Trust is an important part of being an adult.
When you’re a child being trusted is a sign that you’re growing up. Trusted to walk to school on your own, trusted to go out with your friends, trusted to look after your brother or sister, or even just trusted to make your own tea.
But for some people, once you get to the workplace, you stop being given more trust. You get less. Everything you do is watched and controlled. This is a particular problem for people working in social care.
Many home care workers are visiting people’s homes to provide crucial care, but still they aren’t trusted. This lack of trust in staff is hampering the social care system and is undermining the trust placed in it by politicians and the public.
I’ve spent the last six months exploring the idea of ‘self-managed teams’ in social care for the RSA, working with Helen Sanderson and Wellbeing Teams.
By ‘self-managing teams’, we’re referring to organisations that have moved away from a hierarchical approach. These teams don’t have managers - instead they take responsibility for all aspects of their own work, including monitoring, allocating tasks, and setting the overall direction.
The idea of a self-managed team is that care workers are trusted and given more control over their own time, and that they put relationships with clients at the centre of care. It’s an innovative idea that shouldn’t be innovative.
“In the old way I was a nobody, now I’m a somebody” - Care worker, Monmouthshire
The results of this learning are featured in our new working paper Radical Home Care – How Self-Management Could Save Social Care along with other similar examples of innovative practice.
Here are four key challenges that social care is facing which show how self-management can help.
No one really knows what social care is and does
This isn’t an understatement. In a Local Government Association survey, 48% of people had no understanding of what the term social care meant.
44% of people surveyed thought it was provided by the NHS. 28% thought it was free at the point of use.
This level of misunderstanding means that when people need to access social care, they are not aware of what it does, what it can do, what their rights are, and what their options are.
How does this link into self-management?
If we had a better-informed population, they’d be more likely to know how to ask for services that meet their needs. This would encourage more providers to move away from the current system and create more demand for self-managed services.
The opposite is also true. One benefit of releasing staff from a ‘command and control’ structure is that they have freedom to talk in more depth with their clients. This would enable them to look beyond what paid care services can provide and look to their community, reconnecting them with old friends or groups they used to part of. Wellbeing Teams has this built into their model.
Bureaucracy and hierarchy are stuck on a ‘time and task’ model
We are told regularly that nurses know their patients best. This is also true of care workers, but they are often not given the opportunity to get to know those they care for.
At the moment, social care is built on a ‘time and task’ model. Certain amounts of time are assigned to certain tasks, and that’s what care workers are asked to perform. For example, dressing the client: 8 minutes.
These tasks are then ticked off. But real people don’t live in tick boxes. They might need different things on different days. And the care will be better if care workers have the time to build up a relationship, instead of rushing off the moment tasks are completed.
But this change is hard when the entire bureaucracy of the system is built around ‘time and task’:
- from procurement (a contract for performing this task for 10,000 clients for 8 minutes)
- to monitoring (a form asking - did you complete all the tasks in time?)
- to the Care Quality Commission’s inspection criteria.
Video: Helen Sanderson on CQC guidelines and self-managed teams
‘Time and task’ isn’t about what people need whereas self-manging teams can be – letting clients live a fuller life.
Care workers are carrying a huge burden
One of the big challenges of care work is perception. Usually if you hear about a care worker in the media, it’s because of an abuse case. As a result, those who work in the sector become tarnished with the same brush when they are quietly and diligently working to help their clients live their best lives.
The job is tough. The emotional as well as physical burden of home care work can be intense and overlooked. Research published in the British Journal of Psychiatry shows care work is one of the occupations with the highest risks of suicide.
This burden is significantly heightened by the ‘time and task’ model of strict accountability. It can hold workers back from helping clients like they’d like, but also from developing a well-paid career – adding financial stress to work ones.
“Very long hours for very little pay. I’m in this job for the people who need the care, certainly not the money. It is rewarding and challenging. My family do get affected, especially with late finishes and no pay for travel time.” Care worker
Our briefing paper shows that there is some interesting work happening in Torbay, Monmouthshire and Gwynedd looking at system change to enable self-managing teams. There is potential to take this further.
As well as removing the stress of ‘time and task’, an important part of self-managed teams is that they are actual teams who have autonomy over their working environment and who they work with. Supportive colleagues shouldn’t be the exception to the rule, this should be the standard.
The current system is built on the idea of a ‘quick fix’
Building relationships takes time. We all know that. But at the moment, the system demands quick results. One of the big challenges for organisations trying to work differently in social care is being given unrealistic outcomes which must be delivered in a short timeframe.
Crucially, this also leaves little time to experiment and learn how to make things better. Many of the self-managing teams I have spoken to (including Wellbeing Teams) have stated that existing commissioning models don’t enable the flexibility and iteration that is needed when trying out new ways of working.
There is some work being developed on different ways of doing commissioning. Toby Lowe’s Human Learning Systems is about developing models of commissioning that combine the need of the individuals at the heart of the service, the complexity of the system the service is operating in, and the space for services to learn and adapt. The King’s Fund evaluation of the Burrtzorg project in Suffolk is another great example of the need for time.
The social care system isn't working. The public doesn't understand it. It's bureaucratic. It's placing a huge burden on workers. We can start to address these problems by trusting care workers.