A new education programme has been specifically designed and around older people providing a career pathway from apprenticeship through to a post qualifying on the job degree course for care staff, nurses and other professional staff that delivers dignity and compassionate person centred care. It is a work based multidisciplinary, flexible and modular education pathway.
Elizabeth Care® was initiated by professionals leading a quality improvement and practice development company working in collaboration with the University of
Surrey.
How it started:
The learning arises from the accredited 360 Standard Framework® (360 SF) that defines excellence from an older person's perspective. The framework and therefore the course focuses on how to deliver dignity and compassionate care and how to transform the caring culture. The 360 Standard
Framework (360 SF) is a diagnostic quality improvement and practice development framework that shows care organisations how to establish and maintain person-centred cultures; helping care settings to measure quality from the perspective of the cared for person, their families and carers to achieve person-centred outcomes. The outcome standards underpin all other service and practice standards. It helps care settings to systematically plan their Quality improvement (QI) priorities and associated learning programmes at all levels of organisation and practice.
The 360 SF was initially designed by Patricia Duff OBE and further developed with Rosemary Hurtley.
Pat was a Chief Nurse of a Health Authority and Head of Quality Education and developed the first strategy of nursing, and has experience in education, quality improvement, management and care of older people across health and social care. Rosemary has worked as a campaigning consultant occupational therapist for older people in care homes for 25 years developing practice within the sector. They have involved older people, professional experts, colleagues, educators and care providers over the last 12 years in shaping the vision for Elizabeth Care learning. It was then developed further after collaborative working with the University of Surrey, School of Health
Sciences who were able to provide accreditation for the course modules. The School of Health
Sciences at the University of Surrey is a leading provider of undergraduate, postgraduate and continuing professional development education.
The entrepreneurial project developing the 360 SF has been led by two different health and social care professionals specialising in the care of older people. They came together to look strategically at what is needed for delivering a person centred culture, initially for the most vulnerable older people with long term conditions. The implementation of the 360 SF is a whole systems solution that aims to make a direct impact on the lives of many older people as it sets out to transform the care organisation.
Elizabeth Care Course
There are three distinct roles which have been created for the growing complexity of care that needs to be provided in sector.
The course comprises offers education to three levels of care staff (apprentice, practitioner care worker, Elizabeth nurse/ professional) outlined below.
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• At Level 6-7 The Elizabeth Nurse will be:
A practicing specialist nurse for older people, having the ability to give good care and support to the older person and demonstrate quality improvement outcomes for the older person, their families, staff and colleagues.
 At Level 5 Elizabeth carer will be a specialist carer for older people, a blend of care giver and everyday living assistant to the person. This might be an existing care assistant or new employee who wishes to join a new pathway in care of older people at Apprentice or Foundation Degree level.
 At Level 4 Apprentice Role
This will provide a career pathway for a person working in the social care sector.
The course is an important part of the wider vision that addresses the complexity of the care and support needs of older people living with long term conditions, and creates opportunities for developing career pathways for health and social care practitioners. The hope is that the 360 SF framework and the learning through the Elizabeth Care education programme will be a contribution to the Health Minister’s aspiration for this country to be a ‘great place in which to grow old’, and turning this aspiration into a reality. The expectation is that the Elizabeth Care education programme will be a means for attracting and equipping an underdeveloped workforce in social care with specialist skills in person centred care as well giving them a new career pathway.
Why it is needed:
•The increase in complexity of care needs for older people and those living with long term conditions requires greater socio-therapeutic expertise.
• The continuing emphasis on the need for person centred care based on relationships.
• The need to build public confidence in health and social care provision.
• Concern within provision to improve and sustain compassionate care cultures promoting service user dignity and implementing best practice.
• The need for better practice development opportunities in health and social care.
• Need for better career pathways for practitioners in some health and social care settings such as the Independent sector.
Key points of the Elizabeth Care Course:
• The first career pathway in which a care worker can go from apprentice, through to care practitioner to fully qualified Elizabeth Nurse if they wish to, specialising in the care of older people.
• Develops a skilled, specialist workforce for caring for older people.
• Offers a career pathway that professionalises the care workforce.
• Gives work-based on the job learning that has a blended emphasis on taught elements and practical application in the workplace; uses the student’s work based experience as a key to learning.
• Uses a person-centred socio-therapeutic model that promotes integration between health and social care, with a multi-disciplinary approach which focuses on both the social and health needs of the patient/service.
• Enables the creation of a route from FD FHEQ level 4 to the potential of MSc, at FHEQ
Level 7.
The experience of running the first module: Extending Professional Practice: Delivering Person
Centred Outcomes
Running the first module of the Elizabeth Care programme and having students complete it has
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been a huge validation of our decision to put our heads on the block and make the first move!
The module was entitled Extending Professional Practice: Delivering Person Centred Outcomes and was designed for nurses and care workers from different health and social care settings wishing to specialise in the health and social care of older people and the first group of 9 students came from all over the UK with different professional backgrounds in particular there was a mix of social care professionals with care staff. The learning enabled students to develop work based skills to enable them to deliver person centred outcomes from the perspective of the service user/patient and their family carers. Assessment of the final assignments for the module was done between the course leaders in conjunction with the University of Surrey. The assessment results showed significant improvements in practice at the ‘coal face’ showing bottom up engagement with residents and colleagues, showing the importance of building a culture in the immediate care environment enables best practice to be implemented and sustained.
Module Content
The module covered the following topics: examination of the 360 SF and how it applies in practice, the ageing process and society's perceptions (e.g. ageism, stereotyping, institutionalisation), the service user's experience of common long term conditions, approaches to care and delivery of care in the context of maximising the person's quality of life. An IT version of the framework guidance was available to students through the 360 Cloud (education ) providing Standards with their outcome, process and structure to measure success.
Students explored integration of health and social care provision, reflected on their current practice, identified good practice and changes they would like to make in their work place in order to deliver improvements. Students were able to evaluate effects of implementing improvements in person centred cultures/behaviours for the service user, their family carers and the staff involved across health and social care services.
On completion of the module the students were able to:
1.
Explore and analyse outcome measures to deliver person-centred care using the 360 Standard
Framework (360 SF).
2.
Apply 360 Standard Framework outcome standards to identify learning needs within health and social care and determine actions in order to resolve underperformance.
3.
Reflect on challenges in later life for people who live with long term conditions and apply key principles for promoting good quality of life.
4.
Reflect on forms of communication within the workplace and demonstrate skills required to achieve positive relationship building for person-centred care.
This first Elizabeth Care Course is an important step towards credited learning in specialist relationshipbased person-centred care for older people (Nolan et al 2003, Nolan et al, 2006). The programme comprises both compulsory and optional modules building to 120 credits. We know that delivering the health and social care outcomes that older people want with evidence based practice will build confidence in health and social care provision and for the wider public.
Pat Duff OBE says: 'For us I think it signals the introduction of the 360 SF as part of a higher education curriculum focussed on achieving person centred care outcomes and the good health and social care cultures their delivery promotes. At this level of education and learning, practitioners and managers with this new qualification can be looked to take on leadership roles in enabling adoption of the philosophy, principles and behaviours exemplified in the 360 SF into the fabric of socio-therapeutic and management practice at all levels of operation. Sustainable good organisational cultures are made from striving to achieve the shared purpose to deliver person centred outcomes to the central player (the service
user/patient) from their perspective'
The students produced a portfolio including a reflective essay or care study that focused on
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delivering person centred outcomes and demonstrated the application of the 360 Standard
Framework. The portfolio also included reading logs, practical write-ups, a critique of policy, creation of care plans and quality improvement plans
.
The course evaluation scored very highly in the following categories of: student experience and feedback including teacher support, learning experience, module design, student interaction, assessment and feedback.
What was most enjoyed:
'Understanding the person as an individual and how to deliver person centred care required
communication - listen to what they wanted and give them plenty of time to express themselves.
Respect their decision on how they are cared for. Involve relatives in all activities of daily living.'
I thoroughly enjoyed the learning. It was specifically tailored to our workplace and therefore very relevant.
The varying options from different disciplines/lecturers such as OT. Nurse and quality improvement and the business aspect made it a well rounded approach. I very much enjoyed the group work and discussions
and have certainly taken a lot away from the course to develop in my organisation.'
'The lecturers were brilliant, the topics very interesting, the atmosphere was conducive to learning -
All sessions clearly delivered.'
Looking at designing the action plan and focusing on the 'actual' outcome.'
'Making change'
Aspects Students felt they could deliver in the workplace?
'Having learnt a great deal of what is expected, I feel much more aware of Person centred care and ways to improve the lives of my residents.'
'The holistic care approach focusing more on their emotional needs - giving special attention to the older people.'
"I feel all of it is achievable of the involvement of the other groups (residents, relatives and staff).'
'I've learnt how to communicate better with my residents.'
'How to build effective communication between staff, residents and relatives.' 'It's about involving and showing people why change is needed.' 'I've learnt how to understand people with dementia better.'
'Breaking down actions to bite size pieces to be able to formulate action plan and monitor and review - 7
really get the whole "outcome — > process—>structure 'method'.' 'I've learnt how to do an action plan which will help me in my work.' 'To look and reflect on care planning.'
'Much more accurately aware of person centred care and what this entails linked to long term conditions.' 'Taking a second look at what people/residents needs are and what approach to relate to them.
'To make an effort to reinstate our drive to sort out advanced life planning for our residents' I've learnt more about long term conditions and how to understand how to make their life easier.'
This first module was supported by care home owners who have the vision to take their destiny in their own hands and provide support and learning for their staff in order to deliver excellence in care from the resident perspective. The work based learning aims to develop expertise in complex caring for older enabling care homes to develop their own staff instead of relying on staff from other sectors to provide this care. It is acknowledged that care home owners need support to this. The vision for the future is to support work place learning with care homes developed as learning centres
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in delivering person centred outcomes through leadership and action learning, rather than the more traditional methods of learning; the ethos of this learning is to have a culture of sharing as well as demonstration of best practice. This can be done through innovative, forward thinking care homes being developed as learning centres where others come to seek support, observe good practice in action and where they can discuss behaviours and strategies and best practice that can then be taken back to their own work place and organisation. The students’ learning following the Elizabeth Care® course can therefore take place in a group setting enabling discussions among students from other homes facilitating a broader understanding and sharing of good practice. This enables a culture of learning from each other and together rather than having a didactic culture of learning in which students just hear about theory.
Conclusion
We were pleased to hear that unlike other courses our approach spanned the need of the individual person in a holistic manner. We hope to continue to work with other universities as this programme offers a unique approach and clear route through the complexities of integrating the health and social care domains, keeping the needs of the individual at the centre of all learning activities. It is hoped that funding will be released for the social care sector to bring parity of learning in health and social care needs to a hitherto underdeveloped sector, providing care to people with increasing frailty and complex needs. This will empower the social care workforce to enable people to live where they want to enjoy the maximum quality of life for as long as possible.
Rosemary Hurtley 20 1 15
References
Nolan M, Lundh U, Grant G, Keady J (2003) Partnerships in Family Care: Understanding the caregiving career, Open University Press.
Nolan M. Davies S., Brown J. (2006), Transitions in care homes towards relationship centred care using the Senses Framework, Quality in Ageing Vol. 7: Issue 3 P. 5-146
Duff , P, Hurtley, R (First Edition 2005 Revised 2011) The 360 Standard Framework (360SF) ™:
Three sets of interdependent Person centred outcomes for care homes from the separate perspective of residents, their close relatives and staff, 360 Forward
Duff P, Hurtley R (2012) The 360 Standard Framework , www.360Cloud.com
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