Relationship Activated Care: The 360 Standard Framework Defining and Transforming Care Cultures Patricia Duff OBE, MSc, BA, RN, RM, PGCEA Rosemary Hurtley MSc, Dip COT, FRSA Royal College of Medicine, Summer School 2013 Using measurable outcome standards to exemplify and protect Human Rights in care settings

360 Forward provides : Diagnostic assessment Consultancy, education, coaching & training services Working with managers and staff at all levels Health and social care Our aim is to establish dynamic, sustainable person centred cultures in their organisations in line with the philosophy and principles of The 360 Standard Framework. Patricia Duff OBE, MSc, BA, RN, RM, PGCEA Rosemary Hurtley MSc, Dip COT, FRSA

What is the 360 Standard Framework? A diagnostic assessment framework that shows care organisations how to establish and maintain person-centred cultures from the perspective of the cared for person, their families and carers An outcomes based practice development framework for achieving continuous improvement

Defining and Transforming the Care Experience

Assessment Framework – Residents' Measures 1.Receiving person-centred care 2.Opportunities for social/occupational activity 3.Influencing meals and drink 4.Meeting spiritual needs 5.Resolving concerns and complaints

Staff and Relatives’ Measures Staff measures 4. Feeling valued as a staff member 3. Equipped to do the job 2. Having time to deliver good care 1. Finding the work fulfilling Relative measures 2. Communicating with staff and managers 1. Welcoming ambience of the home 4. Seeking to resolve concerns and complaints 3. Being fully informed 5. Contributing to the care of the family member and the community of the home

Managers making it happen Enabling /facilitative management style - clear channels of communication, positive relationship building, collaboration with other professionals and agencies Pivotal leadership role in change management –Operational management –Practice development –Quality improvement –Business planning

Example : Resident Standard 3:1 The resident has a choice of culturally acceptable food and drink that meet his/her dietary requirements StructureProcessOutcome

Characteristics of the 360 Standard Framework Delivers continuous quality improvement and demonstrates measurable change A Standard of excellence in relationship activated care for person-centred outcomes Involves the cared-for person, relatives and staff Incorporates evidence from research and empirical studies Underpins all other service and practice standards Diagnostic with measurable outcomes

2 - Preparing and Planning 1 - Client Decision 4 - Data Analysis 5 - Feedback 3 - Data Collection 8. Internal Evaluation Foundation Commitment Award Foundation Outstanding Progress Award 6. Action Plan 7. Internal Implement Action Plans. Routes : The 10 Step Cycle

Why is the 360 Standard Framework important to the NHS? Good patient outcomes - Create a patient-centred NHS Quality Improvement - Focus on improving their experience and their health outcomes Value added benefits: effectiveness and efficiency Leadership and management enabling tools - Empower professionals – end top-down control

Work-based Learning Key topic areas For delivering quality compassionate care 1.Understanding ageism in society 2.Understanding chronic conditions and their effects on the person –identity, significance, continuity, purposefulness, belonging and being understood 3.Building positive relationships –the triangle 4.Specialist communication skills 5.Understanding transition, loss and adapting 6.Understanding and preventing institutionalisation 7.Inter professional co-operation and collaboration - INTEGRATION

The Elizabeth project Justine Cawley Independent Consultant Associate at Bucks New University

Background Developing a career pathway for people working with older people From apprenticeship to post-registration nursing Mid Staffordshire and other incidents of unacceptable care Over the years older people have been moved out of hospital into residential care and as a result the health input has diminished

The Structure of the pathway Post apprenticeship course Elizabeth practitioner – Foundation degree Elizabeth Nurse – Post qualifying degree

Increase in complexity of care – dementia, long term conditions Need to have higher standards in health and social care No dedicated career pathway for older people Need to give the sector and their staff more status and recognition Why is this needed?

Issues in the sector Societal Organisational Operational Practice- knowledge, skills, behaviours Lack of funding for socio-health nurse development No career pathway to higher education qualification in care of older people

Why training is essential: 65% of people in hospital are over % of people in care homes have dementia or cognitive impairment (Alzheimer’s Society, 2013) Residents of care homes have complex healthcare needs, reflecting multiple long-term conditions, significant disability and frailty.(BGS, 2011) All health and social care providers need training in the complex management of people with multiple long-term conditions (BGS, 2013) People living in a care home and suffering from dementia are more likely to go to hospital with avoidable conditions such as urinary infections.(CQC, Care Update) The social care model is central but insufficient to meet residents’ health needs.(BGS, 2011)

Impact More young people coming into the Sector A more educated and adaptable workforce A career pathway that young people want to enter Work based learning and an alternative to University Less turnover of staff More profitable sector Happier staff More career opportunities More customer satisfaction

Enabling the Willis and Francis Report Recommendations The culture of healthcare provider organisations is routinely assessed More family and user involvement in education Streamline communication skills to provide dignity for people with dementia, mental health and chronic disease Flexible education programmes for nurses and carers, people and their families Work-based learning New status of nurse for older people (Francis Report)

Integration Integration is essential if we are going to give older people the care they deserve. Partnership is essential – Partnership which are equal Social Care sector is very fragmented. NHS have the money and Commissioners have the power Social care have less qualified staff

Social Care Sector Predominantly SMEs who are fighting to survive High turnover of staff Lack of awareness of partnership – lose staff to NHS High drop-out rate with young people

Partnership and integration Partnerships are sustainable They are equal They have good foundations and have identified core common goals They have common training routes

Building Bridges Construction began in 1831 but the project was beset by political and financial difficulties. By 1843, with only the towers completed, the project was abandoned. The bridge was finally completed and opened in 1864.

Bridges and innovation Underpin foundations of the weaker side or use strengthening members across it Victorians great engineers and innovators We have to be a different sort of innovator by being builders of social structures that work and provide excellent care.

‘ Thank you Rosemary Hurtley Justine Cawley