Using the outcomes approach

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Friend not foe

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Supporting meaningful outcome-focussed recording

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in social care. Make recording ‘live’ and

joined up across organisations.

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This resource contains examples

of how recording from different

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settings can be used to support people

and teams’ reflection and discussions.

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The purpose of Friend not foe and this video is

to support meaningful outcome-focussed recording.

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This video covers principles which come

under two different themes – looking at

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making recording live and joined up, and

secondly, ensuring recording is inclusive.

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The first theme is to make recording

live and joined up across organisations.

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One principle is to make recording responsive to

a person’s journey – by capturing their story.

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In this example, Rhodri’s personal outcome is

to have the confidence to walk outdoors again

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and be able to spend time with pals after

being seriously injured in a car accident.

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His story is recorded over time and includes

some ups and downs as his circumstances change.

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After some initial progress,

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Rhodri has a setback with his health and

reports feeling down in the dumps again.

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His progress is restored after seeing

a trusted physiotherapist who supports

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him in feeling safe enough to step out the door.

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In Rhodri’s story, different people, including

Rhodri, have contributed to his outcome.

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His journey included some setbacks,

which are a normal part of everyday life.

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And so we see here how Rhodri’s story and

his outcomes are captured along the way.

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Next, we want to join up personal

outcomes recording across organisations.

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This is about understanding what information

different agencies need from the record.

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A foster carer told us about a

referral form regarding a child

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who had been living in a children’s

residential home for 18 months.

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Not a foster carer in the country

would agree to take this boy due

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to the complexity of his behavioural issues.

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The referral read like a summary of what was best.

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The foster carer said they were ready to say

‘no’, until they saw one of his drawings.

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The picture spoke a thousand words,

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it showed he wanted to be part of a

family and they said ‘yes’ right away.

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Understanding what other agencies need to

be able to understand someone’s personal

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outcomes can make a real difference

to decision making and people’s lives.

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The second theme covered in this

video is making recording inclusive.

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Another principle is to make recording personal

for people with communication difficulties.

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This information was recorded by a

care home for a resident called Hugh,

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who has dementia, after Hugh’s son

Michael shared information with them.

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The staff noticed that when they

played Radio 3 Hugh was more relaxed.

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Michael also told staff that his dad had

always been a shy man who was not a ‘joiner’.

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However, when the staff started to

play Radio 3 in the residents’ lounge,

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Hugh started getting up and moving to the

music, as if conducting the music himself.

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This then led to other residents

connecting with Hugh around the music,

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which was becoming a regular

feature in the care home.

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We also want to make recording

personal across the life course.

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The examples in this guidance are for children and adults.

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It is important to recognise that a

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personal outcomes approach is for

everyone – from cradle to grave.

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This can sometimes be forgotten

towards the end of life – when

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there are still opportunities

for outcome-focussed practice.

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There is a separate video which includes

a story of outcomes at the end of life.

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Friend not foe.

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Supporting meaningful outcome-focussed recording

in social care.

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Make recording personal and accessible.

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This resource uses examples of how recording

from different settings can be used to support

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people and teams’ reflection and discussions.

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The purpose of Friend not Foe and this video

is to support meaningful outcome-focussed

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recording.

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This video covers the principles of Friend

not foe which relate to making your recording

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personal and accessible.

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Friend not foe is about recording personal,

not standardised or organisational, outcomes.

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We want to capture what really matters to

the person using their own language where

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possible.

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Let’s take an actual example from a support

plan.

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The written statement, “Archie needs to

comply with his care plan”, is unlikely

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to reflect what matters most to the individual.

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This seems more likely to reflect a professional

or organisational goal.

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A more likely and personal outcome might read

like this:

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Archie really wants to stay in the children’s

home because he trusts the staff and likes

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the other children, who are all younger than

him. He understands that he is going to have

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to stop drinking which will assist him to

manage his anger issues, as stated in his

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care plan.

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This ties in with the principle that recording

should be personal, rather than everyone’s

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outcomes being the same.

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You can find more examples in the written

resource.

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Another principle of Friend not foe is to

recognise and record the different types of

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outcomes that matter to people.

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Outcomes are not always about changing or

improving everything.

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Outcomes can also include maintaining quality

of life or process outcomes, which are about

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how people are supported.

You may consider an outcome which is about

maintaining quality of life.

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Or we can think about a process outcome, like

the following example.

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“My support worker makes me feel good about

myself, like I can do stuff.”

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These short examples can tell us a lot about

what really matters and how people want to

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be supported.

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On the same theme of making recording personal

and accessible, another principle is to emphasise

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people’s strengths, whilst identifying priority

risks.

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Here we can see a part of a bigger family

focus plan from Friend not foe.

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The plan includes both risks and strengths.

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An example of a risk from the plan is, “In

the school, Aled is usually really good. But

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when he loses his temper, his behaviour can

result in the school phoning his mum and asking

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her to collect him.”

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An example of a strength is, “Aled is a

brilliant reader and has read some great books.

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He wants to keep reading good books.”

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Having Aled’s strengths recorded helps us

recognise what he is capable of and how he

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can best be supported.

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Continuing the theme of keeping recording

personal and accessible, we also want to make

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recording clear and concise.

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Sometimes fewer words can say more, especially

when they are written by the person themselves.

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Over-recording can be driven by anxiety about

records being scrutinised for legal or compliance

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purposes.

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This means that important information gets

lost.

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It can be very useful to work with your team

to support each other to be concise with recording.

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Friend not foe Recording stories one

Supporting meaningful outcome-focussed recording

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in social care

Recording stories one Fran’s Story

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It was gold, it really was

This is one of two personal story videos in

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our series to support the written resource,

Friend not foe.

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The resource was produced to support meaningful

outcome-focussed recording.

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This is Fran’s story, titled “It was gold,

it really was.”

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Fran’s story supports the principle of outcome-focussed

recording from cradle to grave.

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Fran tells us about accessing his records

as an adult from his adoption as an infant.

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Fran never met his birth parents.

He lived in a Barnardo’s children’s home

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for the first few years of his life.

He still has difficult memories of that time.

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Fran ended up being fostered by a couple who

then adopted him at the age of sixteen.

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He didn’t look for his birth parents as

he didn’t want to upset his new family.

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Later, Fran left home, got married and had

children of his own.

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When he was in his thirties, he decided to

look up his birth records.

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So he made an appointment with Barnardo’s

to go and read his file.

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Fran told us that reading his file was an

amazing experience.

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Three things stood out for Fran. Firstly,

he found out that his mum knew everything

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that had happened to him as it had been recorded

by the social worker right through. Lots of

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things had happened to him.

He’d been in trouble with the police and

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at one point had been stabbed.

It meant a lot to Fran that his mum knew about

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his life.

Fran describes himself as quite a respectable

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artist.

He does painting with Formula One teams.

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The second thing that stood out for Fran from

his record was that his mum was a brilliant

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artist.

He was very excited by that discovery because

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of the connection he felt to his mum.

The third thing that stood out for Fran was

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that for the first time in his life, he saw

a picture of himself as a baby.

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It reminded him of his son as a baby, with

a Mohican haircut.

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Fran was grateful to the social worker who

took the time to record that information.

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It filled a gap for him and he told us, “It

was gold, it really was.”

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Friend not foe Recording stories two

Supporting meaningful outcome-focussed recording

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in social care

Recording stories two Helen and the Heron

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Recording outcomes at the end of life

This is the second of two personal story videos

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in a series to support the written resource

Friend not foe.

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The resource was produced to support meaningful

outcome-focussed recording.

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This is Helen’s story, titled “Helen and

the Heron”.

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Like Fran’s story in our other video, Helen’s

story supports the principle of outcome-focussed

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recording from cradle to grave.

While Fran’s story is about accessing his

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records from birth, Helen’s story is about

recording outcomes at the end of life.

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The Hospice Movement teaches us about what

matters at the end of life, as summed up by

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Cecily Saunders, the founder of the movement:

“You matter because you are you, and you

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matter to the end of your life. We will do

all we can not only to help you die peacefully,

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but also to live until you die.”

Hope can still be a part of the end of life

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and people often want to keep doing things

for themselves and set goals to maintain their

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quality of life.

Listening to and recording what people want

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to achieve and what will make life meaningful

is as important as ever.

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Helen, who is in her seventies, has had cancer

for three years.

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She knew it was incurable at the time of diagnosis,

and her main outcome has been to remain living

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at home as long as possible and to have her

husband and daughter around.

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This is what was recorded about Helen’s

wishes, which has been agreed with her family

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and which the professionals who are supporting

her understand as important too.

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“Despite her advancing cancer, Helen wants

to continue to walk to the river every day

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with her partner and her daughter Rhian, as

long as this is possible. She always looks

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out for the heron which she sees as a good

omen for her family.”

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The background to what is recorded is that

Helen is finding walking more tiring due

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to her cancer and she knows that walking will

not be possible for much longer.

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She has found meaning in these walks and her

family plans to take her to the river in the

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car when walking is no longer an option.

They have also found a photograph of the heron

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for when Helen can’t get to the river.

This helps the family support Helen and accept

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her condition.

We might think about outcomes for the family

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members who are caring for Helen at the end

of her life.

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We know that Helen’s daughter wanted to

spend time being close to her mum until the

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end of her life and that finding shared meaning

and hope through watching the heron was comforting

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to her as well as to her mum.

Having a shared record helps everyone involved

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to understand priorities at every stage of

life.

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It doesn’t need to be lengthy to tell us

a lot about what matters.

My name is Mr David Stanbury Britton, and this is my story.

In my younger days, I was a local councillor. I did this for over forty years. People look at me now and just see this (Mr Britton nodded his head towards his contorted hands) – but I’m a lot more than that.

I was devastated when I found out I had Parkinson’s disease. It was even harder when my son was diagnosed. Life isn’t fair sometimes. You’ve just got to make the most of it. When my wife died, I was on my own. My son’s illness was worse than mine, and I was in the dark. Cassie was my wife’s two eyes. That little cat is a symbol of hope; she’s more than just an animal.

After her passing, people tried to help me – but they kept saying “David, you need to think of your health and get rid of the cat”. But why couldn’t they understand, Cassie isn’t an animal, she’s my only friend. She’s my daily reminder of my wife. I wanted to make new friends, and do more things, but there’s no way I was moving out of that bungalow, if Cassie couldn’t come too. No one ‘got’ that. I was in and out of hospital all the time, and I was worried who would look after Cassie when I wasn’t there. The worry made me more unwell, and no one could understand why I didn’t want treatment. Truth is - I just wanted to be with my cat. But why was that so difficult? “You need to go to hospital, David.” “That bloody cat is making a mess everywhere, why don’t you get it re-homed?” “David you’ll be much safer in a care home, wouldn’t you feel better with more people around?” Isn’t it funny that people think they can tell you what you need.

Things are so much better now. I go to coffee mornings three times a week, and film nights every Thursday. I don’t just have friends, I have a best friend. I go to his flat every week for a ‘tot’ of whiskey. When I go to hospital, the carers still come to feed Cassie. One of them even plays with her so she doesn’t get bored. This means I can get better, without worrying.

I’m even part of the committee in the complex. My background of being a local councillor means that I know the area really well, and I’m good at organising things. I’ve got my voice back, and it’s a good feeling.

When I was younger I trained at Llandough Hospital to be a nurse but I left to have children. I went back there for 13 years or so as an auxiliary working nights cause that way I was there for the kids in the day.

00.31 I’ve done 20 odd years I worked with different charities but all around mental health, I’ve been a trustee and Vice Chair and Chair of a couple, and I absolutely loved it. And then about five six years ago, I mean I was walking with a stick by then anyway, but about five six years ago, seven, suddenly everything just crashed and I couldn’t…partly my back, I couldn’t stand up.

01.00 And it was catastrophic. I was in Llandough for roughly two months and most of the time sort of on the bed, on bed rest, and as the ulcers healed so my foot twisted. So it wouldn’t go on the floor at all. It was, it started to get for me almost a game, because the doctors tried very, very hard to discharge me, they kept telling me medically I was fit “You can go home” but I think I’d become one of those social cases where the doctors would say “Go home” and the nurses would say “No she can't til she’s got a package of care.”

01.46 I accept now I couldn’t manage without my package of care. There’s a lot I cannot do for myself but it was horrendous. I didn’t feel as though I was in control of my home anymore, I didn’t feel as though I was in control of me.

02.02 A couple of I went on to what they call Your Choice and it does give me a lot more control. I seem to go in phases say for hospital appointments and I can go to two or three a week for a couple of months, and whereas before I just had to cancel all the meal breaks that it covered well now I can bank them so they’re allocated to me in a separate area and I can take them back and use them for whatever I want which is a huge difference from the actual package of care.

02.38 Before Your Choice was introduced to me if I didn’t use that time which could have been I had a hospital appointment or whatever, those hours were lost.

02.51 I used to be involved with five or six charities all around mental health and because of my health I’ve had to give most of them up. I’m still involved with two. One of them is an Advocacy service, which is really, really brilliant. And when I go to a meeting it used to be I’d have to say cancel lunch and tea calls and I just lose the time and for years I’ve just lots the time. But now I bank those times so my lunch and tea call will give me an hour back which yes, you’re in discussion with the office about when they can send somebody out, but I enjoy doing the meetings but it also means I’m gaining in terms of getting stuff done here that I want.

03.45 I want to get a lot of my crafting stuff down because I want to start doing crafting again but literally this room has been full because everything I’ve needed for the past six years has been in this one room. And what I’m doing with the banked hours under Your Choice, people come in and they’ll help me pack stuff up, they’ll take it upstairs and bring down what I want down here.

04.10 And one of my carers she helped – she’s the one that helps with the showers in the week, she does my shopping call, and she thinks it's great. She enjoys doing it, and so do the others that have been here. They say they can see a difference in me and they want to get something down that I’m going to do and enjoy doing rather than just – basically I watch telly 20 hours a day.

04.43 And so yes, I’ve been to Barry Island on a train this summer, and actually got off the train, had a bag of chips and came back again.

04.54 But what – the one thing that – it's been me holding back a bit because Tory the carer’s more than happy to do it, I want to try getting on a bus. Now I know the busses take wheelchairs, but my wheelchair like me is slightly bigger than the norm, and the thought of trying to get it onto a bus is scary.

05.20 But before the winter sets in we’re going to do that. And yes, I mean if I can manage to accrue the banked hours again and maybe tag it onto the two hours social call, which is what I call it, I don’t know what it's supposed to be called, then maybe we will go somewhere on the bus because that's what – that's my next big hurdle, is trying a bus.

05.44 And since I’m getting the extra time with a carer that is – I don’t like the word ‘dictating’ but in a sense that's what I’m doing, I’m saying “This is what I want, this is what will make a difference to my life and my existence.”

06.01 And it's happening. So I suppose I am feeling – I’m feeling more confident I think, or better about myself when I’m actually – when the carer’s here.

06.16 When the carer isn’t here if I’m having a bad day I’ll go back into the ‘can't do anything for myself’ but that's wrong because I do get a lot of support now, and this Your Choice has been really amazing for that.

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I used to look after a customer who

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lived in the tor vine area she was quite

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a poorly lady she suffered with COPD

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which are quite bad she her husband was

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also quite an ill gentleman and she had

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family but they were full-time and her

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daughter were two women they come home

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on a Friday and it was around the

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Christmas sort of time when she was

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wanted me to take her out into the

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community to do some Christmas shopping

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she hadn't been out for a long long time

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and she wants to go and buy her

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grandchildren Christmas presents but

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they it had to be for me personally so I

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arranged for her mobility scooter to be

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put on charge and made sure it was all

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up and running and because she was on

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oxygen 24/7 how to arrange for somebody

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to bring a small canister of oxygen so

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that we were able to take it out with

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her while she was out in the community

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so I picked her up of any evening and we

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went to come brown shopping with all the

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Christmas lights and she done lots of

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shopping for her grandchildren they were

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you know 16 17 but it was irrelevant to

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her it was the fact that she was able to

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get out and do and buy personal items

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for those children and we don't quite a

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bit of shopping we had a whale of a time

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it was really emotional but it was fun

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as well went to Starbucks that she does

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something where she's never been before

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I had coffee and we had cake just

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general chitchat about anything and

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everything and it was it was just a Me's

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and it was lovely to see her have a

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smile on her face which is not very

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often but it was very emotional for me

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as well it was lovely to see and think

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that I've given somebody a wish that

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they wanted to do but you know that they

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couldn't achieve that without some sort

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of help

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she sadly passed away a couple of months

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after that so I think for me and it was

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something that I will always look back

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on every time I Drive past her home I

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think about it is very fresh in my mind

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although it was several years ago and it

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has been sadly passed away but I think

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for her she probably knew it was her

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last Christmas and it was something that

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she act to achieve to be able again

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and about in the community so yeah

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beautiful

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- lovely lady

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you