1 Supporting positive relationships and transformational leadership.
3 Strengthening partnership-working.
4 Challenging the negative stereotypes of care homes.
1 Supporting positive relationships and transformational leadership
• Care home owners, providers and managers should:
– recognise that positive relationships between older people, staff and relatives are at the heart of good practice in delivering quality and promoting ‘voice, choice and control’ and take steps to help its realisation
– recognise the importance of creating positive transformational leadership which starts from those at the top of the organisation – actively role model the types of behaviour that they expect from their
teams
– review how their organisational culture may be inhibiting the realisation of effective leadership across their workforce
– enable staff to have ‘protected time’ to foster positive relationships with, and greater knowledge about, the older people and family members
– share (and learn from others about) best practice on transformational leadership.
• Care home owners and providers should:
– enable managers to have regular opportunities to support their practice
– reflect on how their actions, policies and behaviours can impact on the manager’s well-being and ability to deliver improvements within the home
– plan changes in the organisational culture to enable relationship- centred care to flourish
– invest in (and allocate specific budgets for) leadership training/ mentoring/practice development for all managers.
• Care home managers should:
– take responsibility for their own ongoing practice support and professional development, recognising the value of regular facilitated action learning in supporting them to cope and take forward
improvements.
• Regulators and commissioners of care home services should:
– consider introducing mechanisms (e.g. Quality Assurance Frameworks currently being developed by many local authorities) to encourage or require providers to demonstrate that managers are having regular access to external sources of support and practice development – consider the value of partnership programmes such as My Home Life in
offering an affordable approach to reflective learning and professional development for care homes.
• Professional bodies within health and social care should:
– actively promote the value of continuing professional development, highlighting examples of best practice to their members.
• Local and national agencies responsible for commissioning, training and
quality improvement should:
– continue to invest in the MHL Leadership Support and Community Development Programme to enable care homes to deliver quality and ‘voice, choice and control’ to older people
– ensure that all training developed and promoted is affordable to all care homes, big and small.
The need for improved support to care home managers is also reflected within recommendations 3 and 10 of the Commission on Dignity report (2012).
2 Supporting ‘voice, choice and control’
• The Government should:
– invest in helping care homes to develop new approaches so that older people can influence strategic and operational decisions at a level within the care home organisation
– commission schemes aimed at delivering long-term community or volunteer advocacy for older people in care homes so that they can feel more confident in sharing their views and concerns without fear of reprisal (in line with recommendation 21 of the Dignity in Care report, 2012).
• Statutory agencies should:
– work in partnership with care homes to develop a shared
understanding of what is and isn’t acceptable practice in relation to supporting positive risk-taking for older people. This will help care homes feel more confident in supporting older people to take positive informed risks without fear of repercussions
– support care homes to develop stronger links with the community by brokering CRB clearance and providing advice on supporting the volunteer.
• Care homes should:
– consider what measures may be necessary to afford real power and control of decision-making, including in the running of the home, to older people, their families and those who work closest to them
– pilot more creative approaches to engaging the views of older people, including providing informal opportunities for older people to engage in dialogue with staff
– draw on the many examples of positive practice in this report and in the broader range of MHL resources.
• Local commissioning teams should:
– recognise the importance of providing more individual tailored support to older people and their families to cope with the practical and emotional upheaval of moving into a care home
– consider developing a specific post to help older people within hospital and community settings make decisions about their futures.
3 Strengthening partnership-working
• Statutory agencies (including health and well-being boards) should:
– reflect on their working relationships with care homes and agree a statement which communicates the importance of positive
partnership-working with care homes and offers some steps to making this happen
– seek to work in partnership with care homes from an early stage to agree on a shared evidence-based, relationship-centred vision for quality in care homes and use this to identify collaborative ways of working which will help to deliver quality
– create regular practice forums to enable communities of practice across health and social care to develop partnerships based upon mutual trust and collaboration
– actively encourage and support care home managers and operators to participate in any other local structures and processes for
dialogue both between themselves and across health and social care professionals (or if these do not exist, set them up)
– oversee commissioning arrangements to ensure that care homes are actively engaged as equal partners in exploring ways to meet the needs in the community.
• Agencies responsible for local safeguarding should:
– review their processes and practices to minimise the anxieties and stresses experienced by the community of the care home, and improve their capacity for relationship-centred care
– agree safeguarding processes which are proportionate to the issue being raised, within a no-blame culture
– make decisions as quickly as possible
– value care home managers as colleagues who are making complex professional judgements that need support rather than investigation.
• The Government should:
– consider the costs and benefits of reducing the duplication of paper- driven systems from the variety of agencies that work with care homes – review how greater pooling of shared information across these
agencies could release resources back into the services and reduce the time that care home managers spend on paperwork, thus enabling them to focus on their primary aim of delivering a quality service.
• Representative bodies for care homes should:
– consider the value of working together to identify the types of data that may be helpful for care home managers to systematically collect to support their own quality assurance processes and meet the demands of external bodies.
• Commissioners and regulators should:
– assess the resource implications for care homes of introducing any new requirements in terms of additional paperwork or changes in the service specification that are being required of them.
• Care home owners and providers should:
– review their own systems to ensure that internal paperwork is proportionate, relevant, streamlined, user-friendly and non-intrusive.
4 Challenging the negative stereotypes of care homes
• The partner organisations of My Home Life should promote care homes
as a positive option by:
– supporting the ongoing work of the programme to identify and share good practice, through the production of bulletins, videos, website and other communication vehicles to counterbalance some of the negative stories within the press which reduce the value, status and, ultimately the capacity, of care homes to deliver ‘voice, choice and control’ – developing a strategy for encouraging press organisations to report
care homes in a more fair and balanced way.