Quality of care special report – How to grow a new type of care

A care home resident who is unsteady on his feet wishes to walk around the garden unaided. In so doing, he will maintain his independence, have a higher quality of life, and boost his mental wellbeing. He may also fall and badly bruise his knee. What is the best way of delivering high-quality care to this person – insisting he stay inside, or letting him go outside at the risk of a potentially negative outcome?

‘How many providers are really putting the person at the heart of what they do?’

It is not a simple question to answer, but it is one which is becoming increasingly pressing in the health and social care sectors. No longer is quality seen as purely a measure of clinical outcomes. More or less every healthcare organisation now has a clear commitment to delivering person-centred as well as outcomes-centred care. But how many providers are really putting the person at the heart of what they do? How many are really willing to find out that the benefits of the walk in the garden might outweigh the risk of the badly bruised knee?

Democratic delivery of care

Professor Graham Stokes, director of dementia care at Bupa Care Services UK and an honorary professor at Bradford University, is unsure.

“You can’t move in health and social care now without everything having to be personalised and individualised,” he says. “But terms get diluted and as the message is rolled out widely, it’s becoming increasingly superficial. Nowadays, I think if you know someone’s name, you are seen to be working in a personalised way.”

This is unlikely to remain sufficient. The recently published National Institute for Health and Clinical Excellence quality standard for supporting people with dementia, for instance, mentions “ensuring support is sensitive to the circumstances of each person”.

It is, believes Sandra Stark, an important point. “For me, quality is very much an individual thing,” says the new director of care and quality at Bupa Care Services UK. “Consider going to a restaurant - we all know what a good meal is for each of us as an individual, how we like the food served, the atmosphere, the type of food and so on.

“For me, quality in the care home sector is like that. It’s very much an individual thing because everybody has different expectations based on their life experiences and their preferences. And it’s not just about clinical outcomes. There are some core expectations such as prevention of pressure sores, good infection control and effective staff recruitment which we can put systems and processes and measures in place to move forward, but quality is individual.”

It is a point she says is widely and frequently communicated within Bupa. Managers are urged and supported to create a culture in which the resident is at the very centre. But there is also a deep understanding of the importance of frontline staff in defining what quality means.

“I’ve always said that if you want to really know what’s going on in a care home, you bypass the manager and head straight for the care staff,” comments Professor Stokes. “They tend to be the ones at the bottom of the hierarchy, yet they’re the ones who know the most. So there does need to be a democratic approach to the delivery of care.”

At Bupa, that democracy is further reflected in involving staff members of every group in the delivery of quality. “For me it’s now a given that any care provider should be providing a safe quality of care,” continues Professor Stokes.

‘Even office and reception staff should be engaging with people as they walk around a building or a community’

“The current agenda is, or should be, about quality of life. And when you start thinking about quality of life, I think that has to capture everybody who works in that care environment. That does mean even office staff, reception staff - they should be engaging with people as they walk around a building or around a community. Those staff members should know how to respond.”

Beyond walls

It is why all at Bupa receive training to put quality care of residents at the centre of what they do. That includes Person First… dementia second training which aims to capture the essence of what it means to work in a truly personalised way.

The content and methodology of the course has now been shared widely at a variety of conferences and, says Professor Stokes, “the response has been unremittingly favourable”. It is an example of what staff at Bupa say is a desire to spread best practice far beyond its own organisational walls.

“You do get some organisations that are quite insular, and they have some brilliant ideas but they don’t share them,” reports Kate Emery, a manager at one of Bupa’s care homes. “Whereas I think Bupa does recognise a wider responsibility to the community.”

To that end, Ms Emery has been delivering dementia training to staff at her local hospital, and working with community liaison police to help them deal with situations where people living with dementia commit public disorder offences. “It’s not just about Bupa,” she says. “It’s about getting your message out to the community as well.”

It is a theme echoed by her fellow care home manager Lesley Tart, who is forming links with the local junior school. “I don’t just see quality as being in the care home,” she says. “I look at it as being in the whole community.”

For Ms Stark, such work is particularly important at a time when the health and social care sectors are under such intense scrutiny and pressure. “I think there are real challenges in the sector just now - increasing quality expectations, increased customer and regulatory demands, increased care needs of our residents - at a time when our funding is not being increased or in a lot of cases is actually being reduced. For us, it’s how do we address those challenges within Bupa, and then how do we help lead some of the debate?”

That debate is evolving, but it is clear that Ms Stark and her colleagues believe truly person-centred care must be at the very heart of it.