Implementing Quality of Life for Older people

My Home Life Leadership Support Programme 2016-17

1. About My Home Life The My Home Life Vision

Our vision is a world where care homes are great places to live, die, visit and work; where care homes are:

Supported to deliver their potential

Valued and trusted by those who work with them

Cherished by their local communities

My Home Life (MHL) is a UK-wide initiative that promotes quality of life and delivers positive change in care homes for older people. We work with care homes, statutory bodies, community organisations and others to co-create new ways of working to better meet the needs of older people, relatives and staff. It is led nationally by City University, London in partnership with Age UK, the Joseph Rowntree Foundation and Dementia UK. In Scotland the programme is delivered by the University of the West of Scotland (UWS) in partnership with Scottish Care and Age Scotland.

It is a collaborative scheme bringing together organisations which reflect the interests of care home providers, commissioners, regulators, care home residents and relatives and those interested in education, research and practice development.

Evidence Base

MHL have worked with over 60 academic researchers from universities across the UK to develop an evidence base for quality of life in care homes. The review of evidence explored ‘what residents want’ and ‘what practices work ’.

The evidence was found to cluster around 8 best practice themes:

1. Managing Transitions Supporting people both to manage the loss & upheaval associated with going into a home and to move forward

2. Maintaining Identity

Working creatively with residents to maintain their sense of personal identity and engage in meaningful activity

3. Creating Community

Optimising relationships between and across staff, residents, family, friends and the wider local community. Encouraging a sense of security, continuity, belonging, purpose, achievement and significance for all

4. Sharing Decision-making

Facilitating informed risk-taking and the involvement of residents, relatives and staff in shared decision-making in all aspects of home life

5. Improving Health & Healthcare

Ensuring adequate access to healthcare services and promoting health to optimise resident quality of life

6. Supporting Good End of Life

Valuing the ‘living’ and dying’ in care homes and helping residents to prepare for a ‘good death’ with the support of their families

7. Keeping Workforce Fit for Purpose Identifying and meeting ever-changing training needs within the care home workforce

8. Promoting a Positive Culture Developing leadership, management and expertise to deliver a culture of care where care homes are seen as a positive option

Together these themes offer a vision for the developing nature of an integrated health and social care service and, a framework from which to deliver quality of life. The vision is underpinned by ‘relationship-centred care’ where relationships with staff, service users and families are at the heart of quality improvement. What can MHL Scotland offer you? The My Home Life Scotland programme (www.myhomelife.org.uk) is offering a 14 month package of community and practice development, and leadership support to help develop quality of life for people receiving services within the Scottish Borders. The package of support proposed here will:

1. Support participants to deliver quality of life, transformation and voice, choice & control (personalisation) to patients, public, relatives and staff through a leadership support programme.

2. Enhance quality of life by facilitating better relationships between care and support providers and the wider community and health & social care system

3. Help create a sustainable movement of care homes in Scotland, to drive forward quality

improvement and professional development of staff, in order to better respond to the complex needs and wishes of older people receiving care and support and relatives.

“Learn from each other and learn from the very best”

Julia Unwin, Joseph Rowntree Foundation – about My Home Life

“Common sense, best practice and evidence based!” Des Kelly, National Care Forum – about My Home Life

2. Opportunities offered by My Home Life Scotland My Home Life is a movement for quality of life in care homes. It is exceptional. It has so far resulted in:

Improved quality of life of those living, dying, visiting and working in care homes

Enhancing managers skills in leadership, transforming care homes

Perceived reduction in management burnout

More innovative care homes, responsive and ready to meet future need

Development of personalisation in care homes

Development of the care homes role in the local community

Care homes in your area more equipped to drive forward their own quality agenda

Increasing managers’ skills in relationship-building with NHS colleagues to reduce inappropriate hospital admissions

A recent evaluation of the programme clearly shows the positive changes which managers have experienced following implementation of the My Home Life approach in their care homes. In particular, managers reported strong improvements in their leadership capabilities and relationships with staff. The tables below are based on evaluation data collected from participants at the beginning and the end of the programme: Managers Workload and Feelings

Managers reporting high levels of stress reduced from 60% to 36%

Managers feeling enthusiastic about working in care homes increased from 29% to 68%

Managers feeling valued for the work they do increased from 47% to 72%

Managers allowing staff to try out new ideas without criticism increased from 57% to 98%

In comparison to the year prior to joining the programme, managers reported strong improvements both in the quality of interactions between staff and relatives and the extent to which residents were actively involved in decisions affecting their own lives

The programme will help deliver some of the key policy drivers currently being developed in Government. While the My Home Life Scotland Leadership Support and Community Development Programme is based upon and actively works with the experience of the sector rather than being imposed from above, it also sets out to help deliver some of the key policy drivers in Scottish Government. The programme supports the 20:20 Vision: Everyone Matters plan that articulates the core values of NHS Scotland which are: care and compassion; dignity and respect; openness, honesty and responsibility; quality and teamwork. The programme supports the policy focus on improving outcomes and the drive towards personalisation through participation. The Scottish Government is committed to adopting an ‘outcomes approach’ in all services and settings, ensuring a central concern with the difference made to people’s lives. Indeed, the commitment to improving personal outcomes has recently been heightened through a series of key strategies and endorsement in forthcoming legislation, notably the Joint Working Public Bodies Bill and the Self Directed Support Act.

The MHL programme supports: • Dignity in Care • A Personal outcome approach: a key strand of Care Inspections • Quality of life: a key government outcome • Dementia and End of Life Care Strategy. My Home Life is closely linked to the

implementation of both strategies • The Big Society and ‘Think Personal, Act Local’: Creating community is one of the My Home

Life themes and is concerned with enhancing relationships with local people, businesses, schools, churches etc., especially through the use of volunteers

The programme has been very positively received by the sector. It is uniquely supported by all the national provider representative organisations for care homes across the UK1. Because of the success of the programme over the past three years, Joseph Rowntree Foundation has decided to act as a formal partner in the programme. MHL holds the evidence base for the sector and is working to help care providers professionalise and articulate their expertise. MHL draws from and shares positive examples of practice already in place, rather than dwelling on poor practice. Overall, there is a high level of brand recognition within the care home sector. MHL is increasingly seen as the voice for quality for the care home sector and the vision for practice improvement in the 21st Century. Over 4,500 care home practitioners are now involved in the MHL Network.

“The Programme is making a real contribution to improving care standards and the quality of life for older people. The really important thing about MHL is that it is based in the experience of the sector and is not imposed from above” Martin Green, English Community Care Association

3. Who is this for? This program is aimed at managers within Care Homes across the Scottish Borders. Participants will be people who have day to day responsibility and accountability for delivery of a discrete aspect of Care/Support provision, e.g. Care Home Manager Senior Social Worker Allied Health Professionals Service Managers Senior Charge Nurses Senior Nurses/Managers

1 National Care Forum, English Community Care Association, Registered Nursing Home Association, National Care Association, Care Forum Wales, Scottish Care, Independent Health and Care Providers of Northern Ireland

It will be important that participants are able to discuss, agree and implement changes in the area they manage, where necessary supported by the line manager.

4. The Proposal Summary of package Intensive work will be undertaken both with the program participants and with those working in the wider community and health and social care system. This will ensure that the work has a real impact on the culture of practice in Health and Social care and the wider system to ensure quality of life for patients, public, relatives and staff. Particular emphasis will be given to supporting a ‘voice, choice and control’ for older people with complex health needs, including those with dementia. The leadership support strand will work with a maximum of 16 participants. The package would cover:

4 days workshop to work with participants to build on their knowledge of relationship centred care

Leadership support through action learning – 9 sessions over 9 months

Supply of learning resources

Final event to celebrate and share lessons learnt Over a 12 month period we will offer the managers leadership support through an intensive learning package, followed by action learning sets to support their journey of ‘culture change’ in moving towards the evidence-based and relationship-centred vision of MHL. This would entail an initial 4 days workshops for the managers (2 x 2 days) with leadership input and practice improvement support for one day a month for 9 months, thereafter.

4.1 The Leadership Support strand The purposes of the group are for:

Managers to be supported through four workshops and nine Action Learning Sets to engage with the MHL vision and helped to engage in a ‘journey’ of positive culture change within their own areas of accountability

Managers to be supported in promoting the MHL vision

Training programmes often have the tendency of taking staff away from their work and engaging on issues which are not directly linked to their normal day-to-day activities. The model we propose here is about ensuring that the learning brings individuals closer to their day-to-day work, helping staff to think objectively about the culture of care and to work creatively, with support, to identify realistic solutions for improving voice, choice, and control and quality of life of patients, residents, relatives and staff.

During the first two months, each group of 16 participants will come together as the MHL Leadership Support Group on 4 occasions (2 x 2 day sessions) to explore the vision for MHL (8 evidence-based, relationship-centred themes); involvement of patients,

residents, relatives and staff; leadership, reflective practice and facilitating change.

This 4 day programme will prepare the Leadership Support Group to develop skills in developing practice within their chosen area. This will be followed by nine action learning sets. The Action Learning Set

Following the initial sessions, monthly action learning will support the MHL participants to explore challenges and issue in taking forward improvements in their chosen area (9 one day sessions in total).

Action learning involves learning through action. It is a continuous process of learning and reflection, supported by colleagues, with an intention of getting things done. It recognises that individuals learn best when they learn with and from each other, by working on real problems and reflecting on their own experiences. It involves working with real issues with the intention of achieving improvement and transformation in the workplace.

Action learning will involve the group sharing the progress made on their action learning plans and having time to reflect on challenges encountered to find ways forward. Common issues raised in the action learning set will be agreed for sharing with a wider audience and captured, with permission, for evaluative purposes.

Other data will be gathered from the participants to identify any naturally occurring indications of improvement over the 12 month period.

Findings from My Home Life North Lanarkshire “I really try to take a more positive approach to things in the home. When things are not going well I am better able to press the pause button and spend time finding out how people are feeling about an issue and try to work out what is possible”. Care Home Manager, North Lanarkshire “We have a lot of projects coming our way: every moment counts, anticipatory care planning – we can use the learning from My Home Life to help us to do these projects well”. Care Home Manager, North Lanarkshire

The professional development work is a blend of approaches including experiential learning, and appreciative inquiry. Managers are thriving on it and are telling us that our approach is completely different from anything else that they have experienced. They are demonstrating greater leadership and transformational skills which appear to be leading to positive outcomes for residents, relatives and staff and a greater understanding of how their own management style can inhibit or enable culture change in relation to voice, choice and control for residents.

They are quickly seeing the benefits of small shifts in their behaviour/ practices with regard to working with staff and relatives alike. Some managers now have the skills to influence their staff and their provider group/ care home owners. In time they will also be influencing their peer group by spreading the evidence base for quality of life.

4.2 Wider engagement with National MHL Programme In return for participating in the initial workshops and action learning support, the participants within the Leadership Support Group will be working on a journey of transformation in their own area of practice. We will also encourage them to act as advocates in helping others to engage with the evidence base for quality of life, perhaps by offering mentorship and support as their capacity allows. We will provide opportunities for connecting managers, and also officers within Scotland, with others within the other participating partners to share ideas and provide wider support. Finally, MHL will also have access to a range of academic researchers across the country that may be able to offer informal ad hoc advice to Health Boards and Integrated Joint Boards on relevant issues that arise.

4.3 Evaluative summary of programme Throughout the project, data will be captured to evaluate both the process and the outcomes of each intervention. We will provide an accessible and useful document that describes the programme and pulls together lessons learnt. The document will focus on the positive outcomes of the work and the barriers to quality of life that still remain. We will create a product for Scotland which is helpful in sharing what has been achieved and ensuring a level of sustainability of the work in future years. This will also be presented to all participants to help them continue to engage in developing practice.

Managers who have completed the project told us:

‘It’s like turning on a light bulb, suddenly things become clear’

‘We’ve all got the same kind of problems cropping up, it’s great to know you’re not alone and when we talk through the problems the solutions become clearer’.

‘It’s been really helpful for my personal development as well as beneficial to the home….it’s giving me the confidence to stand up for doing things right, it’s very motivating’

5. Timescale and costs

11th October 2016 Leadership Support Day 1

12th October 2016 Leadership Support Day 2

22nd November 2016 Leadership Support Day 3

23rd November 2016 Leadership Support Day 4

15th December 2016 Action Learning Day 1

12th January 2017 Action Learning Day 2

9th February 2017 Action Learning Day 3

7th March 2017 Action Learning Day 4

12th April 2017 Action Learning Day 5

10th May 2017 Action Learning Day 6

6th June 2017 Action Learning Day 7

14th July 2017 Action Learning Day 8

15th August 2017 Action Learning Day 9

20th September 2017 Validation Event

Total cost: £2000 per person

6. Appendix 1: What the sector thinks about My Home Life “Having been involved with the My Home Life (MHL) programme from the outset the National Care Forum is pleased to be associated with it and proud of what it has already achieved. It has given a new focus to quality of life in care homes for older people in positive ways underpinned by sound research evidence. It is our view that the MHL programme has the potential to contribute significantly to improving quality by assisting in transforming care and support services.” Des Kelly OBE, National Care Forum “The My Home Life Programme is making a real contribution to improving care standards and the quality of life for older people. The really important thing about MHL is that it is based in the experience of the sector and is not imposed from above” Martin Green, English Community Care Association “For care providers one of the most important parts of the work of My Home Life is the recognition of Best Practice and the encouragement of the sector to do better. National Care Association welcomes every opportunity to work with the My Home Life project because of the way it supports every provider to achieve the best possible outcome for people in receipt of care.” Sheila Scott OBE, National Care Association “I have often bemoaned the lack of genuine, unbiased, research into the care provided by the independent sector in care homes and nursing homes. The My Home Life project promises to alter that balance by focussing on best practice in care homes, an approach which is not only welcomed by the providers, but will have a marked impact on those using our service.” Frank Ursell, Registered Nursing Home Association. "It's great for staff in Care Homes to have a recognised source for advice based on evidence and good practice, particularly when many are independent, operating in isolation from other larger providers." Hugh Mills, Independent Health and Care Providers, Northern Ireland “My Home Life has proven a very effective means of first and foremost focusing attention on the experience of those living in Care Homes whilst at the same time valuing and encouraging the efforts of those working there. Staff have found My Home Life an aid to accessing and developing best practice.” Ranald Mair, Scottish Care “The raising of standards is the objective of Care Forum Wales and Rachel Mortimore, Manager of College Fields who was awarded the ‘Spirit of Care Award’ at the Wales Care Awards by Care Forum Wales has accepted an invitation from Help the Aged to assist with the appointment of a co-ordinator for Wales to promote the project in the Principality.” Mario Kreft, Chief Executive, Care Forum Wales

7. Appendix 2: ‘Things we have changed’: My Home Life North Lanarkshire, 2013 “I used to take on everything myself and not trust others to do as good a job as me – I was run ragged – now I put effort into making sure I support others to do things – I trust people more now.” “I used to react to things now I consciously press the pause button to give myself time to respond in a way that is appreciative.” “I used to think I had an open door policy – but when I asked staff if this was the case they had a different view – just having the door open and saying I had an open door policy did not mean I had one.” “I used to feel uncertain about taking some things forward – it can feel like taking a risk – now I always ask myself the question what is the worst thing that can happen here! Just even asking myself this question has made me more confident to give things a go.” “I used to run residents meeting and many were asleep during the meeting – I now have changed the meeting to encourage interaction by all – people are now awake during the meeting.” “I used to send a whole pile of clinical information about a resident if they were being transferred to hospital and got frustrated if people did not read this or lost it – now I summarise the clinical information and make sure I forward information about the resident as a person – staff in the hospital have thanked me for this.” “When there is conflict with staff I used to bring them into the office and ask them what is happening – now I help them to explore things in a more balanced way using emotions.” “I never used to share how I was feeling with staff as I did not think it was professional – now I do and it helps the relationship.” “I used to use words like we are going to investigate this – when relatives raised issues of concern – now I use words like I need to find out more about a bit more about what has happened. Investigate can sound as if we don’t believe what they are saying and we need to check this out.” “We used to use words like wanderer we now talk about people who like to be on the move a lot of the time.” “I used to care for people like I wanted my own loved one to be cared for – now I care for people like they want to be cared for and make sure I ask them.”

8. The Team The My Home Life Scotland Team is based at the Institute for Healthcare Policy and Practice, School of Education, Health and Nursing, University of the West of Scotland. The team is led by Professor Belinda Dewar (Director). Institute of Healthcare Policy and Practice University of West of Scotland Faculty of Health Education and Social Sciences School of Health, Nursing and Midwifery Caird Building Hamilton Campus Almada Street Hamilton ML3 OJB Mobile: 07511106411 Tel: 01698283100 ext. 8247 Email: belinda.dewar@uws.ac.uk http://www.uws.ac.uk/schools/school-of-health-nursing-and-midwifery/research/institute-for-care-and-practice-improvement/ Lead for My Home Life Scotland www.myhomelifescotland.org.uk The My Home Life team have considerable experience of working and researching care home practice. Our work has helped us develop a full understanding of the barriers and problems facing both the sector and the wider health and social care system. We have also developed a range of tools for use within culture change initiatives. Full CV and publication details are available on request.