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No care without me…?
Taking note of every edict from Central Government or the Welsh assembly can often feel like entering a labyrinth, with seemingly little content that is relevant at the level of service delivery. Occasionally, however, they do say something actually worth listening too – and so it was with the Department of Health’s, ‘No Decision without Me’ (2012) initiative.
Tying-in closely with the Social Care Induction Framework’s emphasis on Person-centredness and Active Participation, the very fact that the Department of Health was involved, however, in seeking ways of involving peopale more actively, more completely and more often in making decisions about their care does beg the question...WHAT’S BEEN GOING ON UP TO NOW?
The problem with care and support plans?
How is it that the NHS, and conceivably its social care cousin, have been doing ‘something else’? Let’s just analyse what ‘something else’ must be according to this logic: Care and Support that DOESN’T involve people actively, completely and always.
In other words – decisions made for people? On their behalf? Because it’s in their best interests? Because a professional knows what’s best? Because the individual can’t be expected to know or perhaps understand what is required/best? Because the individual must be protected from some aspect of their diagnosis? Because we are actually trying to achieve one thing but telling them another?
All of the above have been reasons why care or support plans might not involve the individual in their own care plan.
Sometimes, of course, these ‘competing’ views have credibility, and represent professional or social concerns and viewpoints which need to be aired. The trouble is that when these aspects become the dominant viewpoint, then the resulting document ceases to be a ‘care’ or ‘support’ plan and becomes a plan to manage the individual.
Sometimes, the plan may have been about managing that individual, and this ethos – however well meaning – will ultimately be disempowering. And ‘disempowering’ is a sociologist’s way of saying they (the patient, client or service user) are not going to be asked completely, fully, and always. If the plan is about managing, it ceases to be outcome focussed and becomes defined by process, and all the 101 things we might do to keep the patient safe/well/happy/compliant (i.e. managed).
Routine practice meets a cultural shift
And so, in the case of care and support planning, the road to hell has been paved with good intentions, which have then become institutionalised, routine and habitual. Professionals and organisations have become comfortable with ways of working with which they are familiar. It is far more difficult to fully professionally encounter an individual and have to consider, WITH THEM, what they want and need, and use this as the key determinant for how their care is designed and conveyed.
Social Services and Wellbeing Act, (Wales) 2014
The above is not easy to achieve, but the notion is straight-forward. Making the individual ‘central’ to the care that they collaborate in is no longer acceptable as rhetoric alone. It is the challenge to all of us involved in care and support to consider and enact this mission. The shift in thinking and understanding that this entails requires effort, and may well be resisted in some quarters by people who don’t like to be taken out of their comfort zone. In Wales, however, it is about to become a statutory requirement through the Social Services and Wellbeing Act, and how its measures affect our practice. We need to get to know this piece of legislation quickly….otherwise our practice might suddenly, but very clearly, be on the wrong side of the line.
Paul Rees – QCS Expert Welsh Care Contributor