Making a drama

Iain’s wife Maggie has the early signs of dementia. However, she hasn’t been assessed medically as such. Regardless, Iain doesn’t talk about his feelings, but if he did, it’s unlikely he’d describe himself as a carer. He listens to a voice on the radio, a voice talking about healthcare policy matters, a tightening public sector purse and an ageing population.

“Are you listening to that, Maggie?” he says “They’re always talking about the same thing, but nothing ever changes.”

Some 50 health and social services frontline staff in the room with Iain and Maggie recognise his cynicism. Possibly, some of them even share it. After all, they’ve been hearing about the integration of health and social care for decades. This time, however, they’re here to fix it. Iain and Maggie are played by actors, and the staff are participating in a training day called ‘Sliding Doors to Better Futures’.

From frontline staff to third sector employees to academics, most of those giving evidence on the Public Bodies (Joint Working) (Scotland) Bill to the Health and Sport Committee have identified ashift in working culture as a key target for legislation. Alison Petch, Director, Institute for Research and Innovation in Social Services, warned the committee not to get “bogged down in the architecture and mechanisms” but to concentrate on reshaping the workforce and to “ensure commonality in the workforce in focusing on the individual.” This, believes Petch, can be “underpinned through interdisciplinary learning.”

Within the NHS and social work professions, the work is already under way. Malcolm Wright, Chief Executive of NES Education for Scotland, says that integration is a key element of his organisation’s strategy.

“We recognise that organisational development is crucial at all levels to support the integration of health and social care, and core to this is the preparation of staff.”

Programmes of joint activity have already included workforce development and education to support both the Dementia and Carers’ Strategies, Knowledge Management and Leadership Development.

The ‘Sliding Doors’ project grew initially out of the Reshaping Care for Older People policy. Gill Walker, former educational projects manager at NES, describes it as “a lightbulb moment”. Walker and Laura Gillies, senior adviser of workforce development and planning at the Scottish Social Services Council, were inspired by the romantic comedy of the same name in which Gwyneth Paltrow’s life goes in two directions, depending on the outcome of one seemingly small personal decision. The same principle, they realised, could be applied to service users.

“What we wanted was to stimulate thought around capacity building and thinking about how, as professionals, we can influence those decisions, and what we do about that and how we support the decisions that are made,” Gill Walker tells Holyrood.

“We wanted to inform people about policy direction, we wanted to engage them with how NES and SSSC were working together and we wanted to excite them about integration and the direction of travel. To bring the policy alive, through these conversations,” she adds.

Gillies and Walker brought in Esther Walker, from learning and development consultancy Forum Interactive, who specialises in using drama to encourage active learning. It was, according to Gill Walker, “complete partnership working. When we first started this, it was really exciting because we just basically sat round a table and threw ideas in. Me, from a health perspective, Laura, very much from social work and Esther was soaking it all in thinking about how we could make it into a drama. We were very clear about how we had to incorporate health, and we had to incorporate social care, and the boundaries there, and how we could work together. How we could learn together, right from the beginning.”

Esther Walker was given the task of building the drama around the issues surrounding Reshaping Care for Older People. “It links to the integration agenda, the dementia strategy and carer strategy,” she says, “so at the beginning, this programme was about Reshaping Care for Older People, that was the impetus behind it, but as it’s gone on, I think people’s interest in it has become much more about the integration agenda, and the need to support that through cultural change.

 “We use a story, because we need something which is going to provide a focus point for all these different agendas, all these different roles and responsibilities and perspectives on the problem, the challenge. If we can focus all that on these two people, Iain and Maggie, it would remind people, and keep the reminder there, that all this is about improving the lives of individuals, and getting them to identify the capacity they have to make an influence. What could you do to influence things so that it goes in the direction that they really want? Round the table, you’ve got all different areas of service, and what they’re doing is learning from one another about what they would do.”

The ability to relate to the characters on a personal level is a key component of the shift in learning that is needed. The character of Iain tells participants: “We’re all older people.”

For Gill Walker, the transition is one of osmosis: “They don’t feel like they’re being educated. But they are. We start off with an exercise called The Good Life. It is about identifying what is good in your life, and what makes your life good. And why. You can’t just answer ‘my dog’– you have to find the why behind it. When you start thinking like that – what’s important to you, then you can translate that to what’s important to the people that you’re supporting. How can you help them keep some elements of that within their lives? How do we work together to do that? It might even remind people of the motivation why they went into a caring profession in the first place. That’s what brings health and social care together. That’s what brings us together. That’s what integration’s all about.”

Stage one of the project saw three pilot days take place across the country in 2011, each with a session for frontline practitioners in the morning and a session for managers in the afternoon. The feedback was “fantastic,” says Gill Walker

Stage two included an online resource on the knowledge services network, which continued the story of the characters for a further five years and illustrated the changes in attitudes and behaviours that are needed to deliver the policy agenda. On the back of the resource, the team were approached by various bodies with requests to run the programme locally.

In September 2012, there were three pilots in local change fund partnerships, teaching them how to run the sessions themselves. One of those was in East Renfrewshire. Zaid Tariq, Planning and Development Officer, said the Community Health and Care Partnership was “delighted”. They had been so impressed with the first event they invited other partnership areas to attend.

“We have used it to support our people delivering support and services from health, social care, independent and third sectors to take time out and reflect on the things that matter most to people,” Tariq reports.

“Quite often, culture change is something that is often missed when looking at change, however, we know that the research around successful change management tells us it is often the most important element to long-term success.”

The event has also been piloted within a university and three colleges. Gill Walker tells how a chance meeting with the head of adult nursing at Dundee University gave them the idea.

“Fortunately, Laura knew the head of social work at Dundee University very well and the next thing we knew, we were sitting round a table with them. A couple of their lecturers had never met!”

In January, 60 students at Dundee University took part, a mix of third year social work and nursing students. It was the first time the departments had collaborated on a learning project. Similar pilots were held in FE colleges in Dundee Glasgow and Kilmarnock with student support workers. Although Gill Walker has moved on from being joint leader of the project, she is sure it will go on growing.

“We have plans to roll this out to at least five partnerships this year, and I actually have a waiting list, although I’m not involved in it anymore. What we do is try to get that alignment across the sectors by the focus on the people. I’m not saying it’s going to happen overnight, but that change is going to happen and we are all going to be part of it. We need to be flexible in our roles. We need to be more creative, and we need, as educationists, to support that creativity.”

The Health and Social Care Alliance has recently announced plans for the creation of a resource-light, partnership driven, Health and SocialCareAcademy for Scotland.  “This collaborative initiative will provide a cross-sector locus for driving integration as part of the wider public service reform and health quality agendas,” according to the Alliance’s strategy document.

Forum Interactive also have more work in the health sector: “We’re now looking at working with midwifery services. People are very interested in using stories to create resources that make you feel things,” said Esther Walker.