After a successful pilot season of Voyage Care’s first ever podcast, we are excited share our second season with everyone! Relaunching as Voyage Care Voice, our podcast will be showcasing real people with real insights.

In this season, we’ll be focusing on how important quality is in the social care sector. This week, we’re back with Amanda Griffiths, Director of Quality and Andrew Cannon, CEO for part two of their discussion. We’ll hear their thoughts on the “Do Not Resuscitate” orders during COVID-19, regulators, training and our incredible service managers.

Great quality care and support

As the leading provider in the sector, we are truly committed to providing the best quality care and support possible. We constantly look for ways to improve the care we deliver, so it enables the people we support to live the lives they choose; lives which are fulfilling, meaningful and happy. To learn more about our great quality care and support, please visit our commitment to quality area.

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Read the transcript of the podcast below.

Amanda:

I think one of the most significant things that I remember doing in my eight years here is when we wrote our safeguarding policy. There’s a very clear couple of paragraphs in there about making unwise decisions because there was some big things that would keep evolving and coming around.

Amanda:

You know what? People can make an unwise decision if they want to. It goes back to that, we have to tick the boxes of compliance, but that’s our role. The role for the people we support is, we give them a bit of advice, if they still want to make that unwise decision, no different to our teenage children who make unwise decisions every Friday night when they go out. We need to give the people we support those same opportunities, it’s part of life, isn’t it?

Amanda:

That’s what I think we do so well, we make people… It’s a difference between just existing and having a real life, and I think we do that well. I really do think we do.

Andrew:

Yeah. I mean, it’s not always easy either. So, it would be easier to do none of these things, right? It would be easier to-

Amanda:

Oh, absolutely.

Andrew:

Keep people in the service. Not in our services, but you hear elsewhere about this idea of medicating people so they’re complying and all that sort of stuff. I went on a visit once, Summerfield Court who invited me. We went on a day out in the peak district, and they had a great philosophy. We were getting to some, a lot of the people we support were wheelchair users, and this is the peak district, the clue’s in the name. So, we were getting to some pretty kind of places that weren’t easily accessible, but the attitude of the guys at Summerfield Court was we make the impossible possible. I just thought, that is fantastic. That is fantastic because why should it not be possible for… It’s possible for us, why should it not be possible for everybody, why should everybody not have the opportunity? I thought that was a great way of thinking about it.

Amanda:

So, in terms of people that we have to work with and things that we have to do, for many people they are seen as really burdensome and a great amount of work. What I’m really proud of is as an organization, we treat the requirements of any of the regulators, the requirements from the national institute for clinical excellence, through the pandemic, the whole issues around COVID guidance, we treat that as business as usual. It underpins it. It’s never a big chore, it is something we do without skipping a heartbeat because we have a process for doing it. We are well versed, the team are great. They use a gap analysis process, so they work methodically through things. They can identify where the changes need to happen. I think it is a place, if you’re going to deliver a real great quality of care and support, they can never be the mountains, they have to be the valleys. Because the mountains have to be those great things.

Amanda:

Actually, the key issues we’ve seen with many of these external parties, who very much tell us what to do is that when you are confident of your quality, you are then quite confident to stand up to them as well. That is really important, because we cannot just accept when people say you have to do x, y, and z because quite often the people who write the regulations, the guidance to meet that, all of the guidance we’ve seen for the past 18 months, they never look at it from the point of view of the people we support, they look at it as a purely mechanical process that they want to tick boxes.

Amanda:

As we’ve said several times, we’re not in the business of ticking boxes, we’re in the business of giving people a life. So therefore, if something is not going to work is going to restrict people, it is so important that we speak up. It’s something we’ve done several times, isn’t it, over the last few months.

Do not resuscitate orders

Andrew:

Yeah, the big thing this brings to mind is the do not attempt resuscitation, the blanket orders that were placed on people. So, at the start of the pandemic, you’ll remember I’m sure, we had a number of GPs, surgeries, and practices, and clinical stakeholders who had written unilaterally that people who we support or to services to say, right, this person, do not attempt resuscitation. In some cases, that was done to people who had capacity. I mean, it’s scandalous everywhere, but where somebody has capacity, it’s like, somebody writing to you or I and saying it.

Andrew:

I mean, this thing actually blew up. We led on it for the sector, and it actually blew up and it led to questions of the Prime Minister and stuff like that. We took legal action against those surgeries and those practices to get those overturned. So for me, that’s not a heroic thing, that’s just a, well, what would you do if somebody wrote to your son or daughter or your husband or wife and said, “Oh by the way, if you’re very poorly, we’re not going to attempt resuscitation.” If it was me, you’d fight it. So for me, that’s the minimum expectation, we stand up for people we support and that they have the same rights as everybody else.

Andrew:

But, that’s another thing that’s absolutely scandalous. That’s when it works badly, when people think about people we support’s lives being somehow worth less or treat people not as individuals any longer. I suppose when you’ve got stakeholders and external professionals, when it works well, you’ve got multidisciplinary team meetings that put the person that’s being supported at the center, it gives them a voice, design services around them, not just provide it by other stakeholders, that’s fantastic, that’s wonderful.

Andrew:

And in terms of the role regulators play in that, I mean, Care Inspectorate Wales are quite interesting actually. So, I’m the registered individual for every one of our services along with the service manager, so that’s why my name’s on the reports. We do that for a number of reasons. We do it so that I share the burden and the risk. If we get something wrong, I’m on the hook for it. I’m pretty sure that’s unique actually amongst the providers. I don’t think anybody else does that, but anyway. I don’t say that to be like, “We’re the heroes,” but I just say that because as I think about services.

Andrew:

Care Inspectorate Wales, what they do is, whoever is the most senior person in the business has to go and visit services every quarter and do a report. It’s something I’ve been doing in our services in north and south Wales. I think that’s quite interesting actually, that’s quite grounding, and it means I’ve pulled files for people we support, I’ve pulled employment records, I go and visit services, I talk to people we support, ask them if they’re happy.

Andrew:

It’s difficult to replicate that at real scale, but I think that’s quite encouraging that regulators are thinking about that, thinking about how connected to… because one of the things  when I’m going to visit services, is the manager on the floor? Are they on the floor and do they know everyone and are they interacting with everyone, you know? And where they’re not and they’re in their office, and they’re doing paperwork… This is why I’m so keen to pull away paperwork, to remove the… Where they’re trapped in their office and we’ve stuck them to the chair, that’s when I get really nervous about the quality of support, because I think it’s our job to liberate them.

Andrew:

I think sometimes regulators can think in interesting ways. I think often stakeholders can work in ways which are really liberating and sort of accelerate and can act as a multiplier to connect on the good work that we do. But yeah, I’m dead proud of the way we fight for people we support. Our legal department’s very active in that actually.

Amanda:

Yeah, they are, and they are incredible supportive to managers as well, when managers have issues, because actually, yes we are a really high quality provider, but it’s really important that we work alongside local professionals as well. Unfortunately, you do find that there will be times when people are less happy to engage, and sometimes it does take that letter to go, reminding people of their obligations, and we never do it, never ever, to kind of say, we’re pushing. It’s always with the best interests of the people we support. If they need that care and support, we have to make it happen, that’s what our role is.

Amanda:

Again, it’s another great example of that, the center being connected with the people who are out there delivering that care and support, and people not having to struggle on their own. They could try for weeks, but actually, sometimes one letter will elicit the response that’s needed. Again, it really is about people we support that we do need to make that everybody in their circle of support is engaged. That is so important.

Andrew:

It’s not something we do all the time, but it’s not a tool we’re afraid to deploy either, is it?

Amanda:

No. Sometimes, in order to achieve really top class quality outcomes for people, you’ve got to be hard, and you’ve got to fight on their behalf as you’ve already said about the DNACPRs. Sometimes, we have to take that responsibility for them, that’s what our role is, isn’t it?

Andrew:

Yeah, yeah. I agree. That was tough, that was really tough, that was horrible at the start of the pandemic. Because they were in lots of different geographies those letter, came from all over the place. It’s just sort of at one level, it’s kind of depressing because it reinforces how people think about people with learning disability. But, the other I feel happy that we were able to escalate the issue and get it overturned and fight on their behalf. It’s a good thing, it’s a really good thing.

Andrew:

I think the role of the regulator is interesting. I think we have to have a regulator in a sector. You can’t just have people running around doing their own thing. You have to have somebody who sets standards, who measure against it, who has a national remit, who has a voice with government and all that sort of stuff. I think that’s a good thing.

Amanda:

I like the regulations underpinning what we do, because it’s very clear what we have to do and it’s very easy. I mean, our outcomes, as they stand tell us that we are consistently delivering way and above. So actually, we find the regulations and the guidance very easy to tick the box of. The more important bit though is about how you apply it for individuals. Meeting those regulations is very, very easy, and I think we do it very well. You have to be very pedantic. I think one of the biggest changes we made many moons ago here was when we wrote our policies to say, “To use very firm language, you must, you will.”

Amanda:

It’s very important because then it’s very clear that this is what will happen. Because a law is a law, isn’t it? A regulation is a regulation. You wouldn’t go into Tesco’s and put a frozen chicken up your jumper. So, the same way, you wouldn’t break the law in a care home, you wouldn’t, it’s a law. So, what’s really easy is that we then interpret those laws. Managers and the teams find it very easy because we write simple processes. The issue is not the regulations and the processes, the issue is the volume of them that are put out to us. It is volume, not what’s actually there. I think managers do that. That needs to be easy to achieve so that their time and energy is spent on the person-centered care.

Andrew:

I agree.

Amanda:

And making life special for people.

Andrew:

I think it’s something you and the team are brilliant at. Sorry to embarrass you now, but I think particularly through the course of the pandemic, but even well before the pandemic, I think you and the team are brilliant at taking really complex guidance and regulation, distilling it down to the kind of, “Here’s what that means for you, and here’s what you need to do.”

Amanda:

That’s Karina’s team, the quality development team are just exceptional at that.

Andrew:

Fantastic

Training

Andrew:

What role do you think training has to play for us? Because, we’ve worked hard over the last few years on defining specialisms, which has been a big change I think over the last three or four years for us particularly. With that, comes different requirements, there’s brain injury rehabilitation, or high acuity autism, or very specific things like Prader-Willi Syndrome, stuff like that. I mean, training has to play a central role in the delivery of great care and support in those areas. Well, everywhere, but in those areas in particular.

Amanda:

Yeah, it does. Again, that’s a development thing. If we look back over the years, with where we are now, we are no longer an organization that just delivers the mandatory requirements to tick the boxes and keep the regulator happy. What we’ve done with the specialisms is we’ve looked at what people need to know, need to understand, and how they need to be competent to deliver that care. So, we’re not ticking a box to say somebody sat in front of the computer and done something to achieve a certificate. What we’ve done is, we’ve really driven that down in terms of our specialisms.

Amanda:

So, if you look at the specialist behaviour support specialism, what we really learnt in terms of the delivery of that was actually for supporting people who’ve got a forensic history or who’ve been in some kind of mental hospital placement and are moving back out, we can’t just deliver a standard induction. Say, you will see the people that work in those services will have weeks in a face to face environment, and it’s not just doing health and safety and safeguarding training, we’re actually investing a lot of time on resilience training. It’s not just MAPA training. We deliver the MAPA training, but then they get individualized, person specific MAPA training so they know exactly how to manage a person that’s not coping situation.

Amanda:

I think what we’ve done and what contributes to our quality outcomes is we’ve looked at, again, putting the person we support at the centre  of everything we do and delivering that training, and making sure people are competent to support that person safely. I think that makes such a big different. But, I think in terms of organization culture, if you take the autism specialism, we haven’t only delivered that for the people working on the frontline, we’ve said everybody in the organization needs to undertake that training. So, we are an organization who understand all about autism.

Amanda:

We’ve not just left that to the people on the frontline, so we all understand. That means that if the maintenance teams or a trainer or anybody’s going into a service, they understand what matters and what can negatively impact somebody. Because the frontline team can be brilliant and can deliver all that training, but then you get a noisy workman coming in, drilling, and completely upset someone.

Amanda:

So, it’s been really important for us that everybody understands what matters. And I think what we’ve done is, we’ve moved from pure training to a real place that we are delivering learning for people, we’re developing people, and we’re making sure that people are competent to do the role, which is so much more than just a training exercise, isn’t it?

Andrew:

Yeah

Service managers

Amanda:

So, Andrew, what do you think is the most important thing about our managers who are working out there managing our homes and schemes?

Andrew:

I mean, I think, look, we could talk for as long as we want about the role that good support plays or the role that you or I play, and all that sort of stuff. But, at the end of the day, great quality care and support gets delivered in our services, and it gets done by people at the frontline who work incredibly hard and make lots of sacrifices to do it, in often very challenging circumstances, in a role that can be really, really difficult led by managers who often take on those roles and responsibilities as well, and have to steer the team.

Andrew:

I think the role of our local managers and service managers in this space is, I mean, it’s incredible because they have to recruit a team, they have to lead a team, they have to communicate with the team, they have to inspire the team, they have to create stable, effective team, they have to coach the team, they have train the team, they have to sell the service, they have to work with local stakeholders, they have to keep up to date. I mean, if you made a list of all the things that a service manager’s responsibilities, it’s almost kind of inconceivably large, the amount of things that we’re asking people to do.

Andrew:

The fact that we have, for the most part, a very stable group of managers, not everywhere, but a very stable group of managers, and we have local teams who are willing to go above and beyond, but at the beginning, middle, and end of the day, this is where quality get delivered and where it gets done. I mean, absolutely no doubt about that.

Amanda:

No, I agree 100%. When you look at, for each of our managers, the way they oversee what in effect is somebody’s home, and they ensure that all the complex stuff that needs to be done just happens. They really are like those proverbial swans, aren’t they? They’re very elegant in the way they do it. You are so right, I think the list of things that managers are responsible for, I don’t think we’d ever get to the end of it.

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