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18th March 2016

Person-Centredness and the Great Untapped Resource

The Social Services and Wellbeing Act focusses on the lived experience of receiving care and support, in the context of Wellbeing Outcomes set by the person. This is a move which is designed to see a regulatory shift from focusing on a service’s systems to a model based on actual personal outcomes.

Many of us will have been inspected on the basis of our paperwork, with inspectors spending little or no time talking to customers or direct support staff – meaning that we have probably had the frustrating experience of our service being marked down in an area because of a recording technicality, when we instinctively know in our hearts that we are providing high standards of care and support. It should therefore come as a relief to us that the actual outcomes of our efforts are going to be looked at more closely. This also begs the question, however, of how these outcomes are going to be achieved.

The Act tells us that the 8 core Determinants of Wellbeing are as follows:

  1. Physical and Mental Health and Emotional Wellbeing;
  2. Protection from Abuse and Neglect;
  3. Education, Training and Recreation;
  4. Domestic, Family and Personal Relationships;
  5. Contribution to Society;
  6. Securing Rights and Entitlements;
  7. Social and Economic Wellbeing;
  8. Suitability of Accommodation.

While these represent a major shift from the current system-orientated approach to inspection, these determinants will continue to be achieved by the same groups of specialist professionals who are currently in situ. For example, medical professionals will continue to oversee the Physical Wellbeing of service users, social workers will continue to be involved in the Securing of a Person’s Rights and Entitlements, Psychologists will work with people who experience Mental Health Difficulties, and Occupational Therapists are likely to offer a lead in Education, Training and Recreation.

The unique skills and efforts of these specialist professionals are never to be underestimated. If we look closely at the 8 determinants, however, then there is one professional group who will be involved in the achievement of all 8 once a person has been assessed as being eligible for services – the Direct Support Worker.

Firstly, in all 8 areas, they are likely to be enacting instructions from specialists at the level of daily service provision. Examples of this are:

  • Determinant A: Physical Wellbeing – a Support Worker carrying out passive exercises for a person living with a spinal cord injury, which have been prescribed by a physiotherapist.
  • Determinant C: EducationA support worker may work as a classroom assistant, supporting a child with a learning difficulty under the direction of a teacher.
  • Determinant F: Securing Rights and Entitlements – The support worker may need to help a person with a sensory impairment to fill in forms which have been provided by a social worker.

Secondly, following on from the support worker’s role of enacting specialist’s instructions, the support worker sends information back to the different professionals who are involved in the person’s care and support. For example:

  • Determinant E: Contribution to Society – If the person attends work, then the support worker is the person most likely to know how well the job is suiting the person, as a result of accompaniment to the workplace and informal conversation. This can then be reported back to the Multi-Disciplinary Team.
  • Determinant H: Suitability of Accommodation - If a person is living with a musculo-skeletal condition which is likely to deteriorate, then the support worker will be the person to recognise that more equipment is needed to help the person to mobile safely, possibly resulting in grab-rails being fitted under the instruction of an Occupational Therapist.

Thirdly – and perhaps more importantly in the context of the Social Services and Wellbeing Act – the Support Worker needs to use the relationship that they build up with the person to help them achieve their Wellbeing goals. For example:

  • Determinant B: Protection from Abuse and Neglect – A support worker is more likely than anyone else to notice the behavioural and emotional changes which might signify abuse from a third party.
  • Determinant D: Domestic, Family and Personal Relationships – a support worker is well-placed to develop relationships with families and informal carers, and to offer emotional support for a person around these areas.
  • Determinant G: Social and Economic Wellbeing – a support worker may help a person with spending time in the community, or with daily budgeting and planning.

We can therefore make an argument that a Support Worker develops the most important expertise of all, which is developing a relationship with a person through which they can enact directed interventions, feedback information about the effectiveness of interventions, and respond to the small changes and needs which occur on a daily basis. All of these roles are intrinsic to the achievement of a person’s Wellbeing Outcomes which, to return to the opening topic of this article, make up many of the yardsticks by which our services will be judged.

If we accept that a support worker fills all of these important roles (and no doubt several others which cannot be encompassed within a short article), then it surely follows that the support worker should be invested in.  In particular, we can argue that the in-depth expertise that a support worker builds-up about a person over time is central to the achievement of Wellbeing Outcomes, as this can be used, for example, to coax a person to engage with a specialist professional who urgently needs to become involved because of a newly-identified need.

While many services undoubtedly value and support their staff, an in-depth examination of inspection reports reveals a common theme of “overuse of agency staff.” It is possible to conclude from this that a service may have a high turnover of their own recruits – and this may signify a lack of understanding of the value of an experienced support worker.

So, while accepting that there will always be people who apply to be support workers for the wrong reasons and that others will be found to be unsuitable during the course of their employment, it is also fair to say that a core of committed support staff are a precious resource who are not always recognised. In the context of the Social Services and Wellbeing Act, this resource perhaps does not simply need to be recognised, but should be actively harnessed and developed. Suggestions for going about this will be covered in a forthcoming series of blogs.

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

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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