Safeguarding - Culture Change
Culture Change Matters
Dementia Care Matters is supporting the drive to increase the profile of and improve “safeguarding”. We feel strongly that with the publication of the Francis Reports this offers a real opportunity to focus on what matters most. Individuals cannot be safeguarded by policies, procedures and systems without first the priority being on modernising cultures of care. Safeguarding individuals first begins with safeguarding people from old cultures of care.
Compassion in Management Matters
The launch of ‘Compassion in Practice’ 4th December 2012, a three year strategy by the Department of Health/NHS Commissioning Board is a pivotal moment. It offers a real opportunity to redirect the national focus of Nursing, Midwifery and Care Staff. This focus on ‘Six Fundamental Values’ – Care, Compassion, Competence, Communication, Courage and Commitment is vital in the future success of safeguarding individuals.
All nurses come into nursing to be compassionate - compassion in practice comes not just from individual nurses but from a fundamental examination of how organisational cultures have in the past prevented the expression of compassion. Compassion in practice will mean that there is a need to create, and require organisations to evidence, ‘being’ compassionate in order for cultures of care to ‘feel’ compassionate.
Staff - Wellbeing Matters
Compassion in nursing is about ‘Giving’ – nurses also need to receive from colleagues, teams, leaders and organisations what they are being asked to give themselves. Compassion in practice comes from compassionate leadership focusing on nurturing staff well being at work. The drive to focus health and social care services on person centred care and relationship focussed support relies totally on nurses and care workers receiving this same approach. Only with this emphasis, when organisations mirror being person centred towards staff, will individuals receiving a service be more likely to be safeguarded.
Feelings Matter Most
Dementia Care Matters welcomes the CQC State of Care Report 2011 / 2012 and in particular its emphasis on people's emotional needs. The report highlighted: ‘Information from CQC’s inspections shows that those services that maintain people’s dignity and treat them with respect, all have a number of things in common: they recognise the individuality of each person in their care, and help them to retain their sense of identity and self-worth; take time to listen to what people say; are alert to people’s emotional needs as much as their physical needs; and give them more control over their care and the environment around them.’
Safeguarding has a vital role in ensuring individuals receive this person centred and relationship focused approach. Achieving these outcomes requires a shift from a practical competency and task orientation approach. The new emphasis needs to be more on fostering emotional intelligence, attachment and connection within cultures of care.
The Person Matters
For safeguarding to be successful individuals receiving support from health and social care services will need to receive six guarantees as a person:
- Evidence that they matter as an individual
- Promotion of their human rights
- Prevention of infantilisation by their families
- Respect for existing or newly formed positive relationships
- Elimination of boredom and ill being
- Dignified meaningful appropriate touch
Safeguarding has been necessary due to the dehumanisation of individuals, people’s lack of rights, families taking over control, new relationships being prevented, boredom and lethargy being highly prevalent and staff being prevented from providing closeness.
The Culture Matters
For safeguarding to be successful individuals receiving support from health and social care services will need to receive six guarantees from a service:
- Safe environments feeling personalised
- Relaxed approaches to daily needs
- Person centred care and support
- Positive social interaction during care
- Joined up health and social care
- Protection from over use of drugs
- Limiting unecessary moves
Safeguarding has been necessary due to an over reliance on sterile clinical environments being safe rather than these environments also exuding warmth and feeling personalised. People need safeguarding from cultures of care that are controlling and which place wrongly place service needs and organisation requirements before the emotional needs of individuals. Safeguarding needs to focus on individuals not being institutionalised, not being given harmful drugs or placed at risk from multiple harmful moves.
The Leader Matters
For safeguarding to be successful individuals receiving support from health and social care services will need to receive six guarantees that a service is led by:
- A new culture attached leader
- Inclusion and no ‘Them and Us’ boundaries
- A service with inspiring leadership
- A team focussed on culture change
- An emphasis on outcomes and quality of life
- Real consultation and involvement
Safeguarding has been necessary due to services being over managed on procedures and process rather than services being focussed on having inspiring leadership. People need safeguarding from services that separate people who live in a service and people who work in a service as this leads to dehumaniszing as this leads to us and them. Safeguarding is needed when services value their compliance with policies and systems rather than being centred in the lived experience of people within the service.
Mattering – Dementia Care Matters Approach to Safeguarding
For many years, Dementia Care Matters has focused on why changing cultures matters through its body of work.
- “Being: an approach to life and dementia.” BEING person centred involves helping staff to shift their focus from only “doing” tasks to being able to reach people on the inside.
- “Enabling: quality of life an evaluation approach.” ENABLING quality of life starts with really seeing, hearing and feeling the minute by minute experiences of people and being determined to improve the moment.
- “Inspiring: leadership matters in dementia care.” INSPIRING leadership in dementia care means shifting people from detached management to attached leadership where people lead from the heart and not just by the hand.
- “Nurturing: emotions at work in staff.” NURTURING staff’s emotions in dementia care and supporting their emotional labour and team relationships is the key to solving the riddle of why being person centred as a service is so difficult at times to achieve.
- “Growing: training that works in dementia care.” GROWING training that works requires a shift from tick-box awareness level training to growing real learning and reflection – turning skills into action through coaching and service development.
- “Achieving real outcomes in dementia care homes.” Our definitive guide to person centred and relationship focused dementia care. Dementia Care Matter's Operational Care Home Manual
This body of work directly and positively links culture change, promoting dignity, respect and measuring well being with the cessation of malignant care cultures and prevention of abuse of vulnerable adults. This is how in our view safeguarding will be effective. This material is available through University recognised courses, Publications, DVDs and Learning Resources.
The Feeling of Mattering
Dementia Care Matters has been researching the concept of Mattering in other health and social care fields. Mattering as an approach has been found to be highly effective in:
- Increasing academic success in students
- Reducing family violence
- Increasing job satisfaction
- Protecting against depression
- Resolving adolescent conflict
- Improving well being and self esteem
- Decreasing levels of suicide
Dementia Care Matters is therefore focusing on how the concept of Mattering within Dementia Care can be effective in safeguarding individuals and reducing the inappropriate use of neuroleptics by providing a positive alternative which focuses on practical strategies on how to:
- Create positive care cultures
- Inspire new culture attached leaders
- Nurture staff well being
- Mentor/coach nurses as leaders
- Foster person centred staff teams
- Identify key positive care indicators
- Measure quality of life
- Achieve on focused outcomes
In recognition of the national focus on the links providers need to make between safeguarding, changing cultures, compassion in care, people's emotional needs and the need for commissioners to focus on measuring progress and outcomes in culture change; Dementia Care Matters undertook the following:
- Dr David Sheard speaking at national conferences in the UK and Ireland on why linking safeguarding to culture change matters
- A Journal of Dementia Care article on ‘The Feeling of Mattering’
- The publishing of Mattering® in a dementia care home Part One focusing on core skills – Feel, Look, Connect, Occupy with a national Dementia Care Matters certificate assessment test.
- The publishing of Mattering® in a dementia care home Part Two focusing on four additional themes leading to culture change – Share, Reach, Relax and Matter with a University recognised project proving implementation
- Extension of our Mattering concept into the NHS
- Publication of a Commissioners Booklet on how to commission an approach to changing cultures
Safeguarding is all about Mattering. Mattering is feeling deep inside that to someone or something and somewhere you really count. Mattering is about knowing that just being who you are really matters. Mattering is having evidence you can see, hear and feel that you make a difference and are needed.
We hope that Mattering offers you the real potential to add to your positive determination in ensuring in these times of austerity that people living with a dementia really count and matter.