Towards Outstanding - Community Circles and Care Homes

Featured article - 16 May 2017
Head of development, Community Circles

Head-shot of the author, Head of development, Community Circles

If you find yourself living in a residential or nursing home, or a member of your family moves into a home as they become older or perhaps develop dementia, what would you expect?

Surely everyone should be able to expect the very best care and support at this time of their life. In reality, however, the Care Quality Commission (CQC) – which regulates care homes – tells us that there is a lot of room for improvement. CQC’s rating system goes from the poorest (“inadequate”), through to “requires improvement”, “good” and the best rating - “outstanding”. In its latest review (The State of Care 2016) CQC said that only about 1% of homes were outstanding. Most worrying was the nursing homes sector, with more than a third “requiring improvement”.

Public services, especially social care, are clearly under serious resource pressure and it is to be hoped that this is finally being acknowledged by the government. Having said this, quality issues clearly pre-date the current financial problems and would seem to reflect deeper issues with service models, leadership, cultures and practices.

Can new ways of working provide the answers?

The good news is that innovative ways of working are providing hope, with some of these new models resulting in much higher ratings than traditional care systems. For example, 92% of Shared Lives schemes – an alternative to traditional care homes for some – were rated as good or outstanding.

The development or scaling up of new options like this and others cited in the Innovations in Dementia paper is long overdue. However, even if these options are scaled more quickly, population changes and projections suggest that for the foreseeable future, large numbers of people will depend on or choose residential and nursing homes. Therefore it's crucial that we look at ways to bring practical, achievable and effective innovations into residential and nursing homes now; improving people's experiences as soon as possible.

Innovations in Dementia / Community Circles

What kind of innovations would work in these settings? A Commission on Residential Care, led by former Care Services Minister, Paul Burstow reported on the sector in 2014. Stand-out findings were:

The public broadly sees residential care homes as places of illness and frailty pervaded by boredom and loneliness
Housing with care providers need to ensure that they and the people that live in their schemes become a more visible part of the neighbourhood, bringing local groups and volunteers in as much as reaching out to people who are supported.

The Commission recommended that homes go beyond physical re-design to provide personalised, relationship-centred support, allowing people to take more control, have a sense of ownership of their environment, be an active and visible part of their community and have a sense of purpose. CQC also explored the factors that lead homes to be valued by their users and achieve outstanding ratings. Crucial elements are:

Personalised care planning
Tailoring activities to people’s interests and helping them develop new ones
Continuous engagement with people
Welcoming families and carers as partners
Bringing the community into homes and supporting people to remain active citizens

Some organisations and homes have taken forward initiatives to address these issues. Innovative homes and organisations are increasingly seeing they need to offer more person and community centred care and starting to use approaches such as Progress for Providers, Making it Real and My Home Life. I was very encouraged to hear recently of a project just starting via a partnership of the National Development Team for Inclusion and Timebanks called Time to Connect UK. However progress overall remains too slow and is hampered by a lack of effective approaches being delivered in current challenging contexts.

Exploring Community Circles in care homes

One example of an organisation that is working to make a significant contribution to the improvements required is Community Circles, where I work as Head of Development.

Community Circles help people to be happier, healthier and more connected with the support of those around them and the help of a volunteer facilitator. The facilitators are recruited, trained and supported to bring together family, friends, community members and (in some cases) service staff to support individuals. They use person-centred methods and tools to identify the things that are important to people and then plan and act to achieve these things. Through this model, Circles are increasing wellbeing levels, combatting loneliness, building community connections and improving care outcomes.

Currently, Circles are mostly used by people with dementia, learning disabilities and mental health needs, as well as older people. There are also projects or plans to test use with other groups who may benefit; for example, young unemployed people, disabled children and adults, and at-risk families. Circles can benefit people living in a range of settings and using various forms of support, for example, with people living at home, in care and nursing homes, in schools or training settings, in hospices, and so on.

We have already been exploring how Circles can be embedded within the work of a home for people with dementia – EachStep in Blackburn. We are delighted with what has happened, culminating with the home being awarded Dementia Care Home of the Year at the National Dementia Awards. We learnt that it is possible to recruit and support facilitators who have helped residents of the home to have a Circle that provides a real impact on their lives – and our evaluation showed a big increase in measured wellbeing for people who had Circles. To see more of the results and hear the stories of people, families, staff and volunteers, visit our website.

Each Step Blackburn

Growing our care home partnerships

Our work at EachStep showed us that Circles can have a hugely positive effect on care homes, so now we are using this learning to explore how Circles can be embedded in the care and nursing home sector of a whole council. Last month we partnered with Wigan MBC with support from the Council’s Residential and Nursing Homes Innovation Fund (“The Deal”) on a three-year programme through which we will develop Circles in care homes across the local authority area.

Over the period of the project we are aiming for significant results:

A substantial number of Circles for people living in residential and nursing homes
A large number of trained and supported volunteers working as part of a self-sustaining network
A good number of local residential and nursing homes embedding Circles in their practice and offer
A larger number of homes on a continuum – from being informed about the Circles approach and what it offers, through to having completed self-assessment on person and community centred care, through to starting to embed Circles
Local organisations set up to support older people more effectively connected to support people living in homes and using their resources more efficiently and effectively via Circles
Build the volunteer base including working with the Council staff volunteering scheme
Local businesses engaged in reciprocal support arrangements with residential and care homes - their staff receiving training providing transferable skills and in exchange providing a supply of volunteers as connectors, facilitators and members of Circles.

Money is, of course, very tight. With this in mind, we are taking on the challenge of achieving these things with modest formal resources and building in sustainability from the start. To do this we are adopting a “depth and breadth” strategy. This uses the council’s “Service Delivery Footprint” to combine detailed development work in a number of homes across three phases alongside less intensive work to support and prepare a larger number of homes to embed Circles in later stages.

The depth activity involves:

Recruiting first phase homes to the programme
Assessing and preparing the home to start to work with Circles including development of an action plan with roles and timescales
Set up mentoring of the staff allocated to support Circles in the home
Recruitment of facilitators, overseeing training and set up support in early Circle meetings
As appropriate, facilitating engagement with local partner organisations to support sustainability – facilitator recruitment and support.

The breadth activity includes:

Awareness-raising about Circles and their benefits and how homes can prepare for and start to use them
Supported self-assessment using Progress for Providers to steer homes to action on person- and community-centred approaches and prepare themselves to work more intensively with the programme and embed Circles in phase 2 or 3
Where homes show high-level early promise, support use of a “do-it yourself approach” (handbooks, on-line training, virtual materials, linking to others)

In working directly with care and nursing homes, we are aware that the changes required by Circles will be challenging for some and that staff capacity is very limited. We therefore need to make the embedding of Circles both inspiring and achievable for home staff

The Community Circles connectors will recruit and train facilitators and allocate them to homes using our tried-and-tested methods. Within the homes one or two members of staff will link Circles into home activity. We anticipate this will require a commitment of 4 hours a week. The home staff will be supported by the Community Circles Connector in the early stages to introduce and embed Circles. They will have overall responsibility for introducing and supporting Circles in the home; ensuring Circles are offered and introduced at assessment; supporting matching to facilitator and Circle start up; and having monthly on-going communication with facilitator, reviewing progress and actions at annual review.

In our work to embed Circles across the local sector we are able to support homes with lots of practical resources that we have developed and can be adapted to local use; including e-training for volunteer facilitators, handbooks for staff, communications materials, leaflets for families and more. Additionally, it is our long-term strategic aim to make Circles available to many more people by creating new ways to share learning materials and resources through our website. These new materials and resources will also support our projects like this one in Wigan.

What's next?

As our work progresses over the coming months we plan to share our learning as we partner with care homes on their journey to becoming outstanding. If you would like to get in touch, or develop something similar in your locality, please get in touch with me via martin@community-circles.co.uk. We're really excited about creating a brighter future for care homes with Community Circles, and we hope you are too.