Conference Review 2010
Scroll onto photo to enlarge
The NASHICS conference, held at the Nottingham Belfry between 30th June and 1st July, produced some challenging and lively debate from the start.
Following the Annual General Meeting, the programme began with a topical teatime session – Best Practice Open Forum with the Fire Safety working group.
The fire safety group are working closely with Chief Fire Officers Association (CFOA) to influence a review of the guidance documents that were published alongside the Fire Safety Order.
Cath Dyson, Director of Health and Safety for Barchester Healthcare gave a very informative and useful presentation that examined the aftermath of a fire at a care home. 
David Hulton, Executive member of NASHICS, went on to reaffirm that the purpose of working with CFOA is to ensure a consistent approach to enforcement of fire legislation, provide additional guidance on identified issues and contribute to the review fire safety guides in the future.
In a lively debate many members discussed the difficulties they have experience when putting into practice advice contained in the Fire Safety Guides, particularly the timescale for complete evacuation and staffing levels, especially at night. NASHICS will continue to work with CFOA to improve understanding and interpretation of the fire safety guides.
An excellent networking dinner was held during the evening of 30th June. Members had an opportunity to meet with some of the conference speakers and colleagues and participate in a general knowledge quiz.
Day two of the conference began early -8:00am for some of the braver delegates with a warm up session run by Sylvie Sylver - "Wake up the day the NAPA way"
The 
formal conference began with a warm welcome to delegates from the NASHICS Chair, Chris
Jackson.
The theme for the conference was Challenges and Choices and NASHICS can offer support to its members via its web site, taking part in key Social Care events and influencing future policies as the organisation is now being approached for assistance from policy makers.
Chris welcomed the Conference Chair, Lisa Fowlie. Lisa is a past president and Member of the Board of Trustees of IOSH.
The first speaker to address the conference was, Anne Williams, National Director for Learning Disabilities at the Department of Health. 
Ann explained the cross government strategy for learning disabilities. This is a 3 year strategy with 4 guiding principles – Independent living, Control, Inclusion and Rights. Over 985,000 people have mild or moderate learning disabilities; over 210,000 people have a severe and profound learning disability. 137,000 people with learning disabilities use adult social services in England and the numbers are all projected to increase. £1 in £4 of adult social care spend is on people with learning disabilities. People with learning disabilities are one of the most excluded groups in our society, and only 6% have a job.
Anne went on to explain that things are changing – there is a major programme to improve healthcare in communities, hospitals and specialist services, including better risk assessment. The goal is to increase the number of people who live in their own home and local and regional action programmes.
There will be an increased use of Telecare to lessen risk and promote independence. Delegates can play a part in this improvement programme by developing their knowledge base, increasing expectations in relation to people with Learning Disabilities and what they can achieve and be aware of best practise – there are lots of websites and written materials available.
Anne’s concluding remarks where that we need to support people with learning disabilities and other professionals to think creatively and to remember, we all take some risks in our lives and people with Learning Disabilities want to have choice and control too.
The next speaker to address the delegates was David Waldren, Director of Adult Services and Regional Development, SCIE. His presentation, entitled Personalisation – making it work: the rocky road ahead for safety, focused on SCIE’s work since 2005.
There are a number of resources available on SCIE’s website and their ‘Rough Guide’ has recently been revised. David went onto quote that ‘the governing principle behind good approaches to choice and risk is that people have the right to live their lives to the full as long as that does not stop others from doing the same...We commend person-centred approaches for everyone’ (Department of Health 2007). 
The Mental Capacity Act of 2005 empowered people to make decisions for themselves, whenever possible. It allowed people to plan ahead for a time in the future when they might lack the capacity to make future decisions for themselves. The Department of Health goes onto state that ‘One of the core components of a personalisation system is an effective and established mechanism to enable people to make supported decisions.
Organisations and professionals need to move away, wherever possible, from making decisions for people and towards a role that informs, facilitates and empowers people to think about how they wish to live their lives...the goal is to get the balance right from being risk averse while still having appropriate regard for safeguarding issues.’
There are some practices emerging to work towards an integrated personalisation and safeguarding framework that will look at the role of the social worker, set up risk enablement panels and shift the focus from fraud and financial abuse to risk management and organisational transformation. David ended his presentation with two key messages as follows:
Rather than try to calculate the incalculable, social workers need to regain their former status as experts in uncertainty. They should ...dare to work creatively and innovatively.’ (Stalker 2003)
‘Care management processes and workforce skills, we were told, needed to be refocused on communication, empowerment and enabling people to take considered risks.’ (DH 2009)
Visit www.scie.org for more information on these issues and also check out Social Care TV at the same web address.
Following a break for refreshments and exhibition viewing the conference resumed with Martin Green, Chief Executive English Community Care Association & Dementia Champion. 
Martin’s presentation focused on the details of Objective 11, considered issues for implementation and set out progress made to date. Progress with Objective 11 is significant, however there is much more work required. It is not about ‘managing’ people’s lives, but facilitating.
In order to do this the quality of leadership is crucial and we need to move away from how we do this for people to how do the people do this for themselves. Health and safety issues are central to care plans and pathways and must not be pushed to the sidelines.
The aim must be to give people a life rather than a service. Martin went on to discuss the use of psychotic medication – this should not be used to routinely ‘manage’ care, particularly within care homes. A good residential care home pays close attention to leadership, staff management and training. It has person centred planning and focused on the individual. There should also be a dementia friendly physical environment with purposeful activities based on individual preference, not just communal entertainment.
There should be active involvement of relatives and friends and strong links with the local community. The SCIE dementia portal offers some excellent advice and information. Some of the future challenges to consider are that the government may strip away some core support that will reduce the flow of new ideas. Staff turnover is high and therefore there is a constant need to reinforce health and safety matters. Much money is spent on training; however, there is no consistent approach or proven outcomes for existing training.
Progress so far has been to get sector bodies around the table.
There is a high level of commitment and enthusiasm; My Home Life, together with existing sector newsletters are being used to disseminate messages and information with a core script.
In practice the Pocket Guide for Care Home Managers is to be published in November and Martin would welcome feedback.
A DVD – ‘Living alongside dementia’ is available (www.ecca.org.uk) and Martin will be working alongside the NHS to make further progress in the future.
A series of workshops followed:
Workshop A - Decision Driving was presented by Mike Stringer of DDV Management. Mike introduced the session by giving statistics on the level of fatalities related to accidents on the UK's roads. The fact that over 28,000 people are casualties each year with an average of 7 fatalities per day is an alarming statistic.
95% of collisions involve some degree of driver error and therefore the weakest link is the person behind the steering wheel when driving on the road.
Mike went on to explain the 90/10 principle which looked at 10% of your life is all up to you and what you do but 90% of your life is about how you react to situations.
Mike explained his theory and gave examples of how situations can influence what happens to you and the effects of the decision you make, based on the situation you are faced with. This linked on to driving safety and how 'decision driving' can improve your chances of not being involved in a road traffic incident.
Using the five principles of decision driving was the basis of the presentation and these wer
e:
Observe
Assess
Signal
Plan
Decisive action
These principles, if applied, are positive actions on improving driving techniques.
The focus of the workshop moved onto the management of SPACE when driving. This is the space you have between the vehicle you are driving and the one in front of you.
A number of examples of the management of space were shown in the form of video clips. The group were shown a particular example where a driver called Aran was lucky to survive a horrendous collision on a motorway when a lorry collided with his car. Aran was videoed by the motorway cameras and the scenes were a stark reminder of the dangers of driving on such roads. Mike explained the principles of decision driving and the application of the space factor and how this would have prevented this incident if used.
Other examples of road incidents were given with an explanation of the assumption drivers have in that they automatically have a 'right of way' when driving. The examples given illustrated how drivers faced with certain situation assume that the road is safe and proceed to drive in their intended direction, which often results in a collision with another road user. The fact that a green traffic light allows you to proceed in your intended direction does not automatically give you the right of way. The message to the group was you should always proceed with caution observing the situation at all times.
A green traffic signal means proceed if it safe to do so and not just GO.
Mike finished the session with a reminder about the importance of decision driving and the management of space when driving.
Workshop B – Sylvie Silver – Director of National Association for Providers of Activities (NAPA)
Sylvie introduced her session by asking delegates to consider 1 thing that was important to them. Discussion followed around the different answers that delegates had given and it was apparent that we all have things that are important to us and should have a choice to ensure that things that are important to us are noted and provided for. This could be something as simple as being able to make your own cup of tea – something that is quite often not possible within residential care premises. 
Health and safety concerns are often used as a barrier to preventing simple home comforts being available. Managers need to have a ‘can do’ attitude, listening to their residents and showing patience. Risk assessments should focus on the activity, the benefits, the hazards and the controls in this order rather than focusing initially on hazards and should use positive language that explores the benefits but continues to adequately control risk for all concerned.
Sylvie ended her session by showing a newspaper cutting of a 92 year old lady who was abseiling down a building. She had been asked by the manager of her residential home what activities she would like to have an opportunity to do. Whilst this lady’s family had not been entirely comfortable with this activity – the home manager had planned and organised this to take place – showing that, even at the age of 92, people have choices and if there is a ‘can do’ attitude then nothing is impossible.
Following on from lunch and exhibition viewing the afternoon session resumed with a presentation from Jo Moriaty, Social Care Workforce Research Unit, Kings College, London, entitled – Our workforce are key – what are the challenges , will health and safety really help? Jo outlined the relevant government plans and what may change in the future. The coalition government plans to support the creation and expansion of mutual’s, co-operatives, charities and social enterprises and enable these groups to have much greater involvement in the running of public services. 
They also plan to extend the greater roll-out of personal budgets to give people and their carers more control and purchasing power.
Current claimants of Incapacity Benefit will be re-assessed for their readiness to work and those assessed as fully capable for work will be moved to Jobseekers Allowance. Jo went on to illustrate that size does matter – presenting the following statistics:
UK population of economically active people is 31.4 million (ONS Social Trends 40, 2009)
1.43 million people employed in the NHS (The Health and Social Care Information Centre 2009)
1.39 million people estimated to be employed in adult social care in England (Eborall and Griffiths 2008)
Along with retail and financial services, health and social care is a major employer of women
Around 84 per cent of social care workers are women (Hussein 2009)
81 per cent of non medical staff in the NHS are women (The Health and Social Care Information Centre 2010.
The National Minimum Dataset for Social Care (NMDS-SC), which is maintained by Skills for Care collect information which is analysed by Shereen Hussien. Results of this data gathering are as follows:
Ageing workforce
Median age is 42 (less sensitive to extremes than mean)
Workers in private sector younger (40) than those in local authorities (47)
Men are significantly younger than women (41 compared with 43)
Care workers (41) younger than managers (46)
Young Workers (under 25)
Make up just 12 per cent of workforce (Hussein, 2010)
Mostly work in residential settings
Travel shorter distances from home
Fewer in London
Ethnic Diversity
2001 Census - 88 per cent of UK population is White British, Black Caribbean and Black African make up 2 per cent (ONS 2006)
NMDS-SC suggests around 83 per cent of workforce is white (Hussein 2009)
Black or Black British workers account for 8 per cent
Disability
Brings benefits to the workforce
Role of people who have personal experience of difficulties
Issues about data quality in NMDS-SC because returns are completed by employers
McLean (2003) found that over a fifth of a large sample of the social care workforce reported a long term disability compared with 8-16 per cent in general population.
The National Minimum Dataset for Social Care (NMDS-SC) continue to gather information on stress & job satisfaction, recruitment & retention, the role of migrant working and the role of induction. There are changes in where people work and staff are increasingly working in other people’s homes where arrangements must be made to help people work safely.
Training is having a positive impact as there are now a higher proportion of workers with NVQ levels 2 & 3, but there is still limited access to training in specific areas such as dementia care.
The priorities for the future are to get a clear picture about workforce by continuing to gather and analyse data; to recognise tensions between needs of people using services and needs of workforce and a need for public debate to explain how complex and important this work is.
Workshop C – Expert Insight: Management Development, the role of the National Skills Academy for Social Care. This workshop was facilitated by Maggie Challis, Head of Endorsement - National Skills Academy for Social Care.
The National Skills Academy for Social Care is currently funded by 
Department of Health and the Skills Funding Agency; however it will be self funding within three years.
The aims of the Skills Academy are to:
Improve skills of existing workforce
Increase flow of skilled applicants into the sector
Improve the quality of training, identify gaps and engage with training providers
The main programmes are Membership, Endorsement and Leadership.
Membership - Employers, Training providers, Local authorities and other commissioners, Individuals, other stakeholders/friends.
Endorsement - Employers have expressed a need to be able to identify high quality education and training providers with key features being:
Outcome-based validation of existing practice
Organisational and staff development process
Based on self-evaluation
Peer review
Leadership –
Coaching and Mentoring Provision
Developing joint approaches with NHS Institute; CIHM; HCA etc.
National Leadership Strategy for Social Care
Personal Employers work stream actively engaged personal budget holders
Endorsement scheme for training organisations launched – endorsement for programmes and individuals next
All programmes are under-pinned by a commitment to person-centred support.
Maggie went on to illustrate what outstanding leadership looks like. Below are nine themes that characterise outstanding leadership:
Think systemically and act long-term
Bring meaning to life
Apply the spirit not the letter of the law
Self-aware and authentic to leadership first, their own needs second
Understand that talk is work
Give time and space to others
Grow people through performance
Put ‘we’ before ‘me’
Take deeper breaths and hold them longer
The workshop continued with delegates working in small groups to explore the Management Induction Standards to identify:
a) Where safety and health feature
b) How we can make the link between the competency statements and the Skills Academy’s ambitions for leadership and management
c) Make recommendations about how care service delivery organisations can support this move
The session concluded with a short discussion on the above points.
Workshop D – Case Study: Medication in Care Homes – well managed or mayhem?
Professor Nick Barber, School of Pharmacy, University of London.
Nick explained the background to CHUMS - Care Home Use of Medicines 
Study and the research team.
Why do errors occur?
He covered the accident Causation Model – Latent conditions – Error producing conditions
Active failures;
Slips and lapses (intend to do the right thing but for some reason forget to do it or do the wrong thing);
Mistakes (doing something you think is correct but it is not) and
Violations (intentional deviations from rules or good practice usually in the belief that it does not matter or will not cause harm – A short cut)
= Accident
Also the defence failures example - Swiss cheese model.
He went on to give full examples of the error producing conditions - Prescribing; Patient and Latent (organisational/Cultural) conditions (Actions and decisions made by those away from the front line, the adverse consequences only emerge when other systems and defences are breached).
He covered the design of the research and the sampling system.
Highlighted the errors found in the sampling and the possible harm.
Causes of administration errors, dispensing errors, and the system wide errors (People are generally doing their best with no idea that errors are occurring, nor how frequent they are).
He then gave delegates 17 draft diagnostic risk factors to check out.
He left them final thoughts;
Care homes fear medication and most of them want change;
The current error rate is unacceptable;
Need measures to improve a system;
Someone needs to take ownership of the “whole system” and to have power.
Fire Safety for Care Services – An enforcer’s view - Andy Chadney, Fire Safety Officer, London Fire Brigade.
Andy explained that the Chief Fire Officers Association (CFOA) have memorandums of understanding with numerous other groups and will work with us to agree a way forward with regard to our memorandum of understanding. Andy met with representatives of NASHICS in May to progress this matter.
Andy went onto explain that fire safety legislation has expanded and only domestic premises are now exempt. Fire prevention measures have been added and is now included in the 12 Fire Safety Guides.
There is still some confusion concerning the subject of the ‘responsible person’. This is addressed in Article 5 of the General Duties and for clarity the ‘responsible person’ can appoint as many competent persons as they like – but you are the ‘responsible person’ so be it – the responsible person could in fact be a company or organisation. The responsible person is the employer and they cannot pass this responsibility onto you, but if it is part of your job or in your control then you could be classed as the responsible person. The responsible person must be above to prove that all reasonable precautions have been taken and show due diligence for the law.
The enforcement concordance agreement, (www.dti.gov.uk/consumers/enforcement ), between the government and business is the enforcers guide. The enforcement model also provides CFOA with a consistent measuring process which includes a scoring system that will determine how often you receive a visit as inspections can no longer be carried out every two years.
The 2nd highest risk is to premises that are residential (sleeping risk) and those for vulnerable persons. Enforcement will be in stages as follows:
Informal:
Inform and educate
– Advice for minor deficiencies
(Notice of Deficiencies)
– Joint Action Plan
Formal
– Enforcement Notice
– Prohibition/restriction
– Prosecution
And the EAR (Enforcement Appropriate to Risk) principle will apply. The Fire and Rescue Service (FRS) will always carry out an audit following a fire no matter how minor, as a small single incident may indicate serious deficiencies.
Regulators Compliance Code – this is a statutory Code of Practice for Enforcers and came into force in April 2008.
The principles of this are:
– Transparent
– Accountable
– Proportionate
– Consistent
– Targeted (i.e. directed at high risk)
A summary of results for the London area are as follows:
845 Audits between May 2009 and April 2010
155 Informal deficiency notices
15 Enforcement Notices
0 Prosecutions
Andy went on to take questions and a lively debate followed that provided an excellent conclusion to the afternoon.
NASHICS Chair – Chris Jackson closed the conference, thanking Lisa Fowlie for chairing the Conference. He felt that the day had provided excellent networking opportunities and much useful information to take away and use to tackle future challenges and enable employers and organisation to make informed choices.
Chris thanked all sponsors, exhibitors and speakers for making this years conference such a success.
Chris then asked Roy Benjamin the first Chair of NASHiCS to make a presentation to 
Margaret McIntyre who announced her retirement from the Association. She had been a member of the National Executive since 2005 and also chaired the conference organising committee. He thanked her on behalf of NASHiCS for all her work undertaken for the Association and wished her well for the future. A presentation of flowers was made.
In conclusion Chris extended an invitation to the Seminar in Leeds on 17th November 2010 and next year’s conference which will be held at the Nottingham Belfry on 29th and 30th June 2011.
Carol Hughes National Executive member.
