Caring with Dignity – the importance of supervision in delivering good care

In a previous blog I have mentioned the Ofsted report, High Expectations, High Support and High Challenge, where the importance of supervision in delivering good outcomes for children was highlighted. I was reminded of this listening to Lord Justice Munby talking about the importance of dignity in how services are provided to those most vulnerable and dependent in society affected by issues of capacity .  If carers can be cared about and looked after by the provision of good reflective supervision and support in undertaking the demanding work that is asked of them then they rise to the tasks and deal with service users with dignity. If carers are treated disrespectfully themselves then perhaps we should be less surprised that this gets passed on to service users.

Obviously I do not condone poor practice and situations where people are treated inhumanely. However there needs to be greater understanding of the dynamics that affect providing good care. Support for staff is an essential element. From the cradle to the grave human beings respond better to praise and encouragement than bullying and harassment.

As the title of the Ofsted report makes clear the key ingredients to effective performance are “High Expectations, High Support and High Challenge”. It’s not living with complacency or expecting an easy life, it’s about helping people to develop and improve,  being supported to work with service users, their families and other professionals to give the best possible care and treatment and expecting to be challenged about how to maintain those standards .

If you would like to know more about the centrality of supervision to good practice;

Practice Matters is running an Effective Supervision Skills workshop on 5th December 2012 in Dorchester

Aims:

. To improve the supervision and management practice of Managers and other staff who may have
supervisory responsibility
. To explore what we mean by supervision and the expectations of those who are being supervised
including at different aspects of the Skills for Care Performance Management continuum.
. Explore the benefits of supervision and how it fits into a performance management framework
. Increasing understanding of when and how to give appropriate constructive feedback to staff.
. Improve communication between senior staff and those they are supervising: assertiveness &
listening skills, empathy
. Formal supervision: contracting, setting agendas and record-keeping

If you are a registered manager or know of others who are or have staff working in senior positions within registered care providers and would welcome the opportunity to build on your knowledge and skills about supervision then please get in touch with Joy Kelly on 07590 661781 or email joy.kelly@ntlworld.com

When carers stop caring – the role of supervision in stopping carers burn out

Why are we continually surprised at the lack of care demonstrated by those expected to care when the care given to them is so neglectful? Menzies-Lyth researched the impact on nurses of working in stressful environments and emphasised the importance of supporting staff to enable them to care (1). Supervision is a method of caring about those who do the caring. Managers need to help staff keep their humanity in delivering care to others. In order to do that staff need to feel their workloads are manageable and that they have emotional support available to them. At its most simple, staff need to feel cared about in order to care for others.

Busy workloads and highly anxiety provoking situations diminish those capacities in us all for caring about anyone else, we revert to “how am I going to survive?” rather than “how can I care for others?” as our way of operating. Supervision is a tool akin to the valve on a pressure cooker, which regulates the working temperature so that care still reaches those on the receiving end of services.

Lack of good quality supervision has been a regular feature when there have been concerns about Children’s Services (2). However it is now beginning to show in reports about lack of care on offer in adult care settings. It is an expectation of the Health and Social Care Act that supervision is offered to all staff but may be a new concept to registered owners and managers, who have not experienced good supervision for themselves and need to promote it within their settings.

Practice Matters is running an Effective Supervision Skills workshop on 5th December 2012 in Dorchester

Aims:

. To improve the supervision and management practice of Managers and other staff who may have
supervisory responsibility
. To explore what we mean by supervision and the expectations of those who are being supervised
including at different aspects of the Skills for Care Performance Management continuum.
. Explore the benefits of supervision and how it fits into a performance management framework
. Increasing understanding of when and how to give appropriate constructive feedback to staff.
. Improve communication between senior staff and those they are supervising: assertiveness &
listening skills, empathy
. Formal supervision: contracting, setting agendas and record-keeping

If you are a registered manager or know of others who are or have staff working in senior positions within registered care providers and would welcome the opportunity to build on your knowledge and skills about supervision then please get in touch with Joy Kelly on 07590 661781 or email joy.kelly@ntlworld.com

Feedback from a previous Practice Matters workshop on Supervision is on this blog – Effective supervision – Feedback from Training.

(1) Menzies-Lyth (1988) Containing Anxiety in Institutions Free Association Books

(2) Munro, E (2011) The Munro Review of Child Protection: Final Report A child-centred system Department of Education

Looking after ourselves

Community Care highlighted the growing issues of violence facing social work and social care staff. Additionally the state of social work is the subject of  hard-hitting report from BASW reading both of these has struck a chord with me from being with social workers and social care staff on training events.  Training seems to be one of the remaining places where social workers still feel supported and cared about. Increasingly the squeeze on budgets is paring training down to the minimum. However on a recent occasion, drinks and a lunch were provided and serviced by staff at the training venue. What struck me about this were the responses of the social workers who commented on how much better they felt when people said hello and asked them what they might like to drink. The startling observation was how little care was available during the working week. This was not a universal observation some social workers report strong team cultures of support and managers listening to them. However there is a fairly constant message echoing BASW’s findings that social workers feel undervalued and pressured. Whether explicitly or implicitly social workers, especially those dealing with child protection in the initial phases, are still subject to timescales and the moral imperative to take on additional cases to prevent a child dying or  a poor OFSTED inspection if there are unallocated cases.

The workload pressures lead to social workers working longer hours, which brings knock on effects to having a work/life balance especially for those with parenting or caring responsibilities too. Agile working (or “hotdesking”) is also a contributory factor. Many teams are now “virtual teams” covering large areas they meet up electronically and minimally in face to face contact. In other places they are expected to work from an office building but could be anywhere in that building not necessarily next to colleagues doing the same or similar work and it may take time for them to find a suitable colleague to consult with if they need advice or back up before or after doing a visit. With the pressures of work in some areas social workers report that there is rarely the possibility of back up and joint visits and even if they are arranged the back up can be reassigned at short notice leaving social workers deciding whose welfare they need to protect theirs or the child’s. Social workers know there are risks to keeping children safe but are not being supported in sharing these concerns with senior managers. They can feel as if they are not “up to the job” if they raise issues about their own safety.

Processing what is happening to them as people, working with children and families often acutely distressed and traumatised, appears to be minimally addressed in supervision where checking up and ensuring targets are met still prevails.The ideas that social workers could be affected by secondary trauma or compassion fatigue seem to be given scant attention by managers of services and occupational health departments. If social work is the 4th emergency, service as indicated by Tim Loughton on BBC breakfast 17/05/2012 and Community Care live 16/05/12, then some of the debriefing systems used in other services should be considered for social workers.

Additional pressures from social work being conducted in more fluid environments are that it is possible to always be in contact with the work and turning off requires discipline. I am sure I am not the only trainer to notice the increasing use of mobile methods of staying in touch with the office while on training. Emails can be checked and responded to. Calls are taken and matters that would once have been left for others to deal with are being managed from the training venue (hopefully during breaks ….). Extending this social workers are working anywhere, at home, on training and at work by remaining connected through technology.

What can  be done

Child care social workers have been waiting for the top down reforms that the Munro Review advocated. However there are things to influence change from the bottom up.

Saying no

• when on training/leave/out of the office put  a note on emails explaining when you are returning and who can help in your absence AND STICK TO IT. It is an important part of self-protection to be able to let go and delegate work to others. You are not indispensable and other people can do your work, not as you would have done it may be but it is important to look after yourself.
• similarly do not answer work phone calls if not at work and make sure messages are redirected. Technology is to assist us in doing our job not dictating our job to us.
• if you are unable to take on any more work insist on supervision to discuss case management and ask your supervisor why they think you have the capacity to do more.
• this one is more challenging – if you have said you are unavailable to the court remain unavailable, other professions are not asked to make themselves available when they have indicated otherwise so isn’t it time social work was given the same respect by the court?

Getting support

• insist on regular supervision in which how you feel and think  are addressed as well as what you do.
• build a professional network
• consider joining a social work organisation BASW and/or the College of Social Work

Play

• make sure you have time off and that some of your time off includes things you enjoy, walking the dog, zumba, a game of football whatever it might be.

Relationships

• prioritise those relationships which sustain you
• manage those that drain you

Avoid

• opening a packet, a can or  a bottle as a way of coping with your stressful day

Social work does not need martyrs, it is time for social work to be the assertive and confident profession promoting social justice and improving service users’ well being.

Effective Supervision – Feedback from training

Practice Matters recently ran a training day on Effective Supervision which was attended by social care workers and Registered Managers. Participants were very enthusiastic about the day and had high expectations of using the skills they had acquired in their work settings. The focus was on acquiring practical skills and provided an opportunity for people to practice their supervision skills in a safe environment.

Themes that emerged included the confusion between supervision and appraisal. What is the difference between supervision and performance appraisal? Certainly a key part of supervision is facilitating staff to do a good job. This involves supporting them and encouraging their development to become better practitioners . It might mean that there are developmental issues that become part of a performance appraisal but the formal process of performance appraisal needs to remain separated from the ongoing process of supervision. Everyone needs to know they are doing a good job and it should never be “taken for granted”. It is crucial to the validity of supervision that staff are supported and valued for the work they are doing.

Another dilemma was how do you know you are providing good supervision when you have never received it? Registered Managers reflected on how hard it can be to provide staff with supervision and yet not to receive it themselves. Finding support as a Registered Manager was a theme that emerged during the day. Owners while  supportive of the aims of providing good care may not always appreciate the need for training and supervision for Registered Managers as well as the staff team. This echoes the finding highlighted by Community Care on 04/05/2012 that social care managers are committed yet undervalued. The Registered Manager’s role can be an isolated one. In some areas there are support groups running for Registered Managers either with external facilitators or that Registered Managers organise themselves in trying to address this gap; www.coachingwithcare.co.uk/new-shoots-events/

Working in social care, staff need to feel appreciated, skilled and able to deal with the emotions arising in the work. Many care homes are offering their residents a loving environment to approach the end of their lives. To carry out sensitive and attuned care requires staff to have reflective space to deal with their emotions so having supervision as a highly valued element within the care home ensures this can happen. Residents and their families may not know what makes the difference in care homes but the participants on our training day were able to identify the role supervision plays for them in feeling able to continue to work in palliative care.

Resources

Skills for Care / CWDC Providing Effective Supervision http://www.skillsforcare.org.uk

Hawkins, P and Shohet, R 1989 Supervision in the Helping Professions Open University Press

Morrison, T 1993 Staff Supervision in Social Care Longman

Wonnacott, Jane 2012 Mastering Social Work Supervision Jessica Kingsley Publishers