The Loop | Issue 12 | January - March 2024

ISSUE

12 JANUARY - MARCH 2024

The Loop

IHSCM Quarterly E-magazine

2024 Future

Protecting "hidden

Survive

Predictions

risk" patients

Veganuary

Contents

ISSUE

12

4.

Editorial

6.

Plain language query building for clinicians

10.

Protecting “hidden risk” patients

14.

Why an EPR supplier duopoly in the UK would stifle future innovation

16.

Future predictions and solutions for 2024 and beyond

20. How to survive & thrive during Veganuary 2024

24. The Social Impact of Living Memories Reminiscence Resources and Tea and

Memories groups from the perspective of one UK Care and Residential Home Group

26. Emotional exhaustion in social care 28. The best place to start is with us...

32. The Attitudinal A-B-C of Social Care 36. Inclusive Dementia Care for the LGBTQ+ Community

CEO: Jon Wilks, Chairman: Roy Lilley, Strategic Advisor: Shane Tickell, Director of Social Care: Susan Jones, Membership Manager: Emma Caton, Operations Manager: Jade Maloney, Social Media Administrator: Rachel Jury, Operations Administrator: Charlotte Joseph, Digital Content Consultant: Luke Farmer

EDITORIAL

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Welcome to your first 2024 issue of this opportunity to wish you a healt packed with fulfilment and positivit Positivity is a tricky thing to write about when many of you will have spent the last part of 2023 and the first part of 2024 managing as best you can around the most recent industrial action at the behest of junior doctors.

As the waitlists grow, patient’s frustration unsurprisingly mounts and many will resort to social media to describe the NHS as broken, not fit for purpose or, to use the CQC’s objectionable phrase, ‘inadequate’.

If you aren’t striking then you’ll have been working your socks off, I know, and to be labelled as being part of an organisation that is described in any of those previous terms is horrible. It saps strength, drains energy, and dilutes optimism.

If you’ve been striking (and we have numerous clinical members) then, despite your resolution to do what you need to provoke a government re-think on pay, you’ll have been riddled with anxiety about patient harm – or you certainly should have been.

But a New Year is a chance for all of us to breathe in and take stock. Specifically, I suggest that the stock taking should consider what it is that you are trying to achieve for you and your loved ones. I am no great believer or supporter of New Year resolutions. In my experience, they tend to hang like a damp jumper unless we are fully and reliably committed to them through a genuine belief that they can be achieved.

f The Loop and may I take thy and successful New Year, ty.

Instead, I’d suggest that you concentrate on a single, simple goal for this year.

It doesn’t require investment in new LuluLemon gym attire. It doesn’t require boarding up the drinks cabinet. It doesn’t require any financial commitment at all.

Nor does it involve eating questionable flora, fauna or faux!

they interact, creating a virtuous environment of helpfulness and support. I’d certainly hope that what I have described is your experience of the IHSCM in 2024. It is certainly what we are aiming for.

Stay safe, stay strong and thank you for the brilliant work you are all doing.

I’d propose that your single, simple goal for 2024 is for you to make people feel better. I don’t mean curing anyone of anything. I mean helping people with whom you interact to feel better. When they have engaged with you, they feel uplifted. They feel more positive. They feel oxygenated. They feel optimistic. They feel supported. They feel valued. They feel respected.

The wonderful thing is, you don’t even need to get trained, upskilled, developed, or toned. Just make it your business to pick people up and make them feel better about themselves, their work, and their lives. This might take the form of more regularly saying thank you, or sincerely asking how they are, or listening more, or just being, well.… nicer!

Smile more, appreciate more, praise more.

Show a little more patience, tolerance, and encouragement. Help people to be their best.

Chief Executive

JON WILKS

And as the positivity flows from you so it will flow from them to those with whom 005

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Plain language building for clinicians As a clinician, how easy is it to find all your currently diabetic patients from a full patient database?

As a data technician, how easy is it know all the many diabetes, and related, codes needed to provide a clinician with a full cohort?

How much time is spent refining and maintaining a database query?

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e query

There is long-standing issue with getting information from health data – the clinician who knows what they want often does not have enough technical knowledge to create the query in SQL. A technically skilled colleague conversely may not be familiar

enough with clinical terminology/ coding systems to create an SQL query with ALL the required codes.

This communication barrier often leads to delays in query development; further exacerbated when those queries are run, and further refinements are identified.

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The aim of the Query Builder is to put the power back into the clinical user’s hands to build clinical queries in clinical terms, without needing any knowledge of the technical structure of the data itself, by using familiar terms such as observation and effective date rather than an implementation of specific database tables and field names.

Take an exclusive look at our Query Builder (beta version) to see how natural language can be used to easily identify and retrieve patients, or health data, of interest.

This short video shows you how to create a cohort and then construct a basic query; for example, ‘all GMS registered patients aged 18 or over in a specific post code area who have become diabetic in the last two years.’ Sounds simple but diabetes can be resolved and then reoccur several times.

With the Query Builder you can specify that you only want to get those patients who are currently Diabetic rather than those who have had a Diabetes diagnosis (which may have been resolved).

Coming next is Data Sets – giving you the ability to get the information you need about your patient cohort, such as current smoking status or the last three blood pressure readings.

Later in 2024, you will be able to create your own custom dashboards to visualise your data sets with drill-down to patient level, followed by the ability to view an entire person record.

Contact us for more information – info@voror.co.uk.

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Protecting “hidden risk” patients How do you reduce clinical risk in waiting lists?

And free up capacity?

And tackle health inequalities all at the same time?

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An innovative approach developed at Guy’s and St Thomas’ and funded by Guy’s & St Thomas’ Charity can identify high risk patients who are on a waiting list, enabling them to be prioritised for urgent care and contributing to a reduction in health inequalities. This is already working in diabetes, with plans to take it wider Details of the pilot project, published in a new paper in Diabetes Research and Clinical Practice, show how the pioneering platform can flag “hidden risk” patients, whose condition is deteriorating but clinicians may be unaware. It prioritises them to get the treatment they need to stabilise their condition.

Results from the project showed that of more than 4,000 people on a waiting list for diabetes appointments at Guy’s and St Thomas’, 549 (13.6%) of them were at risk of their health worsening. Of the 101 highest risk patients the tool prioritised to be seen earlier than scheduled, 40 received treatments that reduced their risk and prevented their condition getting worse.

The proof-of-concept study, funded

by Guy’s & St Thomas’ Charity, also found that a disproportionate number of patients highlighted as high-risk were from minoritised backgrounds and lived in areas of social deprivation.

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The project started in diabetes and is now live in rheumatology, with renal and heart failure in the final stages of validation. The team plans to roll it out to benefit patients with other chronic conditions.

urgently prioritise high risk patients for clinics. It also highlights the patients of lowest risk who could be seen less frequently in clinic, saving them needless journeys to hospital and freeing up appointment slots.

The COVID pandemic led to a backlog of outpatient appointments and increased waiting lists. People with diabetes are at risk of complications which often result in hospitalisation and even premature death. Many of these complications can be delayed or prevented with prompt, effective intervention and enhanced care but clinicians are not always alerted to changes in a patient’s condition while they are on a waiting list.

Janaka Karalliedde, a consultant in diabetes and endocrinology at Guy’s and St Thomas’ and who was lead author on the new paper, said: “This platform has been invaluable in helping us look after our most vulnerable and poorly patients.

By working out patients’ risks, we can make sure those who need urgent care are seen quickly while also helping us use our resources in the most strategic and efficient way.”

In a bid to tackle this issue, the Trust’s Centre for Innovation, Transformation and Improvement (CITI) worked with the diabetes team and analytics partner Factor 50 to develop a data informatics tool.

Clinicians and hospital administrators have a dashboard which flags any risks to patients since their last clinic appointment. It enables them to

The partnership between Guy’s & St Thomas’ Charity and the Trust’s Centre for Innovation, Transformation and Improvement (CITI) is central to the charity’s long-term focus on innovation and improvement, driving positive change for patients. The charity has committed to further funding that will support the next phase of the programme.

George Brown, 71, has had diabetes for 48 years and used to check his blood sugar levels by doing regular finger-prick tests. Under the pilot project, he was flagged as of higher risk and given a digital sensor to use.

The sensor connects to a phone app which regularly monitors his levels and flags any potential issues in real-time to him and also to his clinicians.

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The retired electrician, from Ladywell, said: “The sensor is much easier to use than having to prick my finger. It has an alarm which tells me if my sugar levels are too low or high, and I can better manage my diabetes at the time. The sensor and the app are very easy to use, too.”

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Why an EPR supplier duopoly in the UK would stifle future innovation I was talking to a junior doctor recently who was disenchanted and burnt out, and had a desire to forge a career in the digital health space. Our conversation touched on the ongoing junior doctor pay dispute, which looks remiss of a resolution.

Rachael Fox, Executive Vice President EMEA, Altera Digital Health 0014

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The net cost of pay restoration for junior doctors has been calculated at approximately £1bn, or the equivalent of a handful of big bang EPR procurements, as it was candidly pointed out to me. It is also similar to the figure by which the NHS tech budget has been reportedly cut.

The conversation left me considering the viability of such huge sums of money being spent on inflated monolithic EPR deployments that take years to implement, the impact on the wider NHS and the future of the clinical systems market should a(nother) duopoly be allowed to develop.

As a new year begins, there is an opportunity to re-evaluate what is best for the NHS and potentially plot a different course that encourages competition, innovation, and the best use of taxpayer’s money in the context of ambitious tech targets.

Ambitious targets If all trusts are to meet the target of corelevel digitisation by 2025, set in the LongTerm Plan, they need to achieve greater speed to value from their system suppliers.

From my experience there’s no reason why a hospital following a phased departmental deployment plan shouldn’t be up and running within months, not years, of signing a contract that doesn’t run into the hundreds of millions. However, often what delays this is the time and money wasted on procurement, and decisions to implement being drawn out.

The importance of competition Few organisations can achieve the big bang approach to EPR implementation pushed by some of the international suppliers. With reduced national funding for EPR projects, this becomes a more unrealistic, or risky,

proposition for trusts should they find their funding is withdrawn or reduced and they have to consider a different approach available to them at the outset.

With the financial constraints most trusts operate within, it is dangerous to rely on the two big suppliers. A duopoly, as we’ve seen in primary care where two organisations share 90% of the market, is not in the interest of the NHS—not from a financial or innovation perspective, nor does it motivate suppliers to provide the best possible systems at the most sustainable price.

The future of the UK clinical systems market If a duopoly in secondary care EPR systems is allowed to evolve, I fear that reaching digital maturity will continue to be just out of reach.

The value for healthcare professionals and patients from clinical information systems relies on shareable, actionable content.

Once we have this information from all care settings being shared efficiently, then I believe the next big push will see greater focus on real-time clinical decision support.

In addition, real-time, up-to-date views of capacity and demand will also be crucial.

At the core of each of these priorities is openness: being open to understanding what hospitals need to speed up their processes, now and into the future; listening to clinicians to ensure every action we take makes technology easier to use; and remaining open to working with every other provider, preventing costly rip-andreplace programmes that take years to realise value.

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Future predictions and solutions for 2024 and beyond 0016

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Sue Jones, Director of Social Care, IHSCM

I don’t know about you, but it certainly feels that social care is about to go through a monumental transition over the next two to three years.

There are many factors involved; cash strapped local authorities, overstretched NHS & social care, care needs rising, as well as technological advances.

In addition to those factors, we are also seeing care providers facing

a long and difficult road trying to adapt to accommodate these changes.

Below is a summary of what the challenges are, specifically relating to social care and how we can solve them.

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Government intervention for health and social care Whichever government comes into power, unless this country makes a decision as to the path we are trying to create for our health and social care future i.e. fully funded through increased taxes or 2-tiered approach, then nothing will change.

My question is “Can we afford to wait for that decision”? The answer is quite simply “No”.

Local authorities There will be more local authorities whose books will not balance over the next 12 months. Many independent reports are in the public domain, provide this evidence, including Fair Cost of Care.

This will have a detrimental effect on all who need access to some form of social care, putting more pressure on an already stretched sector. For care providers who are reliant on social care contracts, this could well mean we see many care providers having to close because they cannot make the money they need to survive financially.

Technology advances Over the last 3 months I have seen some amazing technological advancements in health and social care, two spring to mind. There are now robots in people’s homes that can interact with a person who receive support. These robots

allow the person to manage their medication, send/receive alerts and communicate easily with loved ones or care providers. I have also seen a demo of a 3D wearable headset.

When worn, it enables the likes of doctors, nurses, occupational therapists, to view what the person who is wearing the device is viewing. This can help health care professionals provide instant diagnosis and treatment. My concern is how care providers will react and adapt to these advances i.e. choose to embrace or not. We know technology is coming on a big scale and we need to plan to ensure care providers can adapt.

So what does all this mean to care providers?

The above is the harsh reality that is being faced, but I honestly believe there will be winners to these changes. Those winners will be the ones who choose to put plans in place to adapt now. This requires a change management process. At the Institute of Health and Social Care Management, we are putting the final touches in place of a proven transition program that will enable care providers to take control of their own destiny.

Do you want to be part of this program? If the answer is yes, then email sjones@ihm.org.uk.

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How to survive & thrive during Veganuary 2024 Veganuary is an increasingly popular event where those taking part try an animal-free, plant-based diet and lifestyle. It’s an honourable thing to try as it can help the environment and drive more sustainable business practices. However, as with any lifestyle and diet changes, there is a period of adjustment where you may need some additional support.

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To help you if you’re taking part, here are some tips on ingredients to look out for, how to keep your energy up, and some easy food swaps you can try.

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The Veganuary challenge is an opportunity to try new things, but your health and wellbeing are more important, so let’s get into it...

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The vegan diet is usually higher in minerals and vitamins.

The vegan lifestyle uses more natural and organic products.

The vegan lifestyle promotes sustainable business and manufacturing processes.

The vegan lifestyle could lower the risk of heart disease, diabetes, and high blood pressure.

What is Veganuary?

Vegan + January = Veganuary. Yes, it’s challenging yourself to go vegan for the whole month of January to see if you experience any health benefits and could do it full-time. It also helps dismiss any myths or rumours you may have heard about the vegan lifestyle.

Veganuary has been around since 2014 and more than 700,000 people took part last year. On their website, they are ‘urging everyone to cast a vote for a greener planet, lower food bills, better health and kindness to animals’. Considering the increased number of vegan (according to The Vegan Society) searches for ‘Vegan food near me’ and vegan products on the shelves, it’s fair to say they’ve had an impact.

The benefits of the vegan lifestyle Going vegan is not easy. There are many ingredients in food, cosmetics, toiletries, and clothing which use animal by-products and parts, so it can be time-consuming.

However, you may find the benefits worth it: • The vegan diet is high-fibre and nutrient dense.

• The vegan diet is generally lower in sugar and calories.

• The vegan diet has fewer processed foods.

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If you’re interested, here are some tips and things to consider throughout January to keep your body and mind healthy...

Ingredients to look out for One of the main barriers to vegan living is the hidden animal-based ingredients in everyday items. As well as swearing off dairy, meat, fish, eggs, etc. You should look out for these on the packaging: •

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Casein – A protein found in milk and typically used as a muscle supplement, as well as in baby powders and cheese making.

Whey – A protein and additive found in milk commonly used in protein powders and cheese making.

Lactose – A sugar found in milk used as a stabiliser and sweetener in many processed foods.

Gelatine – A thickening and gelling agent made from animal collagen.

Beeswax – A wax produced by bees that can be a lubricant, polish, used in cosmetics, candles and more.

Carmine – A pigment made from insects.

Isinglass – A kind of collagen derived from fish used as a preservative or a clarifying agent.

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L. Cysteine – Made from hair, feathers and hooves and acts as a preservative.

There are many more, but most vegan products are certified with official vegan logos from places like The Vegan Society to make it easier for you to decide.

Although there are plenty of accidentally vegan products too – you can find lists of these online, and there is one on the PETA website too.

Simple and easy swaps Vegan products are far easier to find than in previous days. As well as having a vegan logo on the packaging, many businesses are creating dedicated vegan areas in their shops and supermarkets for ease.

For toiletries – choose products which are sustainable and recyclable, like bamboo or paper cotton swabs, reusable cotton washcloths, natural shampoo bars, period pants or menstrual cups.

For household items – choose natural cleaning products like white vinegar, eco products or reusable cleaning cloths.

For foods – try plant-based milk over dairy, agave syrup over honey and Fairtrade dark chocolate over Milk chocolate.

Ways to boost your energy and nutrition levels Our bodies get most of their iron and B12 from animal products – these are nutrients that help our brains function, and red blood cells form and move around, so when we are deficient in them, we often feel fatigued and have low energy.

To help keep your energy up and prevent tiredness and brain fog, it might be worth considering choosing things like fortified plant-based milk and cereals or taking vegan-friendly supplements.

Products like these usually contain other beneficial nutrients as well, such as zinc, calcium and Vitamin D, which are harder to find in vegan foods.

If you’re unsure about making any lifestyle choices or are concerned about going over the recommended daily allowance for these nutrients, speak to your doctor for advice.

General Veganuary tips 1. You don’t have to go all in if you have a challenging month ahead. Try swapping out one meal for something vegan or choosing vegan hair or skincare for the month instead. Little and often is always one of the best ways to make changes like these.

2. Focus on sustainability. Oftentimes, natural, local-grown foods and small independent retailers are more likely to have sustainable, low-carbon and veganfriendly produce, so consider shopping local, if nothing else.

3. Don’t be afraid of meat substitutes. They make easy swaps and are designed to be as close in texture and taste as possible to animal meat, so it’s a straightforward way to start.

Veganuary doesn’t have to be a trial, it can be full of interesting swaps and discoveries. Just make sure you make smart choices for your life and schedule, even if it’s just going for soy milk in your morning coffee.

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The Social Impact of Living Mem Reminiscence Resources and Te and Memories groups from the perspective of one UK Care and Residential Home Group Living Memories CIC is a non-profit community enterprise that we created in 2017 to use archive films from the 20th century to help to reduce the isolation of older people, including those living with dementia.

During Covid, with support from major UK film archive collections we created a unique interactive online streaming platform, Living Memories Online, offering over 3,600 archive films and newsreels. We were very fortunate to be able to trial the use of Living Memories Online during and after the Covid lockdown in one national care home group and below is the practical feedback that we received.

For Residents Both the Living Memories DVDs and Living Memories Online (LMO) resources have great benefits for the residents in our homes, whether for those living with dementia or those who need to connect through 0024

conversation with others to enhance their wellbeing and to stimulate the mind with memories of their lives .

Bringing folk together and generally watching short archive film clips sparks much conversation and this type of archive of adverts, film and other historical content just triggers the memory of things they may not have thought about for many years.

When we hold sessions, there is much fun and laughter and you never quite know what will be triggered. Recently one older lady shared how she was a milk(wo)man!

So often when people are sharing, their fellow residents and staff never knew that about that person’s life, which then

mories ea

stimulates further discussion after the sessions and keeps a conversation going.

With the pandemic and isolation and lockdowns, the Tea and Memories sessions run were vital for enhancing wellbeing and now we can begin to open the doors again to the public, staff are inviting in visitors to join in with these sessions. Very often family members learn things they didn’t know about their loved ones!

For Staff and Volunteers The Living Memories Online archive films and newsreels really do help activities coordinators, staff and volunteers to plan topical sessions with the residents on subjects they would like to be reminded of. Very often those leading the sessions

Brian Norris, Founder and Executive Director, Living Memories C.I.C.

may be young and the printable reminiscence guides with the LMO service and DVD’s make it much easier for them to run a session.

Staff can pre-plan sessions by looking through the archive online and store the film clips in their collection on LMO. As mentioned above, staff often discover things about people that they care for day in day out, that they never knew about them. That is great for personalised care because you can build on that and then find other stimulating things from their past experiences, work, family etc.”

Our Living Memories reminiscence resources are available on https://www.livingmemoriesonline.com and https://livingmemories.imagencloud.com Enquiries to: brian.norris@livingmemories.io Phone: 07922 233363 / 01297 552358

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Emotional exhaustion in social care Care work takes emotional resilience like no other profession, as anyone reading this will know. However, one thing that is underestimated is the intrinsic link between the positivity of the team and the wellness of those they serve. Nothing spreads quicker across a health and social care organisation than the wellness, OR ‘unwellness’ of the staff.

Anoushka Farouk, Founder of Aventurine Therapies ~ RTT® Therapist & Emotional Wellbeing coach for Social Care 0026

Care work takes emotional resilience like no other profession, as anyone reading this will know. However, one thing that is underestimated is the intrinsic link between the positivity of the team and the wellness of those they serve.

Nothing spreads quicker across a health and social care organisation than the wellness, OR ‘unwellness’ of the staff.

Key signs that a team are suffering from emotional exhaustion are: • Low morale • High sickness rates • High staff churn • Workplace gossip and complaining • Unwillingness to cover shifts • Generally…An unhappy team vibe The emotions we experience as humans are an invisible force that is powered with either positive or negative energy.

These emotional ‘disorders’ become exacerbated by stress, grief, tiredness and worry, increasing the field of negativity around us like a big dark cloud.

Imagine the effect that would have on an 97 year resident with post-war PTSD! Just as we can feel the vibe of a warm hearted genuine friendliness towards us, we, as empaths in the care sector can also sense unhappiness, stress, the need for healing and support. People who work in the care sector tend to be naturally gifted with this empathic ability.

It is both a blessing and a curse – often leading us to carry around the weight of the world on our shoulders after a heavy shift.

So in order to care effectively – we absolutely need to care for ourselves.

At the risk of adding more pressure to the plates of our care managers I would like to note that the resilience of a good care team depends heavily upon the wellbeing of their leader.

All too often we hear of General Managers suffering from overwhelm, burnout and emotional exhaustion to the point that they begin to lose sight of why they do what they do.

Sadly, as the pressure rises, the love of the role starts to fade and this has a dangerous ripple effect - towards the team, the residents, families and friends…including their own.

Now, I’m not in any way suggesting that the manager is to blame for any of these things – Instead, I would like to highlight the huge opportunity that is available for managers to influence the performance and wellbeing of the team. It starts with you. A team are much more likely to be honest about their own care needs if they see a manager making time to tend to theirs. A harmonious workplace creates a sense of purpose, belonging, and connectedness, not only for the staff, but for the residents, their family and friends.

When we strive for improvements in quality of care and resident experience, we should also be striving for good quality care and wellbeing for our front line teams.

If you would like to get hold of some free resources, book a wellbeing workshop or hear about other services that can support you or your team visit: https://aventurinetherapies.com/ careforourcarers/

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The best pla to start is wit You know what it's like, you get out of the wrong side of the bed in the morning and your whole day goes down the drain. Oh, hang on, just wait a minute, what if that isn't the case? What if you get out of bed on the wrong side and you just acknowledge that you got out of bed on the wrong side and that's the end of that?

Feels different doesn't it?

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ace th us...

Lucy Buxton RN, Advanced Personal Evolutionary Coach, NLP+ ® Trainer, Trainer of Hypnotherapy, Director/Owner, LjB Coach Consultancy

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This is where I know you are curious and want to know how you can achieve that. Well, I haven't got enough words in this article to tell you exactly how, yet what I can say is that it all starts with you. Your body first, then the relationship you have with yourself. When both of these are reasonably good you can then move on to your relationship with others.

Overall well-being is built up of several different elements/ dimensions. Physical, mental, emotional, financial, occupational, environmental, social and spiritual. We can cope if one of these dimensions is out of kilter, yet two make things tricky. Some people could manage two, but not three.

Let’s take a look at this in a little more detail. If you focus on getting your body in a good place then you will be less likely to catch illnesses for example. Or you are more likely to bounce back quicker if you are ill. So, ensuring that you undertake some form of exercise is key. Great sleep is also essential. The amount depends on the individual and their age. 7 hours is a good amount for adults. We also need to pay attention to good nutrition and hydration as well as reducing the amount we may smoke or drink.

Just go back to the 'getting out of the bed on the wrong side scenario'. If we exercise, have good nutrition and hydration as well as a decent amount of sleep we are more than likely to be able to manage those little hick-ups that occur throughout the day.

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You now need to work on the relationship you have with you. Fantastic!!

This will enable you to be able to then work more effectively with others, share more, and empower those you spend time with.

Funnily enough, doing that will help your overall well-being. I mentioned social, occupational, and environmental as three of the elements of well-being. So, work makes up a big part of this and this is where coaching comes in.

Coaching helps employees and colleagues feel more connected to one another and the roles that they undertake. It helps people recognise their strengths and identify areas for improvement. Did you know that teams of people who access coaching report higher levels of satisfaction in their roles?

Coaching also helps create a more positive work environment.

Just before I leave you (yes, I know, it’s been short and sweet) let's just think about 'getting out of the bed on the wrong side ‘again. Just imagine you did, and you knew that it didn’t matter because the team at work and those around you in your daily life, supported you, encouraged you, and empowered you. Feels good doesn't it?

Yeah Next time you get out of bed on the wrong side, remember you have choices, one of those being that you can choose to see the outcome of your day differently…

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The Attitudin A-B-C of Social Care I wish to attempt to conjure the A-Z of the right attitudinal approach to work as a social caregiver. I, certainly, am no authority to tell you what to do or even how to do it - but over the course of my work experience, I have had the course to ruminate over some of these issues and I suppose I could help underline some of what most of us already know or remind others of the traits the drain of long hours of shifts have worn off. So, here we go!

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Oluwatosinloba Adewunmi HR Administrator & Care Worker

nal A - Agreeableness.

It is important for every member of staff, from top management to the care assistant, in a social care organisation to possess the quality of being agreeable. Not that no one should disagree with his/her workmates, but one must have an underlying understanding that one thing trumps all others - the delivery of quality care to ones’ patients. Carers need to learn to disagree without being disagreeable.

B - Belief As much as possible, top management, line managers, and care staff should contribute their own quota to ensure the patients we care for receive the best quality service.

Naturally,we would face challenges in meeting our objectives. But it is critical that everyone in the social care industry believes quality care is practicable and achievable.

When and where this belief is lacking, monotonous routines will soon cascade into a lack of motivation and everything will appear not to work. From this very slippery slope, there is hardly ever a coming back!

C - Caring Now, I assume everyone within the social care industry truly knows what care is all about. Care is indeed what it is! But, what is Care?

Care is that attribute of wanting to see someone else satisfied. Someone else being one's patient, colleague, line manager, executive management, and (believe or not) oneself. It is not easy to truly care, but it is not impossible. It starts by making a choice to try. One step at a time, even when you fail - continue to care until it becomes a part of you.

Please watch out D-E-F!

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THE LOOP Mike Parish, Director, LGBTQ+ Dementia Advisory Group CIC

Inclusive Dementia Care for the LGBTQ+ Community A short dig into the history of LGBTQ+ people and their experiences of engaging in health and care environments will reveal good grounds for their anxieties about how they may be treated, how they may have their defining sexual orientation or gender characteristics either ignored, ridiculed or where they are too fearful to reveal them 0036

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A recent report by Compassion in Care (https://compassionincare. com/wp-content/ uploads/2023/08/Stripped-of-allPride-part-2.pdf) gives shocking and worrying evidence of extensive abuse of LGBTQ+ people in care.

This is compounded often by insufficient protections for whistleblowers.

There are about 1 million older LGBTQ+ people in the UK. Many of them will have lived at a time when homosexuality was illegal and indeed prior to 1967, could be punished, potentially, at worst by life imprisonment.

For those experiencing cognitive problems or dementia their recollections of the legality of homosexuality may lead to fear and confusion when receiving care at home or entering care environments. In addition, many older LGBTQ+ people may recall hostile encounters with the police, judgemental attitudes by health and statutory providers or hostility and rejection and discrimination during their lives.

A report by Stonewall (https://www. stonewall.org.uk/lgbtq-facts-andfigures) notes significant ongoing, unequal treatment or discrimination when encountering health services.

The UK Government’s own 2017 report on the National LGBT Survey (https://assets. publishing.service.gov.uk/ 0038

media/5b3cb6b6ed915d39fd5f14df/ GEO-LGBT-Survey-Report.pdf) recognises ongoing anxieties, fears and discrimination targeted towards LGBTQ+ people in many areas including health.

Given the knowledge of the combination of discriminatory experiences, anxieties around revealing sexuality, the role that dementia plays in confusion about safe spaces as well as a lack of structured procedures for care providers in how to best support clients from the LGBTQ+ community, it’s no wonder that experiences of these people in care can be haphazard, potentially abusive or something to be feared.

How do we address this?

We need to understand what the problem is; what clients from these communities need in terms of reassurance about dignified and relevant care, explicit engagement with clients through reassuring publicly visible information when seeking care providers, how the care provider will proactively support people from these communities and what this looks like in practice, be understanding of their anxieties and make clear their intention to deliver relevant and respectful care in safe environments.

This starts with ensuring that knowledge and training is provided to staff to ensure they understand what good care looks like in relation to minority sexual or gender identity communities and that this is embedded in care provider

organisations, management structures and policies and driven by senior management to ensure that standards are met. In addition it is important to have rigorous mechanisms to address abusive or inappropriate behaviour by care staff.

Good practice would include; addressing the fears or a clients reluctance to divulge their gender identities or relationships and not to make assumptions especially at first contact with client. Reassurance that this sensitive personal information is kept confidential, giving time for the client to ‘feel safe’ and tell their story. Listen to anxieties, fears and hopes for fully respected and safe

engagement with carers.

Trust takes time to build where fear where public or family rejection has been a feature of their lives. Its also important to recognise ‘chosen families’ (comprising long term friendships and nonbiological kinship bonds) these are a common feature of people from within these communities rather than next of kin and may or may not formalise their relationships with marriage or civil partnerships.

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