent it services need to adopt a culture that not only identifies harassment and bullying, but has procedures in place to prevent it and support staff who suffer from it. Managers should refer to the ACAS website for more information on this topic.

Albert Cook – BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

 

Social Care Institute of Excellence Report prejudice and social isolation experienced by LGBTQI+ Disabled People

Until now, not much has been documented about the experiences of using self-directed social care support by LGBTQI (Lesbian, Gay, Bisexual, Transgender, Queer, Questioning and Intersex) + Disabled People. However, a recent report by SCIE found that LGBTQI+ LGBTQI+ say they have experienced prejudice and social isolation. They also say they are worried that if they come out to PAs (Personal Assistants) / support workers or those that assess and review their support, then that support could be compromised.

A new report, along with two films and two at a glance briefings, highlight, for the first time, some of the issues faced by LGBTQI+ Disabled People in England. They say that too often they have to make ‘bad bargains’ with PAs / support workers whereby they have (out of necessity) carried on with PA relationships even when there was an element of self-censorship or discrimination.

Quote from the report

A man who was not out to his family with whom he lived at the time, said that he had built up enough rapport and confidence with one support worker to come out: “…So I thought I would tell him about my sexuality and he went straight downstairs and told my mum. She was crying. She said to me, ‘Is this true?’ So, I had to lie to my mum and say, ‘I’m not gay.’”

LGBTQI (+ Disabled People say there are many benefits to using Self Directed Support, such as having more choice and control over their care. But they say that this can be a challenge for a number of reasons. They fear coming out to PAs / support workers because their care might be jeopardised. They say that when care needs are being assessed and reviewed there is a lack of attention to sexual orientation and gender identity. They also say that they can experience social isolation; they have experienced prejudice; and they often feel isolated from the wider LGBTQI+ community.

The report and films have been produced by the University of Bristol, the Social Care Institute for Excellence, Regard and Stonewall.

The research

In a survey, in-depth interviews and a focus group of LGBTQI+ Disabled People who use self-directed social care support, researchers found:

  • More than half of those surveyed said that they never or only sometimes disclosed their sexual orientation or gender identity to the Personal Assistants who they paid to support             them
  • More than a third of those surveyed said that they had experienced discrimination or received poor treatment from their PAs because of their sexual orientation or gender    identity
  • More than 90% of those surveyed said that their needs as a LGBTQI+ disabled person were either not considered at all or were only given some consideration when their needs were assessed or reviewed.

Social isolation is a big issue. When asked about getting support to do LGBTQI+ ‘things’ (e.g. go to an event/bar, have help to have sex with self or others) 22% said that their PAs did not help them with any of these activities.

Benefits of Self Directed Support

Having control over support arrangements is the most commonly cited reason in the report for preferring Self Directed Support. Interviewees gave many positive examples of the benefits of Self Directed Support. Previous experiences with agency staff who changed has frequently often led people to opt for Self-Directed Support as they want to be in control of who comes into their homes.

‘Bad bargains’

The study demonstrates that the reality of choice and control for LGBTQI+ Disabled People using self-directed social care support varies greatly. In more instances than not, those in the study had reservations about being open with PAs and staff about their sexual orientation or gender identity; they had experienced direct and overt discrimination from some PAs or support workers; they had made ‘bad-bargains’ whereby they (out of necessity) carried on with PA relationships even when there was elements of self-censorship or negative attitudes.

Professor David Abbott, Professor of Social Policy at the School for Policy Studies, University of Bristol, says: Self-directed social care support continues to provide opportunities for LGBTQI+ Disabled People to exercise choice and control over the support that they get. When support from PAs really meets the needs of LGBTQI+ Disabled People, people in our study talked about the positive impact on identity, inclusion and belonging. But our collaborative research also highlights the barriers that people faced and the lack of routine attention being paid to their human and legal rights.

Summary

This report highlights the concern of LGBTQI+ Disabled People in England who receive self-directed social care support. Leading to a loss of confidence in their PA’s and support workers. In the light of the report managers must ensure that support staff are appropriately trained, and aware of their responsibilities with respect to; trust, confidentiality, equality, discrimination and duty of care.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

The 6Cs in social care

This week’s blog draws the reader’s attention to the Skills for Care 6C’s. The 6Cs are the values which need to underpin the culture and practice of social care service who deliver care and support. Skills for Care have a new guide to explain how the 6Cs link to the important values, recruitment, qualifications, and leadership frameworks in social care.

What are the 6Cs?

  1. Care
  2. Compassion
  3. Competence
  4. Communication
  5. Courage
  6. Commitment

They underpin Compassion in Practice, the national strategy for nurses, midwives and care staff. The 6Cs, were developed as a way of articulating the values which need to underpin the culture and practice of social care services who deliver care and support. These are immediately identifiable as values which underpin quality social care provision too. As integration between health and social care continues and increases it is helpful to focus on common values expressed in ways which increase consistency within all aspects of the work we do, the workforce, leadership and organisations.

Compassion in Practice

The 6Cs are defined in Compassion with Practice as:

Care

Care is the core business of social care services and the care delivered helps the individual person and improves the health of the whole community. Caring defines us and what we do. People receiving care expect it to be right for them, consistently, throughout every stage of their life.

Compassion

Compassion is how care is given through relationships based on empathy, respect and dignity – it can also be described as intelligent kindness, and is central to how people perceive their care.

Competence

Competence means all those in caring roles must have the ability to understand an individual’s health and social needs and the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence.

Communication

Relationships are essential to effective team working. Listening is as important as what we say and do and essential for ‘no decision about me without me’. Communication is the key to a good workplace with benefits for those in our care and staff alike.

Courage

Courage enables us to do the right thing for the people we care for, to speak up when we have concerns and to have the personal strength and vision to innovate and to embrace new ways of working.

Commitment

A commitment to our service users and populations is a cornerstone of what we do. Staff need to build on our commitment to improve the care and experience of our service users, to take action to make this vision and strategy a reality for all and meet the health, care and support challenges ahead.

Learning

Skills for Care have mapped the 6Cs at learning outcome level to the Care Certificate and the diploma in health and social care mandatory units at levels two, three and five.

The mapping shows that the 6Cs values are relevant at all levels. It is important that learning providers see their work as an opportunity to embed the 6Cs into social care practice, through the values and behaviours they encourage and through the activities and materials they use.

Leadership

The culture of a social care service is reflective of the values of those leading it. Every social care service and individual in a leadership role should ask whether the 6Cs underpin the leadership and management styles of the service. If they do not then it is unlikely they will be part of the social care service culture or experience of those receiving its services.

Skills for Care, home of the National Skills Academy for Social Care, has published the Leadership Qualities Framework (LQF). It illustrates the attitudes and behaviours needed for high quality leadership at every level of the sector. Those using the framework may find it helpful to use the 6Cs by reflecting on how they demonstrate the 6C values within the domains of the framework.

Summary

Registered managers should ensure that the 6Cs become an inherent part of the culture of their service. It is an essential part of the national strategy Compassion in Practice, and will be part of the new CQC approach to inspection.

Albert Cook, BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

New CQC inspection regime Adult Social Care Service

After months of consultation the CQC has at last published guidance to providers on how it monitors, inspects and regulates adult social care services. The new guidance I believe represents a major shift in the regulators approach to inspection. The guidance ‘How CQC monitors, inspects and regulates adult social care services’ November 2017, suggests a movement away from the frequency of inspection to more reliance upon information that is returned by providers.

Insight

CQC will use Insight to monitor potential changes to the quality of care. The CQC Insight system is designed to bring together information about a service in one place, and analyse it. This helps the regulator to decide what, where and when to inspect and provides analysis to support the evidence in inspection reports.

To monitor changes in the quality of care, inspectors will check CQC Insight regularly. If it suggests that the quality of care in a service has improved or declined, inspectors may follow this up between inspections or ask providers to give them further information or explain the reasons for the change. They may also decide to re-inspect the service, if there are significant concerns, or may carry out a focused inspection.

Provider information collection (PIC)

The provider information collection (PIC) allows social care providers to submit up-to-date information about the quality of care their service provides at a location. The PIC builds on and replaces the previous provider information return (PIR). PIC information is reviewed and analysed before being passed to inspectors as part of the regular updates they receive about the services they inspect.

Providers should be in no doubt of the importance that CQC place upon the provider information collection and must update the PIC at least annually. If they do not do so, their rating for the well-led key question will be no better than requires improvement at the next inspection.

Inspection

The biggest change to inspection is the frequency in which it is carried out.

A service will have a comprehensive inspection at the following frequencies:

  • Services rated as good and outstanding – normally within 30 months of the last comprehensive inspection report being published.
  • Services rated as requires improvement – normally within 12 months of the last comprehensive inspection report being published.
  • Services rated as inadequate – normally within 6 months of the last comprehensive inspection report being published.
  • Newly registered services and those no longer dormant – the first comprehensive inspection will normally be scheduled between 6 to 12 months from the date of registration.

Comprehensive Inspections

Comprehensive inspections take an in-depth and holistic view across the whole service. Inspectors will continue to look at all five key questions to consider if the service is safe, effective, caring, responsive and well-led. They will give a rating of outstanding, good, requires improvement or inadequate for each key question, as well as an overall rating for the service.

I guess that many of those services who are rated as outstanding or good will welcome the new frequency of inspections. Given they will only receive a comprehensive inspection every 30 months, providing there are no concerns with their provider information return. As a former principal inspector, I have real professional concerns about this length of time between inspections. Figures show that the duration of time the average service user lives in care home does not normally exceed much more than 2 years. This in effect means that there will be vast changes in the needs of service users over this period of time and a reliance on documentation to evaluate their quality of care. Nor does the approach take into account staff recruitment difficulties, and staffing changes.

Given that only 2% of Care services are rated as outstanding, it seems that fewer inspections are less likely to give the general public more confidence in the care sector. I think the CQC is in danger of forgetting that a service does just have to achieve quality but has to demonstrate how it can maintain it.

Summary

The CQC new guidance for providers of adult social care services shows a major shift from the importance of on- site inspection to a reliance on information gathered from providers. I remain to be convinced that fewer inspections will lead to improvement in the quality of services, given the ever-present changing social dynamic of a care service. CQC will claim that they want to place their focus on services that are underperforming. However, a question that is bound to be asked is: “will the new inspection regime be of benefit to providers and service users, or has it come about through a tightening of the resources that they now have available”?  

Albert Cook, BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

 

New innovation to improve the lives of people with dementia

Manchester University Institute for Dementia are pushing the boundaries out to bring about new innovative thinking to improve the lives of people who suffer with dementia.

Imagine a pub designed for people with dementia, complete with old beer adverts, games of dominoes and darts, a DJ playing a selection of music from the 50’s and regular live entertainment, where people with the diagnosis can feel welcome and those who look after them can receive support.

A pop-up pub like this was set up in Salford recently by the university’s Institute for Dementia as part of Dementia United – the Greater Manchester partnership whose five-year improvement plan aims by 2020 to make Greater Manchester the “best place in the world” for its 30,000 residents with Alzheimer’s and similar conditions. It also wants to reduce dependence on health and care services.

This pub experiment is one of a number of innovations under the umbrella of Dementia United, led by the health and social care trusts enjoying their newly devolved status, and the Alzheimer’s Society. Its 41 partners, including charities, sports organisations and three universities, are working out how to tackle dementia from the perspective of those who live with it.

With 850,000 people living with dementia in the UK (1.3% of the population), according to Alzheimer’s Society figures, the eyes of the UK are focused on Dementia United.

Maxine Power, director of Dementia United, says: “This is a once-in-a-lifetime opportunity. Dementia is an area with a huge amount of activity, but it is like an orchestra without a conductor. Devolution brings clarity and a focus on care for people in the places where they live, rather than on organisations. Culturally that is a massive shift for our system.”

Dementia United goes way beyond pubs. It is about rejecting a model of care that health professionals agree is neither fit for purpose nor financially viable, and the opportunity to create a new one. Greater Manchester spends £270m a year treating and caring for people with dementia. The figure has not decreased in the past five years, despite many attempts to improve dementia care, and there are 20,000 hospital admissions for the 30,000 people in the area with dementia.

This is outrageous, says Power. She is adamant that in five years Dementia United will reduce that figure – mainly associated with unplanned hospital admissions and admissions to care homes – by 20%.

This will be guided by five pledges, to be implemented by 2021: improving the lives of dementia patients and their carers by questioning them about their individual needs; reducing variation in care quality (and a diagnosis rate difference between 63% and 90% across the city); the introduction of a key worker for each person with dementia; the redesign of services around users; and access to the best assistive technology.

Dementia United was set up in late 2015 as an “early win” under the devolution of Greater Manchester’s health and social care.

There is dementia knowledge in Manchester to back it. Its three universities formed a dementia research consortium in May 2016 and Prof Alistair Burns, the national clinical director for dementia, is based at Manchester.

Progress is being made. A measurement tool of “lived experience” has been developed, including numerical and qualitative measures of how people live their lives, which can be shared across Greater Manchester’s health systems. Work is under way on a dementia “dashboard” to allow inter-area comparisons and set standards. External evaluation methods of Dementia United are being developed jointly by the universities of Salford and Manchester.

Discussions are going on with Social Finance – a not-for-profit organisation bringing together government, the social sector and the financial community to tackle social problems – to build in additional financial support.

Assistive technology is advancing apace, with Manchester University’s dementia platform evaluating devices, such as watches with accelerometers to measure movement, to establish value for money. Everything in Dementia United must be supported by a business case.

George McNamara, head of policy for the Alzheimer’s Society, is working with Dementia United to make it a reality across Greater Manchester and is receiving inquiries from politicians worldwide, particularly the US. He says: “We are seeing the devolution of powers and funding on an unprecedented scale. What is significant is the scale and the marrying together of a number of political objectives and cultures into one vision.”

Patrick Hall, a fellow in social care policy for the King’s Fund, admires the ambition of Dementia United, but is concerned about its sustainability given the financial climate.

He says: “The locality focus in Dementia United is very welcome and anything that gives impetus to that for the care of people with dementia would be looked on by the King’s Fund very positively. However, it is being set up in the context of unprecedented cuts in social care and a decline in the number of community nurses. Only time will tell whether Greater Manchester has got the model right.”

Summary

Dementia services need innovation as an alternative to some of the existing practice This innovative approach to improving the lives of people with dementia is to be applauded. Especially, the pub experiment which offers the opportunity for people to continue as far as practical with a ‘normal life’.

It is sound practice to evaluate the experiment and share the learning with other services within the sector. Patrick Hall, a fellow in social care policy for the King’s Fund is right to add a note of caution. The proof of the pudding is the sustainability of any new innovation.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

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