The following article first appeared in The Sunday Times Think Tank section on 12th June 2011.  We thought it worth reprinting here as an idea of our response to the Winterbourne View scandal.

Banishing the Cold Comfort of Care Homes

Carers should make the lives of the vulnerable more fulfilling.  Hugo de Savary explains how.

Thirty two years ago my sister Laura was born; soon afterwards she was diagnosed with a complex learning disability.  My parents were told; “She might live, she might not, but by the way, good luck.”

At each stage of her life we have tried to get the best for Laura, but when it came to caring for her in her adult life the options available didn’t measure up to what we believed she deserved.  So we created Home From Home Care, now a small group of residential homes that together providej care for some 40 people with epilepsy, autism, cerebral palsy and a range of other special neesd.

After a decade working to help young adults like Laura live a fulfilling life, I was appalled at the verbal and physeical abuse recently uncovered by the BBC’s Panorama at the Winterbourne View home in Bristol.  Eleven people have been arrested so far and the government has, rightly, ordered an inquiry.

However, poor care not only consists of such outright cruelty or neglect; relatives have also come to dread the sort of uninspired “care” in which their loved ones are not actually being abused but lead lives characterised by boredom and lack of achievement.  Working with a clinical phsychologist, we are creating a blueprint for good care tha could be replicated by organisations big and small throughout Britain.

One of the problems with the current model is that it has become very property-focused – as the Southern Cross collapse has demonstrated – with care often becoming effectively the “tenant” of a leased building.  But financial struggles can help businesses to focus on what really matters.

Three years ago our business was hit by the credit crunch.  As our bank struggled to stay afload, it cancelled some of our funding, jeopardising our ability to pay our staff.  During the next nine months, battling the perfect storm of financial crunch and a slowdown of placements from local authorities, we had to face the realities about making our business work.  There was only one way to do this – to concentrate on the quality of service.

Good care results from good people working intunitively, suppporting people to lead more fulfilled lives.  At Winterbourne, it was clear that not just the residents but also the staff were bored – some fo the time they were goading the residents to get a reaction.  If a carer is stting around drinking coffee or watching television, they are not caring.  But they are not getting any job satisfaction either.

Providing good care means encouraging people to participate in meaningful activities and events that are not only beneficial to their mental and physical wellbeing but also build their independence and broaden their potential.

One of the challenges in looking after adults is that if they choose not to go for a walk or play cards, or whatever activity is on offer, there is little the staff can do.  Ask Laura if she would like to go for a swim and she will look at you as if you are mad and then say no.  The answer is to provide choice; asking “shall we go swimming or ice skating?” will make the difference between someone spending a day watching television and being out and about.  A programme of regular acitivies also means staff are engaged with residents in a way they, too, can enjoy – which strengthens bonds between residents and carers.

So we are creating a framework to link the theory of good care to practical delivery, working with a leading psychiatrist and psychologist and our staff of 160.  We have identified some 140 “management inputs” that affect the day-to-day running of a home, from making sure the printer is working (to print out the care plans) to ensuring all people in the home get to the activities they are doing that day.  Then there are the 120 “care inputs” that directly affect the wellbeing of each person we support.  Next, it is important to match the right staff member with each resident, a process that produces 80 considerations for each member of staff.  This equates to about 5,000 variables that directly affect the smooth running of each of our homes.  Each support worker is given a number of responsibilities and tasks (based on the variables) that they have to do on a daily, weekly or monthly basis.  This is the real crux of the issue, because in many care settings there is little management and structure for workers.

A specially designed IT program holds data on every resident – what their favourite food is, what they like doing, what their goals and aspirations are and obviously their assessed needs.  Instead of a piece of paper filed away somewhere, this is a dynamic profile that can change as a person’s needs and life change.

To anyone in business this seems like a commonsense approach.  But for the care industry this has not been done before.  We have found that if support workers are given more responsibility, they are more motivated and committed and will ultimately deliver better care.