20th December 2015

A Little Knowledge is a Dangerous Thing?

A man on cloudIf we have reached a supervisory level within Health and Social Care , we will have worked with a number of highly necessary experts from different specialist fields. We also supervise people who will be a conduit of information between this clinical expertise and the service-user.

Therapeutic Relationship Concept

These direct support staff develop a deep knowledge of people as individuals via the concept of the Therapeutic Relationship, which enables the support worker to recognise signs of pain, distress and cognitive dysfunction through signs which may be minute and unnoticeable to a visiting professional. If things work as they should, then this information is reported to the appropriate specialist, who will then advise on specific treatment and support measures.

These measures are then likely to be enacted through the support worker, thus fulfilling the two-way chain of information. Perhaps the most basic example of this would be a support worker reporting symptoms to a manager, who then involves the GP, who then prescribes a course of medication, which is administered by the support worker. The support worker is then expected to report on whether the treatment is having the desired effect, if it is unsuccessful, or if unwanted side effects are outweighing the gain of the treatment. The support worker can therefore be seen as the interface between the person and the whole service.

Knowledge is Power

The Social Services and Wellbeing Act 2014 talks about the necessity of “a knowledgeable workforce” to assist people in meeting their Wellbeing goals – which perhaps acknowledges that there has historically been reluctance to equip this very important team member with the knowledge and skills that would enable them to work “knowledgeably.”

Firstly, all disciplines within Health and Social Care are likely to have their fair share of people guarding their territory fiercely, who view the development of expertise in others as being somehow subversive – “A little knowledge is a dangerous thing, don’t you know.”

Secondly, the drive towards person-centredness, while highly desirable and laudable, has also produced a notion that clinical knowledge on the part of frontline staff can lead them to label people according to their conditions, which in turn leads them to work according to a medical or institutional model.

Thirdly, service owners/managers frequently baulk at the costs of training, which include paying staff to attend training, backfilling the same staff in the workplace, as well as possibly paying an external training company. This has led to simply training staff in the absolute basics, such as Manual Handling, Basic Life Support and Safeguarding – and then filtering them into the workplace as quickly as possible.

Finally, the support workers themselves often feel that they are “not listened to anyway” and that they are poorly paid, so feel unmotivated to learn.

Induction Framework

So how do we equip the person to work knowledgeably in the face of these barriers? The Social Care Induction Framework, which takes induction training away from the traditional “mandatory topics” outlined earlier, and covers areas such as Communication and Person-Centredness. This is undoubtedly a step in the right direction, but there is much more that can be done, both by ourselves as managers and the specialists we work with. To produce a truly knowledgeable frontline workforce. I shall return to this topic in my next blog.

*All information is correct at the time of publishing

Nic Bowler

Welsh Care and Social Services Inspectorate Specialist

Dr Nicholas Bowler is a researcher and consultant to government-level [Welsh Government Review of Secure Services, 2009] – specialising in QA/compliance focused projects. He has interests in clinically relevant training, service development and research. He enjoys working with clients to support them in identifying problems and initiating projects to improve practice.

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