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• People want flexible, reliable and responsive service
• There needs to be more constructive dialogue between commissioners and providers
• The views of older people need to be heard and taken into account
• Time-task care plans undermine choice & control. Need to shift to outcomes (as defined by older people)
• An enabling/reablement approach is needed
• The service needs to be funded properly
• Workforce strategies are needed across agencies – commissioners should specify standards including level of wages, expenses and other conditions of service
• Outcome focussed and person centred care largely equates to a flexible, reliable andresponsive service
• The views of older people and their families can conflict, but supporting family relationships is central to providing quality care – staff need training and support in this area
• Personal qualities of frontline staff often more important than competencies
• Frontline staff are generally undervalued and their needs are not often considered.
• Frontline staff often do not have a clear understanding of their role and purpose
• Agency and staff ethos and values are more important than policies and procedures – a kind ‘can do’ approach is needed
• Continuity of care workers (small numbers) and the associated relationships with the older person are of fundamental importance
• Local authority provider have the general advantage of having more time and higher levels of funding – pay and working conditions of staff important
• Micromanagement of provider agencies by commissioners and frontline staff by provider agencies is unhelpful, time consuming and expensive
• Local authority pre-occupation with only meeting eligible personal care needs can be controlling and destructive
• The most common unmet aspiration is to get out – hence the need for domiciliary care to link up more effectively with day services and community based support
• Recognise and value the workforce
• Enhance the role of the workforce in assessing needs, planning, co-ordination, reviews and working alongside others
• Address the workforce implications of developing integrated services
• Support the workforce in delivering outcome and person-focussed services
• Care Council Wales working with Skills for Care and Development should review the NOS, QCF, training and skills for commissioners, service managers and frontline workers to effectively underpin outcome-focussed working
• A step change in collaborative assessment and care planning is required - involving service users, carers and the workforce on a daily basis – not all down to the social worker
• Standardised processes and documentation in assessing, reviewing and delivering outcome-ocussed services are recommended.
· 80% of people were positive about their experience
· Conversely, 20% indicated that they rarely or never receive good care
Things people valued most
· A listening approach that led to flexible and responsive support
· Staff who went the extra mile
· Continuity of care staff
Things people did not like
· Lack of expertise in dementia care
· Not having enough time to provide appropriate care and support
· Lack of continuity of care worker
· Poor communication regarding service changes
· Service providers need to engage directly with service users - rigid time task care plans drawn up by social workers need to be more flexible and outcome focussed
· Continuity of care is important
· It is not acceptable that almost 10% of people rarely or never have as much time as they need with their care workers
· People need to be able to voice their concerns and access independent advocacy - we could work with newly established advocacy services in Swansea (e.g. Age Cymru Swansea Bay)
· Frontline staff need to be able to voice their concerns if they know that older people are not satisfied with their service
· We need to monitor effects of austerity measures - particular concern about decrease in number of people receiving 5 hours of care or less and 20 hours of care or more.
· Staff need to be better trained in supporting people who are living with dementia
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