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Choosing from the menu
What makes for an effective care plan? It’s a question often asked at training and development sessions in health and social care . One of the answers that will come up (hopefully!) is that it is person-centred, that is, the care plan puts the service user right at the centre of it . I think most people will say they try and ensure this happens. To make sure we really are doing this, and not just saying we’re doing it, let’s look at some of the keys to ensuring the development of a real person-centred care plan. And how do we deal with the statement – ‘this might work for some of our service users, but for others it just won’t’?
Someone whose work I’ve used in this field in the past is Steve Morgan, who produces some excellent materials in the field of assessment and care planning in mental health . An exercise he features in his training manual The Art of Co-Ordinating Care invites participants to create a menu for a new café. What has that got to do with co-ordinating care in a person-centred way? Well, the exercise encourages workers to think about what service users and their carers want from a care plan, and first of all, the ways in which we find out. A new café owner might talk to people in their locality, survey them, find out what has been popular in the past and create a menu using available ingredients. In the same way a care co-ordinator might think about ways in which they can create a ‘menu’ of care that meets the person’s needs, and is achievable. If you want to discover more about Steve’s work on assessment and care planning there are links to a number of resources on his website.
So, creating a menu, or drawing up a person-centred care plan, is not as straightforward as saying to a person “what do you want?”. The Department of Health booklet Service Users and Carers and the Care Programme Approach: Making the CPA work for you acknowledges that the service user has the best knowledge of their own situation. However, in terms of what services are available, you are likely to need the help of someone working in mental health services. That should not mean that care plans are only going to be based on a traditional menu of services or that the kind of service that’s always been on offer. Workers need to be encouraged to tailor care to meet the needs of the person in an imaginative way.
Designing the care plan
So what are the keys to drawing up a care plan that is genuinely person-centred?
- Don’t be too restricted by care plan formats which aren’t very user-friendly. Before you complete your own organisation’s care plan you might want to invite the user to write things down, or create a picture of the things they want to get out of their own care.
- We want a care plan to meet someone’s hopes and aspirations, but let’s not create false expectations. We can invite users to draw up a wish list of things they want to achieve in their life, but we then need to be imaginative in seeing how those wishes can be achieved.
- Our first step in drawing up a care plan is to complete an assessment of need. A statement such as ‘he needs residential care’ is not an assessment of need! Such a statement might form the basis of the care plan, but the plan may come up with alternative ways of meeting the need – which may be for greater support, or reducing isolation or encouraging self-care.
- The traditional approach of a care planning meeting might not suit all our service users. How do they feel about being thrust into a big meeting? Are there better ways of doing this - finding an advocate for the person, or having a smaller meeting with the people the user trusts and feels comfortable with?
- Think about why a service user is asked to sign a care plan. Is it because they agree with everything that is in it, or is it a record that they have been part of the care planning process?
- Care plans usually include an ‘actions’ column. Try to include the user as one of those people undertaking the actions – a person-centred care plan isn’t one where the workers are always doing something for someone else!
Staff might say, “This is all well and good, but what if the person’s mental health condition means they are unable to contribute to their own care plan? Surely we’ve got to do it for them?” For example, if someone is depressed they may be unable to express any hopes for the future, or if a person has dementia they may be unable to describe their current needs. This, however, doesn’t mean we don’t involve these service users. The Social Care Institute for Excellence have produced a recent guide on care planning for people who lack the mental capacity to make decisions about their own care. This guide gives some case examples as to how to care plan with someone whose capacity to engage may be limited. Here are some possibilities:
- Involve families and friends in any consultation about a care plan.
- Find out about what the person’s routine has been in the past, as well as their interests.
- Try to identify options which the person can choose from, rather than an open-ended question (choosing from the menu!)
- Look to explore other means of communication to find out what someone wants, for example in trying to find out about food preferences.
A lot of information about the person is crucial in order to get a truly-person centred plan!