Leading quality as a Responsible Individual: embedding strengths-based practice

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This is a video to capture a training programme. It can be used in a number of different ways by organisations geared at leading

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quality in regulated settings so it can be used by Responsible Individuals, appointed managers, team managers.

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It's also a session that is really relevant for staff to work their way through as well.

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It has been developed so that you can use this resource in a number of different ways to suit the needs of the organisation.

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The focus is on quality in regulated settings with a strong emphasis on embedding strengths-based practice.

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But the emphasis really when we're talking about quality is really through the lens of the individual who's receiving the support.

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Quality is a small word that has a very big meaning in terms of the aspects that

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it covers from the quantitative elements of checks, balances,

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processes, procedures that need to be in place. But there is also the qualitative element of quality in settings which is about what's the

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person's daily lived experience and how are we making sure that regardless of the

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service they're receiving, regardless of why they're receiving that service, as much as possible we're promoting that positive lived experience for the individual.

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The sessions are split into a number of different parts. The first part of the session really is around getting into the legislative context,

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starting to think about what's required in terms of person-centred practice and

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weaving its way through all of this will be the focus on strengths-based practice.

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In terms of the legislative context, we're concentrating primarily on the Social Services and Well-being Act and the Regulation and Inspection of Social Care Wales Act

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which I'll refer to as RISCA from now on. It is important to note that as a regulated setting, you will be working to the requirements

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of RISCA but it's really helpful and important to understand the context of the Social Services and Well-being Act and the way that underpins the requirements of RISCA.

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So this session will be drawing out an insight into both of those pieces of legislation and where they cross over and where they both complement each other.

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The structure of the session is around setting the legislative context, understanding what our roles and responsibilities are

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but really putting the focus on defining quality through the lens of the individual

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linking it back to the legislative context but always thinking about where the individual is

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in the middle of all of the activity that we are taking forward.

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Some of this focus will be on how we will be working with people in a strengths-based way.

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If the resource is being used in a group environment, then the following pointers on

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the slide in terms of creating that learning environment could be really useful for you.

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In terms of confidentiality, the more you can draw on your experiences of working with

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individuals within regulated settings, the more the training comes to life.

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But it's really important that if you're facilitating this session in a group environment that you do not share any personal information about the individuals that you're talking to.

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Drawing on those real lived experiences that staff and managers and leaders will have is really helpful.

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In terms of the legislative context, the journey began with the Social Services and Well-being Act,

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it was legislated in 2014 and came into practice in 2016 and the Social Services and Well-being

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Act was heralded really as the transformation of the delivery of social care and the way in which

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partner agencies come together to promote the well-being of the citizens of Wales.

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There are a number of core elements of the Social Services and Well-being Act, the main

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ones being those on the screen now that draw real relevance across to roles and responsibilities

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and the emphasis for regulated providers. So the Act, as you can see in the title, brings a strong

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emphasis on our role in improving well-being and we'll come on to talk about that a bit later.

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Linked to what you see around promoting and improving well-being is a strong emphasis on early intervention and prevention and we can think of early intervention and prevention in a

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number of ways. There's the element of we want to support people in their own homes, in their

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own communities as much as, and for as long as possible. We want to prevent the escalation of

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care and support needs, prevent the escalation of any risk associated with that individual.

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But there will be occasions where individuals might need temporary care and support. So it

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could be that they have a period of time in a foster placement, in a residential care placement. They might need some care at home through domiciliary support services for a short

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period of time while they rehabilitate, while they get better, while they work on aspects of their well-being and care and support needs, risks that have been identified for the individual.

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But if it isn't, if the intention is that this is a temporary arrangement, then we should always be focusing on how are we building the independence,

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how will we build the resilience of the individual to return to their own home if that's what the desired outcome is? But at the same time, we will also have individuals who,

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because of their needs, because of any risks that are identified, because of their outcomes and what matters to them they may require care and support for a longer period of time, if not indefinitely.

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With the Act came the new requirements in relation to information, advice and assistance. This has been described in some places as a service, and that's often translated into

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things like a single points of access or first gateway contact gateways, for example. In other

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areas they very much see information, advice and assistance as an approach rather than a service.

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But it links very heavily to the previous points around improving well-being and strengthening early intervention and prevention. How are

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we equipping individuals to be able to self-resource, self-manage, self-access

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to support what's available in communities or change their own situation themselves?

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With the Act came a new approach to assessment, a new approach to eligibility and a new approach

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to how we meet the care and support needs of individuals and we will come on to explore the approaches to assessment and care and support planning a bit later. But this is

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the bit where the two pieces of legislation really do come together because the majority

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of providers will be receiving referrals from social care and as a result of that

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will be inheriting the care and support plan that has been developed for the individual. So from a provider perspective, the care and support plan that's developed by social care

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provides the information you then need to be able to go on and develop the personal plan that is required by RISCA in terms of how you will then meet the care and support

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needs of the individual. And it is important to remember that if an individual is receiving

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support from a provider because they've been commissioned by the local authority to do that, the local authority does still retain the responsibility for

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making sure the care and support needs of the individual are being met appropriately.

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There is a strong focus on safeguarding within the Act and the Wales safeguarding procedures

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have been issued under the Social Services and Well-being Act, and it is really important

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that providers are making sure that they are fully aware of the content of the procedures,

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the roles and responsibilities and the duties associated with those procedures, but also that there is an element of understanding the ethos and the

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culture that sits underneath the way in which those safeguarding procedures are delivered.

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Advocacy is a strong and core element of the Act. It is referred to in a particular

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part within the Act, but it also gets referenced across a number of other

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parts of the Social Services and Well-being Act and advocacy has a number of different aspects.

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It can be delivered in a number of different ways from self-advocacy,

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friends and family through to independent professional advocacy services. The bit that's really important to remember is the principle for

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why we would be looking to provide advocacy support to individuals, and that's to make sure that the individual fully understands the process, fully understands the

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information that is being shared with them and that they're able to retain the information for

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long enough to be able to understand what's associated with receiving that information,

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the discussions that are taking place, the decisions that may be being made. It is also important that we recognise that the individual we're supporting is able to

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weigh up the information that's being provided in order to make an informed choice and decision

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Where we identify that the individual is unable to overcome any of those barriers that's where we

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need to be considering if there is a need to provide advocacy support for the individual.

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And finally, there's a strong emphasis on cooperation and partnership that sits at both an operational and a strategic level. As providers, we need to be thinking about who are

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the different agencies that we're working with in order to meet the care and support needs of the individual at a strategic and operational level. The local authority and its partner agencies

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are continuously reviewing what well-being looks like for the individuals across Wales and across

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the footprints of the health boards, and then considering how well the well-being of individuals have been met and will be making decisions in terms of service availability, services that need

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to be commissioned, developed, decommissioned but constantly making sure that we're in a position to be able to meet the well-being and care and support needs of individuals in Wales.

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The Regulation and Inspection of Social Care Wales Act (RISCA) came in the year after the

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Social Services and Well-being Act, and that too has a very strong emphasis on improving

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the well-being of individuals through the statutory guidance and regulations. You'll

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see reference to the role of providers in promoting and improving well-being.

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The definition of well-being for individuals actually sits within the Social Services and Well-being Act, and this is where we start to see some of

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the read across really early on and we'll go on to explore the definition of well-being.

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RISCA places a stronger emphasis on giving individuals a stronger voice in the discussions

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that are taking place in relation to their situation, decisions that need to be made,

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the development and the review of the plans that are being developed with the individual that isn't

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simply that we've had a conversation with the individual, but the principle of co-production is really strong in terms of the assessments of individuals, the development of any personal

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plans should be done with the individual as opposed to being written on their behalf.

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There is a strong emphasis on strengthening the protection of individuals, not just from

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the safeguarding agenda, but how do we making sure that we're considering all aspects of an

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individual's well-being, making sure that we're responding to the companies that are identified to

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and for the individual, and considering how we're managing any identified risks. But those risks

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are being managed in a positive way as opposed to encouraging an ongoing risk-averse culture.

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There is also a strong emphasis on increasing accountability, for example the introduction

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of the role of the responsible individual. In terms of increasing accountability, it doesn't just include the emphasis on the role of the responsible individual, but it's also thinking

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about how providers are ensuring that the quality of what they're providing is to the standard

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that's required and we're going to explore aspects of that as we go through the session. When it comes to well-being, there are two definitions within the Social Services and

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Well-being Act, which as mentioned earlier, read across to RISCA. There's a definition of well-being for adults and there's a definition of well-being for children. And

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on the screen at the moment you'll see the definition of well-being for adults. The code of practice that sits under the Social Services and Well-being Act draws out the duty to promote

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well-being and it is important to recognise that promoting well-being does not always mean

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we have to provide a service and intervention or an allocated practitioner or professional.

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A conversation with somebody about how their day has been for some people will promote their

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well-being. But the spectrum of need and the spectrum of what promoting the well-being of individuals means can go from the conversation about how the day's been, how they are feeling,

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is there any support they feel they require through to an assessment being undertaken by social care, through to the referral to the provider to provide support and

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services through to having to complete an adult risk report because we have concerns

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that the individual is experiencing or is at risk of abuse and neglect. It is really important to recognise that

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well-being means different things to different people at different times. And whilst we should be making sure that we're taking a holistic approach to the

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well-being of adults, we shouldn't be insisting that we're making a point of trying to fill in all of the circles and gather information about all of the

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circles because they won't always be relevant or meaningful or purposeful for the individual.

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So the definitions of well-being of adults is on the screen. The definition of well-being for children is very similar.

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It works its way from physical and mental health and emotional well-being and goes clockwise to suitability of living accommodation

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and it's the last two circles that are different. In children's well-being, we still have a duty

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to promote the welfare and development of children under the Children Act 1989.

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One of the things we need to consider is the need to try to remove generic terminology

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when we talk about individuals in discussions or assessments. We tend to fall into the trap of using generic jargon or a catchall phrase that we all use.

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But the question is, if we're really taking a person-centred approach in relation to the child or the adult do we then delve a bit deeper to understand what that

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generic terminology that we use actually means for the individual? One of the key questions in practice everybody can use is the question, so what?

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It allows me to delve a bit deeper into what well-being means to an individual.

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So for example we will often hear what's really important for Mrs Jones is that her independence is promoted or her independence is maintained. We will all have a different

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view of what we think independence means for Mrs Jones and what happens when a generic term

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like that is used is we can often fall into the trap of making assumptions if we think we know what that means without asking the ‘so what’ question that delves a bit

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deeper means we ask so what does independence mean to Mrs. Jones? What does independence look like for her?

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How will she feel if the aspects of her independence she identifies are being promoted?

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We'll see blanket phrases like ‘Mr Smith needs support with his personal care’. But what is personal care? Personal care can mean something to every single individual.

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We've got to ask the ‘So what’ question to know for that individual what are the personal care needs that are important to him? Personal care needs will be identified by the

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practitioner and family members but are they the same as what the individual would describe. The more I go deeper, the more I can tailor the support around the individual.

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We'll hear phrases like ‘for the individual to be kept safe, for the child to be happy’.

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What makes children happy differs across the board. So ask the so what question that says.

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So what makes this particular child happy? How do they feel when those things are happening?

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So an activity that you could do by yourself or in a group is to take your work hats off

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and think about what well-being means to you as an individual. First off, think about the words

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that you would use to describe well-being. Maybe jot them down, get somebody else to jot them down.

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Then take a step back from that list and ask yourself or ask each other what does it really mean when the generic jargon is stripped away? Have you used words that

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we use generically in our practice, or have you really described what's important to you? So if you're in a group activity doing this, for example, somebody says what's

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really important to me, what well-being means to me is, is “good physical health”. The rest of the group are encouraged to ask the “So what” questions - “So what

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does physical health mean to you? What does it look like? How does it make you feel?”

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Challenge yourself or challenge each other using the “so what” question to be able to delve a little bit deeper and think about what does it really mean? It's almost that

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you're getting into what makes you unique, what makes you individual, what makes you tick, what makes you smile compared to what makes everybody else smile.

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So we've given consideration to what well-being looks like and what it means, but it is also

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important that we give consideration to the principles of the two pieces of legislation that

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essentially underpin the practice and the approach we should be taking to support individuals.

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What you can see on the screen are the core principles, but I probably prefer to refer to them as the foundations for practice.

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We have to be mindful that these can sometimes become boxes on forms. It is terminology that is being constantly used, but when we take a step back,

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do we actually take the chance to describe what this actually means in

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practice? Do we describe what it means through the lens of the individual? Do we describe what it means through the lens of the staff member, for example?

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What's really important is that we're able to take each of these principles and translate what they mean in practice. So if you are responsible for leading quality

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within your organisation, for example, you might want to give consideration to these being some of the measures of quality not in a bureaucratic

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sense but more in terms of these being aspects of quality in the way that we support individuals. So if we were to take each one in terms of what they mean, let’s say choice and

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control first, I want to hear what the individual's thoughts, views, wishes, experiences are as much as possible. We want to be able to promote choice and control. It is not

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always possible, but that's not to suggest we shouldn't be striving to achieve it. There will be instances where individuals can't verbally share their voice. And I think

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just changing our emphasis on why this is important is key because what we're wanting

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to do in terms of promoting voice choice and control is really get an understanding of what life is like for the individual. How do they feel? how do they want to be?

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If the person's able to verbally articulate it, great. But there might be occasions where we're reliant on other people to be able to share those insights such as siblings, parents, grandparents,

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carers, neighbours, friends, potentially other practitioners. But what's important is when we're drawing on our observations of an individual, when we're drawing on the input of

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other individuals that we're making sure it comes back to the individual as opposed to what we're

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hearing other people saying about how they feel themselves (maybe it's their guilt about not being able to support an individual as much; maybe it's what they think the individual needs to receive).

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So where we are drawing on observations in behaviour, terminology, language, body language,

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for example, those observations are just as important as the words that somebody articulates

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to us when we're then drawing on other people's input. And that insight into the individual,

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we've really got to make sure that they're talking about the individual themselves. When it comes to co-production, that often gets described as “we work in partnership with

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people” but co-production really is focused on trying to reduce the power imbalance that we sometimes have between practitioners and individuals. And if you think about

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what our role is, our role is to understand what life is like for the individual in order to identify if they have any care and support needs, what are their outcomes,

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what matters to them, and what risks are being identified for that individual? Our professional judgement and anybody working in a regulated setting regardless

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of their role is a professional and a practitioner in their own right. Their input is important but is just as is important as the input of the individual or their carer

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or their representative. So try to think of co-production as a way to get the view of

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the individual through the individual's lens and through everybody else's lens. Co-production in terms of practice then is if I'm writing an assessment,

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I should see evidence throughout that assessment of essentially a two-way conversation. The development of the personal plans should be done with the individual or their representative. It's

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not “a we've had a lovely conversation with you so we will now go and write up the plan”. The plan is about how that person's going to be supported in their day-to-day life

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so that individual should be enabled to contribute to what that plan looks like as much as possible.

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Strengths-based approaches we're going to talk about as we go through the session. This isn't simply a case of writing down the good things or the nice things about an individual. There is a

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difference between there is a box on a form that allows us to capture strengths versus we are adopting a strengths-based approach. When we're identifying the strengths of

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an individual child or adult, it's really important that this contact gets to that,

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that there's meaning and purpose. It's pointless writing in a box somewhere on a form that is headed strengths that Betty is still able to drive at 87 if when I

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have a conversation with Betty and ask, When did you last drive Betty? She says,

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not for a couple of years as I’ve completely lost my confidence and I doubt I'll drive again. We've noted that she can still drive but the

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context isn't relevant in terms of where Betty is at the moment. I don't just identify the things that are working well for the individual, but I'm

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thinking about how we are using those to develop the plan for the individual. A strengths-based

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approach would mean I'm seeing personal plans that reinforce the strengths of the individual,

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the things they can do themselves, the things other people can help with. Our plan shouldn't just be based on the things the person can't do or they need help with.

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A good strengths-based approach means I've got a plan that reinforces, builds on the strengths of the individual.

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In terms of being outcome focused what we're essentially talking about is what matters to the individual. What is it that makes them smile? What is it that makes them

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feel content? What is it that gives them purpose, makes them feel unique? There is a difference in terms of this is what's really important to me versus this

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is my preference about how my needs are to be met. So when somebody says I prefer to have a shower over a bath, that’s the precedence over how the personal care

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needs to be met. That's very different to them saying, I want to be able to sit out

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in my garden and look at the tree that my husband planted when we first got married,

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because that is something that's really special to me, that's unique to the individual. Positive risk taking probably happens more than we give ourselves credit for. The question is,

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are we actually explicitly describing that we are supporting positive risk taking?

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Everybody's life has an element of risk associated with it. And what we need to be thinking about is the context of all of the other principles you can see on the screen,

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because you can't really do one of those in isolation. But when we're thinking about positive risk taking, we're giving consideration to what

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the person is telling us about the lived experience on a day-to-day basis they would be wanting to have. Where we identified that there are strengths for this individual are

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there things they can do for themselves or other people who can help them. Are we doing too much for people? Are we giving too much service or are we micromanaging aspects of their

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day to day lives that we don't really need to be thinking about? The key is how we then articulate,

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become confident and share with each other that we are essentially promoting risk taking in

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order to provide the individual child or adult with the most fulfilled life that is possible.

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The key with positive risk taking is that we all collectively understand the risks, that we collectively understand the likelihood of that risk, the impact of the risk that we share,

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the management of that risk in terms of planning, and that we are collectively reviewing that and measuring the impact on the person's experience in terms of being proportionate. This

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is where we really need to think about how much do we end up doing for the child or for the adult.

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When it comes to being proportionate I see plans that are hugely detailed in terms of almost every

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movement of the individual on a day to day basis. What we have to remember is that children and

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adults are in receipt of care and support services from providers because they have specific needs

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that have been identified, there are risks that have been identified for the individual, the individual is telling us what matters to them. And what we should be doing is planning

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an approach that responds to those three areas. We need to leave flexibility for individual to

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exercise their choice, to change their mind, to do something different day to day where

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it's possible. So there is something about how much do we end up doing for the person

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rather than with the person, or even leaving the person to do some of that for themselves.

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An activity you can do as a group or individual reflection is to think about how well we

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see these principles playing out in our organisation and our setting. Think about how you can use some of these to share your descriptions and understanding of quality.

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Just take a moment to reflect on what this means, how you'd describe it.

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How would you know that everybody knows that this is how we work in practice? These could be features that you use to describe in a statement of purpose or in the

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information guide for individuals. If you're a Responsible Individual who's measuring the

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quality of assessments and plans, you might want to be looking for evidence that these principles are playing out in the practice that's being delivered by the organisation.

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We’ll move on now and bring some of the things we learned about the legislative

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context. We want to see how the principles for practice pull through and underpin

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all the practices and processes we've got in our organisation.

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We're now going to give some thought to working with people in a strengths-based way. But it is important to recognise that it is about the person-centred approach here. It's about

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making sure that we're really understanding the individual in the middle of all of the activity. It's the point that was raised before around the well-being activity of delve deeper,

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ask the ‘so what’ questions and really get a sense of what this means for the individual.

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When considering the RISCA statutory guidance and regulations, it's really interesting when

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we map out the stages of the individual's journey from the point that the referral

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is received by a provider through to closing down any intervention or provision. And again,

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that will vary based on an individual's circumstances. It could be that the provision was put in place for a temporary period. It could be that the needs of the individual have

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escalated such that they need a different type of support or it could be that the individual

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has sadly passed away and the service is no longer required for that individual.

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But what we need to be thinking about is how do we actually make sure everybody understands each of the steps of the journey, getting the understanding of what does quality look like

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at each of these stages and understanding of why are we promoting a person-centred strengths-based

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approach throughout each of these steps of the individual's journey coming into the service.

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Starting with the referral that's received (which could be a self-referral, It could be from health, it could be from social care) what's really important is through that referral as a provider,

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you're gathering as much information as possible to gain an understanding of the individual.

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It's important to remember that at the point the referral comes in and the point in which the provider starts to undertake their suitability assessment as required in

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the regulations that we have a read across to the statement of purpose. So the referral that comes in from the person commissioning the service should

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be accompanied by a care and support plan, potentially an assessment.

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But the more information that you can gather at that stage about the individual allows you to do that suitability assessment, it allows you to check across to

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the statement of purpose that what's been asked for is in line with what you've stated you provide as a provider. It's also your opportunity to think about

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matching. So it might be a case of matching a member of staff to support the individual,

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it could be matching the individual to other people who are receiving the service already.

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If it's determined that as a provider you're able to provide support to the individual,

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you're required to provide the Service Information Handbook. The regulations and the statutory

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guidance are clear about what content needs to be included in the Service Information Handbook but

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what's really important is as a provider you take a step back and really think about who is this

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handbook for? Go back into that handbook and have a look for the jargon, the generic terminology,

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go back into that handbook and read it as if you're the child or the adult coming into the setting or receiving the service for the first time. What difference are we making to the life of

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the individual? Do you understand what's in that handbook? Does it tell you what you really want to know? So some of the best handbooks I've seen develop will be those that have been developed

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with the individuals who receive the support from the organisation in children's residential homes.

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I've seen children and staff produce DVDs as their version of the Service Information Handbook.

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You get the staff perspective of what it's like in the home, but the children and young people are also contributing to what life is like in that home. I've seen examples where providers have

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asked staff to all walk out of the building and stand at the front gates, looking back at the home, describing what they see. Describe how they feel walking down the

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path. What does that look like? What does it feel like going through the front door? What do you see? What you smell, what you hear? So there's information handbooks. They do

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need to satisfy the requirements of the legislation. It's also important that

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we're thinking about does this provide the individual with the information that they really want to know? Ask people who were in your services already, ask people who

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have left whether they received the information that was really important them from that we may through service agreements and then you will develop the personal plan for the individual.

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Now, the personal plan needs to be in place before day one of the individual coming into the setting and be heavily based on the information provided by social care. But it is really important that

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we are starting to give consideration to the principles of the Social Services and Well-being Act, not just the principles that underpin RISCA in terms of the development

33:29

of the plans. So am I seeing evidence of the individual's voice choice and control? Where it's appropriate? Where it's possible? Is the plan co-produced with the individual? Is it

33:39

strengths-based? Is it outcome focused? Does it promote positive risk taking? Maybe it's a bit

33:45

too early at this point to hugely delve into that area, but this is why you see the next steps in the process. Is it proportionate? We don't know the individual particularly well at

33:55

this point because they haven't even come into your setting or started to receive the service.

34:00

The individual then comes in to your service. You as a provider are required to undertake your provider assessment. Again, same set of principles apply as the individual settles into receiving

34:10

the service or settles into the new setting in which they're now living. Staff in the setting

34:16

will be developing relationships, rapport, trust will be building with the individuals, getting more comfortable potentially with their situation and living arrangements.

34:26

That's why it's really important that that personal plan is then reviewed after the first seven days using the principles we've just described. But really doing that alongside the

34:36

child or the adult who's now got a better sense of what of what's happening around them ongoing,

34:41

that will be daily, weekly records, them being kept, supervision will be taking place with staff.

34:47

And again, one of the key things to think about when we're in the ongoing delivery phase or the

34:52

review of personal plans is it can be very easy to fall into the habit of monitoring

34:57

and measuring the activity that is being delivered. They're receiving the care that they need, they're accessing the service they need, they are having the opportunities to do what's

35:06

important to them but one of the questions that rarely gets asked is, So what's the impact we're

35:12

having on the day to day life of the individual? So in those weekly or daily records, in the

35:17

supervision sessions, in the reviews of plans when they're happening, as well as making sure

35:22

that we're complying with what we should be doing in line with legislation we are making sure that we're delivering what we say will deliver in the plan and that consideration is being

35:29

given to impact and what difference are we making to the life of the individual?

35:34

To set the context of the relationship between Social Services and Well-being Act and RISCA – the Social Services and Well-being Act brought with it an assessment model that

35:43

you can see on the screen now which are the five circles on the left-hand side, a lot of assessments within social care being referred to as what matters conversations

35:52

or what matters assessments. If you've heard reference to what matters, it is essentially the assessment of the individual that's being described. And what should be happening is through

36:02

the assessment process, I'm establishing what the personal circumstances of the individual are,

36:07

the outcomes of the individual: what are they saying matters to them? But I don't want to then capture the rest of the model in separate boxes I want to make the linkages across to them.

36:18

So when an individual says these are the things that are really important to me, these are what matters to me, this is how I want to be. This is how I want to

36:24

feel my what matters conversation in my assessment approach then explores okay,

36:29

so what's stopping that from happening currently? why aren't you able to do the things that you're describing (barriers). Consideration is then given to how much of that you are able to do

36:37

for yourself? who else can help you? what can you access in the community? We then move on to exploring what the risks are if the individual is not able to do those

36:46

things that matters to them, if they're not able to feel the way they’re wanting to feel. That's what I want to be exploring and that's what I want to capture through the

36:53

care and support assessment. I equally need to be identifying what the care and support needs

36:59

of the individual are. The Social Services and Well-being Act brought with it an eligibility criteria that is now based on individual care and support needs. So through that assessment,

37:08

not only am I identifying what the outcomes of the individual are, I'm wanting to identify what

37:14

the care and support needs of the individual are equally. And I can use the same approach - these

37:19

are the circumstances which we've established and instead of personal outcomes, I change it to care and support needs. I then explore with the individual and those around and what's stopping

37:28

that need from being met. How much can they meet the needs themselves? Who can help them? What can they access in the community to meet the need? What's the risk if the need isn't being met.

37:37

All of this information collectively informs the decisions around eligibility. If it's

37:42

identified that an individual has an eligible care and support need that is then translated into the care and support plan for the

37:49

individual. The box on the right-hand slide of the is a high level description of what the care and support plan needs to capture. This is what then gets passed through to providers.

38:00

The assessment model I've just described - whilst that is one that is put onto social care in terms of their care and support assessments - as providers,

38:09

you equally need to assess the individual's needs as we've just see.

38:14

The approach that's just been described around, identify the outcomes, identify the care and

38:20

support needs, explore with the individual and those around them, what's stopping them, what's helping them, what's the risk if it's not achieved is an approach that providers

38:30

can equally use when they're undertaking their assessments and formulating plans.

38:36

Once a provider receives the care and support plan, this is where the duties

38:45

under RISCA kick in in terms of undertaking your assessments and developing the personal plan. RISCA is clear that the personal plan needs to include the individual's personal outcomes,

38:57

an understanding of their care and support needs, what their personal preferences are about how they want their needs to be met and their outcomes achieved? What are

39:06

the risks or the challenges identified for the individual and is there a need to consider specialist assessments that have been undertaken or need to be undertaken?

39:16

Think of it as the care and support plan essentially describes to you What

39:27

needs to happen and why while the personal plan is taking that a step further in terms of now getting into the detail of how we are going to be able to do that.

39:37

What you can see in the grey box is a summary of what then gets put into the personal plan for the individual. Remembering the principles we described earlier should

39:48

be underpinning the approach by which the plans are developed.

39:55

Whilst this slide looks quite busy what it is doing is focusing in on is what do

40:00

we need to be capturing through the assessment and the planning process. Now the words we often hear used in practice will be the words ‘wants and ‘needs’ spoken by

40:10

everybody around the individual, and sometimes the individual might be using those words, for example What I want you to do for me is this / What I need you to give me is/ What you need to do for my mum

40:21

is/ What we want you to do is call in four times a day to provide care/ What we want you to do is

40:27

stop the child from being exposed to risk/ What we need you to give the child is a stable placement.

40:33

Quite often the words ‘wants’ and ‘needs’ have been used to describe services, activities, interventions, things that are done ‘to’ the individual. But what we need

40:45

to be understanding and describing is what the actual care and support needs of the individual

40:50

are and not the service requirement or the intervention that's required.

40:57

This is where some of the generic jargon terminology starts to come in . For example: the care and support need will be described as ‘the person has needs in relation to their personal

41:06

care’ or ‘the person needs help with their medication’ or ‘the person needs support to be able to socialise’ – we fall into that habit of describing what it is we think we need to provide.

41:18

Whereas really describing care and support needs through the lens of why do they need something in

41:23

the first place is far more helpful. So when describing care and support needs, don't think what is it they need instead think about Why do they need it? For example if

41:32

we’re writing that someone needs help with personal care, what's the personal care they need and why do they need it? Is it because they're prone to UTI so we need to make sure

41:42

that they're clean and they're kept clean. Is it because they're prone to pressure sores so we need to keep them clean. Is it the care and support need is in relation to managing their emotional

41:51

needs, managing some of that self-regulation due to trauma that they've experienced previously.

41:57

Is their need for support around medication because their dexterity in their fingers doesn't help them to be able to pop tablets out of blister packs or is it because they

42:06

forget to take it because they've got memory challenges? So care and support these needs describe the reason why somebody needs the support as opposed to what it is they need.

42:15

And I have to combine that with what matters to the person, what are the outcomes they're saying are important to them and what are the risks that are being identified for the individual?

42:24

Remembering the principle of positive risk taking. So my assessments and plans need to encompass what's within this blue line. And the more

42:33

we're able to describe it through this lens, the better chance we've got of moving from

42:38

being fixers to facilitators of people's well-being on their lived experiences.

42:44

So again, we can see where the principles for practice lend themselves nicely and need to underpin the approaches,

42:52

the practice, the steps, the parts of the process that we should be following.

42:58

Take some time to reflect on the input that has been shared in discussions either by yourself or in groups, considering the principles of practice that you can see on the screen,

43:08

share with each other those experiences of where you have seen those principles

43:14

in practice. What do you hear when services and support is being provided that gives you

43:19

the reassurance that that is the practice and the culture of your organisation? Maybe

43:26

it's a case of what you see recorded or written down in the paperwork that needs to be produced

43:33

Do some reflection on how well you are delivering on the principles – trying

43:39

to take a strengths-based approach. Start the conversation or reflection with identifying the bits you know we do well, the things we're confident with, and this is how we know we do

43:48

them well. This is how we know we do them well is the most important part of the conversation.

43:54

And then it might be that you move on to think about maybe we need to concentrate on some of

43:59

these other ones a little bit more. Maybe there is scope for us to do things a bit differently.

44:04

So take about 15-20 minutes in your groups to really unpick what this looks like, what it sounds

44:12

like within your organisations. Share the examples of where it's working well, Share the examples of

44:18

where you're reflecting, where are there areas a bit more or something different could be done.

44:24

To summarise the element of person-centred practice, making the links across to what

44:29

we're required to have in place, and again thinking about the lens of quality,

44:35

some of the key areas in which we can really focus in on are we getting person-centred practice right? Do you describe it in your statement of purpose? Is that approach described in the

44:45

information guides in a way that the individual can understand, almost start to feel what their

44:51

experiences will be, are we thinking about the care and support needs, the outcomes, the risks?

44:57

Are we delving deeper and asking the so what question of what the terminology means when we're

45:03

considering our suitability assessments? When we're developing and producing our assessments

45:08

and personal plans and undertaking the reviews are we describing our standards of care and support,

45:16

are we recognising that actually those standards of care and support read right across to the definition of well-being in the Social Services and Well-being Act

45:24

And when it comes to being inspected by Care Inspectorate Wales, they will be focusing in on those well-being outcomes. They will be looking for the evidence of person-centred

45:34

and strengths-based practice across all of the aspects of what we're required to provide.

0:01

This is part two of the training session in relation to leading quality in a regulated

0:09

setting. In terms of part two. So in terms of part two, the aims and objectives would be to reflect on the learning from session one and how practice has been

0:18

shaped. That's not always an expectation that things have fundamentally changed, but that there's some thinking happening with some reflection and there's some

0:27

insights into practice that maybe you hadn't had before that you've got now. That's what you think individually or as an organisation.

0:36

We're going to focus more on the strengths-based approach in practice in part two and introduce the

0:44

principles of compassionate leadership to build on the strengths-based approach and to lead us into

0:50

how we can shape quality standards and how these inform our quality of care reviews as providers.

0:58

When it comes to quality, one of the key things to do is to be clear about what is our definition

1:10

of quality as an organisation? What does it look like? What does it mean? How would it

1:15

feel for people? How is that promoted across the organisation so that everybody understands it?

1:22

How is it measured in terms of how do we know we're doing it? And then how is it monitored n in terms of what's the impact we're having on the lives of the individuals that we're supporting?

1:33

That's the thread that's running through the part two session. So picking up in

1:39

terms of our approaches to working with people in a strengths-based way, working in a strengths way where it's something that gets talked about a lot.

1:47

As we discussed in part one, it isn't simply a case of we need to pull out the strengths,

1:52

we need to identify what works and we need to think about what the person is able to do. We need to see it as an approach, an approach that then

2:00

goes to support independence, resilience, choice for people and improves well-being.

2:06

We've got to think about a strengths-based approach in a number of contexts. It could be that we are wanting to improve an individual situation and we'll

2:18

use those strengths to be able to do that. It could be that maintaining the current situation for the individual is what we're aspiring to do and we can. We

2:27

need to think about how we adopt the strengths-based approach to do that. But it might also be a case of the person’s situation

2:35

is likely to be, and is deteriorating how we still maintain as much independence

2:40

and resilience and choice despite that decline in somebody's circumstances.

2:46

A strengths-based approach has to be collaborative. It can't simply be a case of the practitioner tells the individual what they're good at. If we're going to play to

2:55

people's strengths and use them, the individual has to have an element of self-belief and insight

3:01

into that being the strengths in terms of what they're capable and able to do for themselves.

3:06

We need to understand if they can trust other people and feel comfortable having other people to help them, or if it is that they feel able to go and access support in their communities.

3:17

The approach needs to be proportionate and flexible and appropriate to the individual’s circumstances. But like the example we used earlier about Betty being able to

3:25

drive – when you actually speak to her she says she hasn’t driven for two years as she has lost her confidence and is unlikely to drive again.

3:33

In terms of children, we'll hear references to the strengths for a particular child

3:38

is that they're attending school. But without the “so what” question there’s no

3:43

context about what this means for the child and why that's a strength for them. Is it

3:50

the fact that they're going to school and the strength associated with that is because the

3:55

time they're in school, they're not home exposed to domestic abuse between parents at home? Is it

4:00

that when they're in school and they're on the playground, it's the only chance they have to develop their social skills and spend time with peers? Is it because the school meal

4:10

they get is the only nutritious, hot cooked meal they get that day? Or that the cook or

4:15

the cleaner of the school is the trusted adult that the child knows they can go and speak to?

4:21

So again, it's not the high-level generic statements that we're looking for. It’s the detail of the context for the individual, what does it mean to them?

4:31

The strengths-based approach will be aligned to positive risk taking. If we're able to recognise the strengths of the individual, we can use those. We can play to those strengths

4:41

to help to mitigate against any risks that are being identified for the individual.

4:48

Ultimately a strengths-based approach has a focus on what matters to the individual, and it isn't just about identifying what they can do for themselves,

4:54

but who and what else is around them to help. For example, maybe some of our activities as a practitioner is connecting individuals up to members of their community.

5:04

For example, we know that there are two or three individuals living on the same housing estate who don't get out and about, who are feeling isolated and as

5:13

a result it's having an impact on their well-being, which means they could then need some form of care or support to be able to address the consequences of the impact of

5:22

the isolation. Can we think about how we can connect those individuals up together?

5:28

What's really interesting when we think about the strengths-based approach is about being something collaborative, but also recognising how the individual sees themselves.

5:39

For a lot of individuals that we work they we will at some point have heard conversations happening

5:45

around them that describes the things that they can't do and that they're not able to do,

5:51

things we can't allow them to do because there is a risk associated or it will have a detrimental impact on the individual. So we have to think about how we adopt the strengths-based approach

6:00

when the tone and the nature of any discussion or involvement with the individual has been about identifying the support they need as they can’t do things and there are risks associated.

6:10

Knowing how the individual sees themselves and their situation, sees their own world, is really important.

6:17

When we listen to family members, when we listen to other practitioners, when we listen to neighbours, carers, friends, who is it that

6:26

they're actually describing? I had an example shared recently of a lady who was a midwife for many years and the staff had

6:34

noticed that she would continuously go up to the members of staff holding their arms

6:39

checking that they were okay, genuinely attentive to how the staff were. And it was only when they

6:45

were trying to unpick why that behaviour was happening as the lady has dementia and wasn't able to verbalise or articulate why she was doing it, they started to unpick the story

6:56

of the lady and how she used to be a midwife. So what they did was on eBay, they bought one of the old blood pressure monitors that she would have used when she was practising

7:04

as a midwife and bought it for her. She now goes round taking the blood pressure of the members of

7:10

staff on a regular basis because that's her way of being able to show that she cares for people.

7:18

I've seen an example of an individual who used to be a head teacher and once a week the staff would come to him with their exercise books and their pens and they would sit down at

7:27

the table with the gentleman and he would teach a lesson as if he was back in school.

7:35

Another example was of a gentleman who every day knocks on the office door in the residential home where he lives to collect his wages (which is only paper money). This gentleman used to be

7:43

a coal miner and this how he would collect his money – what was important to him them was his role as the person that brought the money home to the family and the one who put the

7:50

food on the table and looked after his family. He hasn't lost that element of identity and purpose.

7:56

So really think about first off, who do you see? Who do you describe? Do we spend

8:04

enough time trying to understand the person they see in the mirror? Do we ask the individual who they see when they look in the mirror? Because that

8:11

opens up conversations about really finding out who the individual is.

8:17

If I'm working with children and young people I ask them who they see? Do they see themselves as a superhero, as somebody who's strong and confident,

8:26

or do they see themselves in a different light because they’ve maybe been described negatively by other people? Do I ask them if they could be a superhero or have a superpower?

8:35

What would it be? Are there elements of that they've already got in themselves?

8:42

There's really something about how we see, and everybody else, sees the individual and

8:47

how they actually see themselves. So when we're thinking about our strengths-based approach, an

8:54

exercise that you can have a go at either through individual reflection or in a group is to really

9:01

start to think about how as an organisation, do you work in a strengths-based way?

9:07

It isn't a case of we tell people they've done a good job we might follow it up with a personalised email, buy cakes one day, give people half an hour extra for lunch.

9:16

Really give thought to how do you work in a strengths-based way in your organisation,

9:28

either as an individual leader or manager, or in terms of what you see leaders and managers

9:33

doing? What are their behaviours, their traits, their activities in terms of the way they lead.

9:42

If you're a leader and a manager and you've seen your staff work and interact and engage with individuals. Think about what you see them doing and/or what you hear them saying. Does this

9:51

tell or show you, and give you the confidence, that staff are working in a strengths-based way?

9:57

If you're a member of staff, what do you do to promote a strengths-based approach to working with the individuals that you're working with and supporting?

10:13

Really think about what difference you make - it's the “so what” question again - So

10:18

what impact does this approach have on the way individual needs are met and outcomes achieved? So it isn't just we describe how we work and or lead but about the

10:31

impact it has and the difference it makes So to recap. Taking a strengths-based approach means we're exploring in a collaborative way

10:42

the individual strengths, abilities, their circumstances, the people, the things around them.

10:48

It is a shift away from making the deficit the problem, the risk, the challenge, the focus of the intervention.

10:53

It is important to remember the strengths-based approach is not just about arranging services. We have to think about if we took those services away,

11:02

how resilient, how independent would the individual be?

11:09

The next few slides are suggestions in terms of resources or tools that you could look to adopt or could try within your organisations. This is a set of questions that could be used. It's not the suggestion that this becomes another

11:14

page in a form, another document that's filled in and that we work our way through a scripted set of

11:21

questions. They are more suggestions in terms of conversation starters with individuals and we can

11:27

use them in lots of different contexts. It could be just a general chat with somebody. It could be part of the assessment that formulates the personal plan. It could be that when I'm reviewing

11:37

the personal plan every few months, that these are some of the questions that are considered.

11:44

It could be a set of questions that leaders and managers could you use in conversations with staff

11:50

with a bit of tweaking to the wording of some of these questions. For example, what are the things

11:57

you used to do in your job that you used to enjoy doing but you're not able to do anymore? what level of autonomy did you have but you don't feel like you have anymore? What impact is that having?

12:07

What level of autonomy would you like to be able to have when you're supporting individuals? What

12:13

have you been able to do in your role that you didn't think you would be able to do? You can phrase these questions in terms of interactions, conversations, relationships

12:23

with individuals who are receiving support, but also think about those you manage and maybe use the questions in terms of supporting staff and adopting a strengths-based approach with them.

12:35

Another helpful exercise here is to really focus on the individuals because we can talk generically about what we mean by a strengths-based approach but it really comes

12:45

to life when we start to identify individuals we're supporting. So in groups or by yourself

12:55

locate an individual in your mind. think of an individual you're working with who's being supported within your organisation. Then work through the questions on the screen.

13:12

When you think of that individual what have they been able to do that either they or the people around them didn't think they could? What have they been

13:21

able to do themselves? Who has helped them? What support have they accessed

13:31

to be able to do this? How does impact on the support they need going forward?

13:43

As part of our reviews of supporting individuals we always have to be thinking about a strengths-based way of promoting independence, well-being, choice and control. The more we

13:53

can start to recognise and help individuals to recognise their strengths the better. Part of my

13:59

review process should be around do we need to keep supporting you in the way we have been supporting you. Because if the individual starts to share that they've got more confidence

14:07

now and can prove to themselves that they're able to do tasks, they don't need that extra support

14:14

any more. Or they might actually feel more confident to try other things by themselves or

14:24

their family and friends may be willing to help them and they don't feel they need the service. So reflect on an individual, by yourself or in groups, and work through the questions.

14:42

They're good questions to use in supervision, team meetings or peer reflection sessions.

14:48

So to summarise the key features of a strengths-based approach. We need to think about how it values capacity. That doesn't

14:57

necessarily mean mental capacity it is about the individual's capacity to be able to support themselves using their skills, knowledge and connections.

15:04

Focusing in on strengths does not mean we ignore the challenges or spin the struggles into strengths. It is about how we get the balance right in terms

15:13

of making sure we're proportionate in how we support individuals. We have to work in collaboration either with

15:19

the individual themselves or with other people around them.

15:25

We might find ourselves in a position where we're having to challenge other individuals.

15:30

For example, a lot of the reasons why referrals come into social care or come in to providers will

15:35

be because there is a perception an individual needs help with something as they're unable to do something. It is important to have a conversation with the referrer to say,

15:45

Why do you think the person can’t do this thing? When has it happened that they can’t? Give me some examples of why you think that's a risk or why you think they're not able to do something.

15:53

Because quite often when we're talking about risks and the absence of strength, it's not always about

15:59

the risk to the individual. It could be that this is professional anxiety, family guilt

16:04

or worry. That means our sense and perception of the situation isn't always quite accurate.

16:11

Ask the questions of the individual themselves. For example, I'm hearing a lot from other people about what they think you can't do, but what can you do? What have you

16:16

been able to do yourself or with help from others? What's the one thing you want to be able to do but

16:22

no one else thinks you're able to do it? Why do you think they don't think you're able to do it? Explore the conversation. And if we start to adopt this approach and embed it a lot more

16:32

individuals become co-producers of the support rather than passive consumers of that support

16:38

So for this final part of the session, we're going to move into pulling together what

16:44

we've done in part one, pulling together what we've done in the first section of part two to start thinking about how we start to shape what quality looks like.

16:53

Leadership is a key aspect of driving quality forward in an organisation and in terms of

16:58

shaping what quality looks like. Knowing and measuring whether we're delivering the quality we should be providing is often seen as a leadership task. It predominantly is,

17:09

but it's also thinking about everybody who works in an organisation having a responsibility to lead quality in one way or another.

17:17

But for those of you in leadership roles, it is important that you give consideration to

17:22

how well you lead in the organisation. The way in which you lead the organisation will,

17:28

by default, lead to delivering a good quality service, or not

17:34

In Wales we now have Health and Social Care principles of Compassionate

17:41

Leadership developed by Social Care Wales and Health Education Improvement Wales and

17:54

it's really interesting when you start to read the narrative around the principles,

18:03

because for most of what you can see on the screen, we've already talked about it throughout part one of the training and the first part of this part two.

18:13

When considering the principles what we don’t want to do is have lots of generic and technical words that people can't relate to. So one thing to think about as a leader and manager is how you translate

18:27

the principles into language and terminology that people can buy into and recognise. One

18:33

approach to using these principles is to think about is what they are telling us about what we need to do and why we need to do it. But what leaders need to also be able to do is describe

18:44

the how. For example, as a leader you don't want to just stand in front of a group of staff and say

18:52

“I will make sure I strengthen respect, voice, influence and choice”, because the majority of

18:57

the workforce are going to turn and say, What does that mean? What you need to be able to

19:02

say is “This is what I want to do. This is how I will strive to be. This is how I will do it,

19:10

and this is how I would want you to feel if I was leading in this way”. So we need to

19:16

be able to translate the principles into what the experience will be for the people we are leading.

19:25

What are the traits or behaviours of the leader if they're working in this way? How

19:31

does that translate into how staff will then feel if they're being led compassionately?

19:37

Ultimately, if staff feel that they're being led compassionately then that will

19:42

play out in the way staff will go on to support individuals. So if you're a leader, we want to be thinking about what your behaviours, traits and how

19:51

staff will feel. If you're a staff member, think about the same thing. What would you want

19:56

to see in leaders and managers in terms of their behaviours and traits and activities? How do you

20:02

want to feel or how will you feel if your manager is leading in the way described on the screen?

20:14

It can be useful to think about how to translate these into practice. Because the leadership within the organisation, leading compassionately,

20:23

it aligns with the duty of candour that we all have the responsibility

20:28

to work towards. The RI has a responsibility to make sure that the culture of the organisation

20:35

is in line with the duty of candour that we're required to follow. And the two go hand-in-hand.

20:44

So either by yourself in reflection as a leader, or if you're a member of staff think

20:51

about how you sit and look at leaders and managers around you. If you're in a group,

20:58

have a think about how compassionate leadership plays out, or would play out, or should play out.

21:05

So it's thinking about what the behaviours, traits and competencies should be. How should

21:11

managers and leaders be doing this? Is this demonstrated by the managers and leaders

21:19

you see? If you're a manager or leader, do some of that honest self-reflection about whether you think you do that. Quite often as managers and leaders we believe

21:28

for the right reasons that we're leading in the right way. But actually, do we ever test that out? Do we ever check with staff that that's the experience they're getting from us?

21:39

Also think about either for the staff you lead or manage or if you're that member of staff how do staff then feel if they're being led in this way?

21:48

For this final part of the session we're going to think about how we start to shape, describe and define the aspects of quality that are really important. Earlier on,

21:57

I talked about the key stages of setting and managing quality. The first one is to define what quality looks like and should feel like. Second is how it's

22:06

promoted within the organisation. Third is how is measured and fourth is how it's monitored in terms of the impact it's having on the individual's experiences.

22:17

Before we get into the legislative context and policy context of quality it is helpful

22:24

for us to just stop and think about where you are as an organisation at the moment. So either individually or in groups, take ten minutes to think about what

22:36

the key elements of quality are within your organisation and give some thought to how

22:41

it is defined and how it is promoted. But also how is the impact measured in

22:49

terms of making a difference to the individual's daily lived experience?

22:55

As you do this activity, the temptation will be to define processes and activities linked

23:03

to quality. Quarterly reviews, quarterly visits, quality of care review reports,

23:09

checking paperwork. These aren't definitions of quality, they're ways to measure quality.

23:16

What we want to think about is what is it that we're actually measuring? For example, we'll all do reviews of policies and procedures, managers will be reviewing what's in assessments, personal

23:28

plans, review documents. We know we've got to do the task. The question is, what is it that we're

23:33

looking for? So if we came back to the principles of practice from earlier on, if I was, for

23:40

example, reviewing personal plans and the reviews of those personal plans, would I be wanting to see

23:49

evidence of them being completed or would I also be looking for evidence of the individual's voice choice and control, that the plan has been co-produced,

24:02

is outcome-focused and strengths-based, has an element of positive risk-taking and is proportionate. So think about how you define quality before you think about measurement tools.

24:18

So either alone or in a group, we really have to think about what are the key elements or the key descriptions of quality, how are they promoted and how do we know

24:27

whether they're having an impact on the daily lived experience of the individual? A lot of the discussion around quality and the activities that take place will

24:37

be based on the quality of care that is being provided to the individual.

24:43

It's helpful to make sure that when we're talking about quality that we're talking about all aspects of quality. There's an element of person-centred care but we also need to

24:56

think about what else is covered in regulations and statutory guidance and safe and effective

25:02

practice. My health and safety arrangements and my incident management, my medication management,

25:07

my safeguarding arrangements. They're equally important in terms of what quality looks like.

25:13

The leadership, management and culture aspect which we just covered, where I talked about compassionate leadership and the need to define, promote, measure and monitor,

25:24

set the culture of the organisation. That all has an influence and impact on quality,

25:30

as does our recruitment processes. Making sure we're following induction processes,

25:35

registering our staff with Social Care Wales, covering the workforce elements in regulations and

25:43

guidance. And then there'll be the auditing and review processes that we're required to follow,

25:48

equality care reviews, visits, adequacy of resources reports, and so on.

25:55

This is just a reminder that quality comes from a number of different areas that impact on the experiences the individual is having.

26:04

So providers and RIs are required to undertake quality of care reviews.

26:13

CIW in their guidance are very clear that an effective quality of care review seeks

26:18

to determine the extent to which people have their needs met, their rights promoted and that they can achieve their personal outcomes through the service that's being provided.

26:27

We also have to make sure we're focusing on meeting the individual's care and support needs.

26:34

As part of the process of undertaking reviews and the activities that come with that,

26:40

the RI then prepares that assessment of the standard of care and support being provided and will make recommendations for the improvement of the service.

26:50

What we need to be thinking about again is what is being measured. So it's very clear

26:57

that quality is a core strand of the legislation. We've got responsible individuals with a key role

27:02

and purpose to promote quality. But how well are we defining quality? Because if you were to go back into the regulations and the statutory guidance, the features of quality are

27:12

scattered through all of the documents they are not succinct and in one place. Some of that was illustrated in the previous slide with the circles,

27:19

in terms of quality is about person-centred care, safe and effective practice, leadership and culture, and audit and review processes.

27:29

We really need to think about what it is we're actually measuring when we talk about quality.

27:37

A lot of quality of care reviews will list and describe a lot of activity, there will

27:44

be some element of individual experience, but it tends to be quite quantitative. So what we

27:50

need to be thinking about is what do we say as an organisation a our standards of quality? What

27:58

is it we're striving towards? How will we measure it and how will we know we are achieving it?

28:04

And those quality standards need to be clear jargon free, something everybody can relate to.

28:10

As you can see on the slides, the regulations and the guidance are clear about what a quality standard is. It needs to be measurable in terms of knowing what

28:20

we need to do to achieve the quality standard that we've stated. It needs to be measurable in terms of what the impact will be for the individual and their daily lived experience.

28:31

The quality standards should run through the statement of purpose. They may well

28:36

be referenced in your information guide. They need to be the focus of the RI’s

28:42

quarterly visits. They need to be evident in the way personal plans

28:47

are produced and reviewed. They need to be evident in the way staff are working on a day-to-day basis

28:52

supporting an individual, for example the way they are helping with personal care needs, supporting them with getting out and about in the community, going to school, whatever that might be.

28:59

So we really need to think about how are we defining quality. Drawing on the exercise that you've previously done thinking about what it is that we're

29:09

actually defining as quality becomes really important. This becomes even more important

29:14

now because in the annual return that is required by CIW to be completed in line with the regulations in the statutory guidance of RISCA providers need to

29:23

include a statement of compliance against the four areas that you can see on the screen.

29:29

It isn't simply a statement that says people feel their voices are heard or they have

29:35

choice about their care and support and they have opportunities made available to them. We need to be able to demonstrate how that happens. So what's the process? What's

29:46

the activity by which we enable people to have their voices heard? How do we know that that's

29:52

happening and what's the impact that's having having in terms of individuals experiences?

30:00

Same for the second, third and fourth statement. The process becomes a lot easier

30:06

if you've got a set of quality standards that are clearly understood, that are measured. So when considering quality everyone is thinking in terms of what they are seeing, reading, hearing.

30:20

The same thing goes when sending satisfaction questionnaires out, to staff, to individuals in receipt of support, to family members, stakeholders - you need

30:30

to be gathering evidence and intelligence about whether these four things are happening. One of the things you need to be very mindful of in terms of the processes around understanding and

30:40

measuring quality is the person-centred element as well. It's a tricky one because there a lot

30:47

of activities to fulfill. My encouragement to all providers is to just stop and think

30:52

about all the processes we've got in place such as the questionnaires, the surveys, the

30:58

residents meetings. Are they giving individuals the opportunities to really tell you what their

31:04

experience is? The residents meetings that you have - step back and think are they really for

31:09

the residents or are they for the organisation in terms of providing the service. The questions

31:15

that go into questionnaires and surveys as part of quality of care reviews, are you asking questions on the basis of what you think you need to know or on the basis of what people want to

31:23

tell you. Always be thinking about developing a co-produced approach to quality of care?

31:29

If it was me and I was the responsible individual that was having to think about how I conducted my quality of care review, I would probably be sitting down with staff,

31:38

with individuals receiving care and support, with their families, friends and sharing with them what my role is to review and monitor and measure quality. It's part of why I have to undertake

31:49

regular visits. I need to engage with all of you in terms of your experiences. What would you want

31:54

to be able to tell me at those regular intervals and how would you want to be able to tell me?

32:00

Because if you were being really honest, how many people would want to fill in a questionnaire versus can we have a sit down of a cup of tea and cake. A child in a children's residential home is

32:10

more likely to tell you about their experiences kicking a ball around in a football field or having an ice cream down at the beach. So you really need to be thinking about your arrangements

32:19

for gathering information about what you can see on the screen, making sure you're person-centred

32:28

and thinking about the quantitative and qualitative measures that you're putting in place. For example, if you have a question in the questionnaire that asks are you happy

32:39

receiving the service? are you happy living in this home? and people are given the option of yes or no when it comes to writing the quality of care review report it will probably say 98 per cent of

32:49

people in this residential home say they're happy or 89 per cent of the people in this residential home say they feel safe. It's still not clear what that means in terms

32:58

of quality so think about how you expand the question and ask What makes you happy?

33:07

When was the last time you felt happy? What's happening around you that makes you feel safe?

33:12

You know, we all want to make sure that people feel as independent as possible so we will ask the question do you feel independent? Is your independence promoted 92 per cent say

33:20

yes, But how do in know what independence looks and feels like for individuals and how do I know about how we are supporting this and the impact it is having on someone's quality of life. support and information that says an independent looks like this for people and this is how they're being supported achieve it. That's a much fuller picture of quality.

33:31

As an exercise, reflecting on the quality standards you've already written and remember the strengths-based approach

33:38

if you feel you've got quality standards that are hitting the mark, talk about them, promote them, be proud of them.

33:45

If you're not sure how you define it, remember that we know what we're looking for,

33:50

we know what we mean but it may be that you haven't articulated it that clearly.

33:56

The other thing is that when you're looking at those quality standards, really think about through whose lens they're written. So do you have a quality standard that

34:05

says "we want all staff in our organisation to feel valued"? A question on a questionnaire that

34:12

says "do you feel valued? yes or no?" doesn't tell you if staff feel valued. But if I go out to staff and say "what makes you feel valued to work in this organisation?" and

34:23

they can tell me what makes them feel valued, my measurement of quality is going out and finding

34:28

that that is their experience. Do I write a quality standard that says "we actively promote the outcomes of individuals"? Or do I write a quality standard through the lens

34:37

of the individual that says "I'm able to do the things that make happy", "I'm able to do the things I enjoy", "I'm able to sleep well at night knowing I'm safe in my own home",

34:49

"I'm able to spend time with the people who are important to me". Because when I

34:54

go to measure these, I'll include a question on those in my survey and look for that in

35:02

the paperwork and I'll ask people to share their experiences with me when I visit them.

35:08

So have a go at deciding what quality looks like, by yourself or in a group, and have a go at

35:15

writing a couple of quality standards that would sit under each of these statements of compliance.

35:23

As we come back from the previous exercise around developing quality standards,

35:28

this could be a helpful model to come back to and reflect on as its thinking about what

35:33

do we say are our quality standards? Are they clear? Are they understood and are they defined?

35:38

It's thinking about what we measure and how we get the evidence that we're meeting the quality standards or not.

35:46

And then it's about how do we use that information to determine quality impact? It's really important

35:52

that we make a judgment of some sort and I don't mean that in a bureaucratic way, but we have to be able, at the end of the quality of care review processes,

36:00

be in a position to say collectively this is what quality looks like in our organisation and this is how we know we're doing that and this is how we know the impact we are having.

36:10

It's about remembering that a lot of the quality of care review reports, can become a bit of a description and a list of things under a series of headings. But actually what you want

36:19

to be able to do is conduct the analysis, and conclude or summarise what quality looks like.

36:26

Another helpful model to do that which aligns with this one in terms of bringing the information together is the "What? So What? Now what?" model of reflection

36:33

and analysis. For example when writing and concluding a quality of care review report. How do I bring this together into something condensed, tangible that I understand?

36:41

The model explores three key questions. WHAT information have I gathered? SO WHAT - so what are we proud of? So what is working well? So what

37:02

difference are we making to people? So what do we know? So what do we need to work on? So what are the areas that are causing concern?

37:10

So you take that information to feed the 'now what?', which essentially becomes the action plan.

37:17

NOW WHAT do we need to do in response? In terms of the action plan that comes out of quality of care reviews, it's taking the

37:24

strengths based approach. It should be okay to have a quality of care review action plan that

37:29

says we recognise that this works really well in our organisation and we're proud of it and part of our plan is to keep that going, to keep the emphasis, to keep the energy invested

37:41

into the things that are working really well, and that we're explicit about that in our plan.

37:46

The second half of the plan will be the areas we know we need to work on and address and this is how we're going to do it.

37:53

The other thing to think about is what happens with the information when the quality of care

37:59

review report is finished. I see a real mix across providers where it's completed and

38:05

shared only with the service provider, it goes to the commissioner and it's shared with CIW.

38:11

Sometimes staff are just given a copy of the report. I see other examples

38:18

where leaders and managers sit down and they talk through the report with individuals receiving the service or with staff.

38:24

It is really important to think about the ethos of being person-centred, co-productive,

38:30

strengths-based, promoting voice, choice and control (all those principles we've talked about throughout the training) and making sure those people who've been part of the

38:35

quality of care review process are provided with information about what's come from the review.

38:41

To give somebody a full copy of the report is probably too much, but a nice visual summary

38:49

shared with staff, family members, individuals, commissioners that says this is what our quality

38:54

of care review processes concluded for this period can be more accessible. And again, the What? So what? Now what? Model is a really nice framework in which you can say this is what

39:05

we're proud of, this is what we do well, this is what we know we need to work on, these are the things we're going to keep investing our energies in,

39:12

and this is how we're going to work on the areas we know we need to develop. The quality of care review process shouldn't just be an inclusive process

39:19

when people are feeding into it, but actually hearing what's coming out of that review and sharing it openly and honestly with people in keeping with the

39:28

principles of compassionate leadership, duty of candour, and so on, is important.

39:34

So to summarise the key messages coming out of the session: There is a very strong close relationship between the Social Services and well-being Act and RISCA.

39:45

The two complement each other really nicely. A lot of the concepts, the principles, the terminology

39:50

and language of RISCA is heavily informed by the detail that sits within the Social Services and

39:56

Well-being Act, which is why it's really key for us to understand how the two connect together.

40:02

We've explored the importance of defining understanding and measuring quality through the lens of the individual primarily,

40:08

but to strip out the jargon, the generic statements become meaningless if we don't ask the so what questions and get into the detail of what this means for individuals.

40:19

Throughout the sessions, we've explored strengths-based approaches. Remember the strengths-based approach is not just writing down things that are working well. It's what

40:27

underpins and embeds our approach to practice and aligns the principles for practice. It

40:33

aligns very nicely with how we drive and deliver quality within our organisations.

40:40

And finally, compassionate leadership is a really nice tool by which we can drive the

40:46

strengths-based approach. It aligns nicely with the principles for practice. It sits

40:51

as a key feature of how we deliver quality within our organisations.

40:56

So if we bring all of these aspects together, that's when we are in that area of being able

41:04

to drive quality within regulated settings through the lens of the individual.

41:11

So before we conclude the session. It is really helpful when you've had so much information to reflect.

41:18

Some of you will have picked up on key bits in part one that were more pertinent and others will have picked up more things in part two.

41:25

You can go back and watch the video again, but it's so important that you take But it is really important that you take some time to condense all of that

41:31

information you have received throughout the training and the reflections you have made into something that's meaningful for you as an individual as a team and/or as an organisation that you can take away from the session.

41:43

One of the ways that you can think about doing that is to reflect on the materials, reflect on the learning and all the discussions that have happened and make a commitment in terms

41:52

of one thing that you will stop doing as a result of the sessions, one thing you will start doing as

41:59

a result of the learning and the reflections and one thing that you will continue doing.

42:06

Keep these alive, come back to these and review them. Don't just review them in terms of I can say I did it but review it with the so what

42:15

question. Say to yourself I've been able to do it. So what difference does it make?

42:22

So that brings us to the end of the session. Thank you very much for engaging,

42:27

for listening and for all of your individual reflections and group discussions.