Person-centred care during the COVID-19 outbreak: what matters to you

Introduction

We know that every day, you put the person you support and what is important to them at the heart of your care.

During the COVID-19 pandemic, your relationship with those you care for and support is even more critical. You may be the only person providing face to face contact due to COVID-19 restrictions, particularly for people who are shielding. The way you connect and communicate with people you support will impact on their wellbeing, even if you are only with them for short periods of time.

You have valuable existing skills and knowledge that you can draw on as you adapt to some of the changes that may be required in your role during the different phases of the COVID-19 pandemic.

There are many different ways to practice in a person-centred way. This brief guide provides a summary of what being person-centred can mean in practice, tips on how to strengthen the relationship with those you support through good conversations and how this rights-based approach is supported by the Health and Social Care Standards and the SSSC’s Codes of Practice. There are links to further resources should you wish to follow these up.

If you are new to the workforce, please use this information and speak with colleagues if you need support. If you are an existing social service worker, we hope this information enhances your confidence and helps you share learning with others.

With thanks to NHS Education for Scotland (NES) and the Personal Outcomes Network (PON) co-ordinating group for use of their resources, in particular Communicating with and supporting people: information for support workers in health and care settings

Person-centred care Why is it important and how can I be person-centred in practice?

Why practice in a person-centred way?

Growing evidence shows that working in a person-centred way helps to focus on what matters to the person. This leads to many benefits for those you support, their families and carers and for you as a worker.

People being supported in this way have said they feel more in control and involved in decision making processes, and through this have improved:

their quality of life
relationships with their workers, carers and families through being at the centre of shaping their support
their health and wellbeing.

Workers have said that working in this way:

improves job satisfaction
is a more efficient use of their time
improves relationships with those they support, their families and carers
helps put their professional codes of practice and national health and standards into practice.

A person-centred approach emphasises individual strengths, capacities and resilience, making sure people play the role they want to in working towards achieving their own personal outcomes.

The image below from the Thistle Foundation, an organisation which has embedded person-centred support, illustrates how including a perspective based on the person’s strengths can make a difference.

Do we need a different set of lenses? One set of glasses depicted show lenses focused on labels, diagnosis, conditions and deficits which results in viewing people using services as problems. The other set of glasses, below, shows strengths, gifts, resilience and potential which results in viewing people as citizens.

Developing support around an individual’s strengths can lead to better outcomes for the person, particularly during the COVID-19 outbreak.

Evidence shows that focussing on what someone can do or influence in their lives, especially in times of crisis, helps build personal resilience and wellbeing.

This can sometimes mean moving away from a more traditional approach which tends to focus mainly on a person’s difficulties, medical conditions and what they can’t do.

What is person-centred care?

This two-minute video from The Health Foundation explains what person-centred care is and why it is important.

Click on each category to learn more.

There is no single definition for the term ‘person-centred’. There are many ways in which it can be practiced. It is generally agreed however that there are common principles underpinning this approach.

The Health Foundation's Person-centred care made simple: The four principles of person-centred care has an inner circle dived equally into three parts; Care is personalised, Care is coordinated and Care is enabling and the outer circle shows when all 3 parts are achieved, people will be treated with dignity, compassion and respect.

The Health Foundation's person-centred care made simple provides an overview of how person-centred care supports people to develop their knowledge, skills and confidence.

Principles which underpin person-care are:

affording people dignity, compassion and respect
offering coordinated care, support or treatment
offering personalised care, support or treatment
supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.

Being person-centred is about:

showing dignity, compassion and respect
thinking about things from the person’s point of view
considering people’s preferences and expressed needs
respecting people’s values
involving carers and family
offering coordinated and integrated care
enabling people to develop the knowledge, skills and confidence
enabling those you support to manage and make informed decisions about their own health and care.

Being person-centred involves:

a way of thinking and doing things that sees people as equal partners in planning, delivering and monitoring care to make sure it meets their needs and choices
people, their carers and families being at the centre of decisions, valuing them as experts, working alongside health and care staff with the aim of getting the best outcome for the person
focusing on the things that are important to the person in their lives, sometimes called personal outcomes, and building on the person’s own strengths
skills, knowledge, relationships and behaviours which require an ongoing commitment from individuals, teams and the organisation. The underlying approach is often described as doing things ‘with’ people rather than to or for them.

Being person-centred in practice

listen to and hear what the person says and act on that
get to know the person behind the diagnosis, problem or need
make decisions with people, families and carers rather than for them
notice and pay attention to things that might appear quite small but which can make a big difference
ask about the person’s feeling and emotions
show empathy by listening, not making a negative judgment, paying attention and showing that you are treating what they say as important
hold a belief that people are capable and support them
work collaboratively and build relationships with colleagues and other services
remember that people react in different ways to situations, which will be reflected in their behaviours and communication. Take a second to ask yourself what is their underlying intention or need?

While we know that much of your practice is person-centred, COVID-19 has brought about unprecedented times for everyone. You may be facing new challenges, both through your own experiences and through the experiences of people you support.

Remember to be kind and compassionate to yourself during these times. Keeping yourself well during the COVID-19 pandemic is key to you being able to take care of others. We know you are often going the extra mile for those you support, sometimes at the expense of your own health and wellbeing. Self-reflection and care are important so you can be present for those you support. Caring for yourself is not selfish, it is essential.

National wellbeing hub

The new National Wellbeing Hub welcome page signposts and directs people to specific resources information for inidviduals within health and social care and another for managers or employers in health and social care

The new National Wellbeing Hub recognises the importance of your wellbeing. Organisations from across Scotland, including the SSSC, have worked together to create a new platform to help you look after your physical and mental health. Specifically tailored to support the challenges you face as someone working in health and social care during the COVID-19 pandemic, it provides you with comprehensive advice on self-care and personal resilience to help you recognise ‘warning signs’.

Clare Haughey, Minister for Mental Health

A message on the National Wellbeing Hub from Clare Haughey, Minister for Mental Health, thanking you about the value of the work you are doing.

Clare Haughey, Minister for Mental Health - a message for people working in health and social care from Promis Scotland on Vimeo.

Here are some further resources if you wish to learn more about person-centred support in practice.

ihub

The ihub within Healthcare Improvement Scotland has collated a wide range of examples of how Scotland's health and care professionals have found ways to communicate compassionately and make that difference through person-centred practice during COVID-19.

Personal Outcomes Network

The Personal Outcomes Network is gathering outcomes stories from across health and social care practice during the COVID-19 pandemic.

The Scottish Commission for Learning Disability (SCLD)

The SCLD Building bridges to a good life: a review of asset based, person-centred approaches and people with learning disabilities in Scotland includes a range of practice examples from Scotland.

Good conversations Why good conversations matter

Having a good conversation around what matters, whether it is with the individual you support or their family and carers, can help your person-centred practice. Most importantly it helps to establish a relationship, but it also helps you to understand the person in the context of their own life and the things that are most important to them. These things which are important to the person are sometimes called their personal outcomes

We know for many of you, your time will be limited, especially during the COVID-19 pandemic. The way we ask questions and listen, no matter how long the conversation, can make a big difference to how the person feels.

Having good conversations with the people you support will help you build stronger relationships with them and be in a better position to work and find the best way forward for them.

Here are a few examples of the sort of things people have said matters to them:

What Matters to You is a national campaign which promotes why it is important to ask ‘what matters’ and provides resources to support having good conversations. It encourages workers to move their conversation focus from ‘what’s the matter with you?’ to ‘what matters to you?’.

As part of the campaign, Professor Jason Leitch, the National Clinical Director for NHS Scotland, said:

Picture of Professor Jason Leitch, the National Clinical Director for NHS Scotland.

‘There is nothing more powerful than taking a moment to connect on a personal level. That instant human connection matters more than anything else. ‘What Matters to You?’ conversations are deceptively simple, some would argue overly simple, but they are a start. Try it, you might be surprised what you learn.’

The importance of conversations and connection during the COVID-19 pandemic is highlighted in this practice example by Maggie, a community engagement worker.

‘Doorstep conversations are now part of my working week and in some ways, they have helped me get to know families better, and conversations have turned to what really matters in the here and now… Every interaction and conversation potentially has more impact in these circumstances …. it’s important now and always to connect in ways that make a difference to people….Every conversation counts. This was always true but lockdown puts a spotlight on that for all of us.’

This section gives tips on good communication, including starting conversations, active listening and having conversations with carers and families.

Click on each category below to learn more.

In the current COVID-19 context, communication is more important than ever.

As a health and social service worker, you can make sure you are doing your best when communicating with people you are caring for by using the following key tips:

gain the person’s attention before you begin to speak
use the person’s preferred name and tell them yours
consider the environment and things which may impact on communication eg noise, lighting
take time and slow down both speaking and listening
allow the person time to listen and to say what they need to
use pictures, diagrams, objects or photos to provide cues for the person
pay attention to your body language and non-verbal communication
use a calm tone and manner
make things simple and straight forward
check if you have explained things and if the person has understood
speak to the person, not just to their family or carers.

A ‘bite size’ learning resource produced by NHS Education Scotland (NES) for health and social care support workers during COVID-19 expands on these tips. It also includes useful sections on being person-centred, communication support needs and ways of making sure people understand the information you are giving.

Carers and family may not be able to be present when you visit during the COVID-19 pandemic, so please remember it is important to involve carers and family and this might be by phone.

Many of the people you are working with may have communication support needs (CSN).

Speaking on the telephone can bring added difficulties for people with communication support needs. If you need to communicate by phone remember these additional challenges and make time to ensure your communication is as easy to understand as possible and take time to listen carefully. The guide above includes a section with tips and further resources to help you communicate with those who have communication support needs.

Communication and personal protective equipment (PPE)

During the COVID-19 outbreak you may be communicating and interacting with people when wearing PPE, such as face masks and visors.

Points to remember if you are wearing PPE:

people may react to PPE and we may react to it ourselves as staff
it might increase distress for someone who is confused or evoke an unexpected reaction
where possible, explain your appearance in ways that the person can understand
be thoughtful and try to minimise any negative reaction.

The Care Inspectorate has produced a dementia guide which includes useful considerations around communicating with a person living with dementia while wearing PPE.

Conversations about what matters are important. They involve active listening which requires an open mind, concentration and resisting the natural tendency to jump in and ‘fix’ people. There are times when a quick response to a crisis is necessary. But more often, conversations which allow people to reflect on their situation and possible ways forward can build confidence, restore identity and improve wellbeing.

By becoming a facilitator of a conversation rather than ‘a fixer’, you can strengthen relationships.

How asking 'what matters to you?' transformed Callum's life

In this video we hear from Callum, who is supported by the Thistle Foundation, on how being asked 'what matters' changed his and his family's lives.

How asking 'what matters to you?' transformed Callum's life from Shaun Maher on Vimeo.

Here is a link to a Let's talk about it prompt card being used in East Renfrewshire by staff to encourage conversations around what matters:

The following two-minute Good life, Good Death, Good Grief video provides a useful guide to six key tips for active listening:

ask open questions using words like ‘how, what, where, who and why’
summarise what you think the person has said
reflect on what has been said with the person
clarify anything you have not quite understood
give words of encouragement
react empathetically to what the person has said.

Six key tips for active listening video

Open-ended questions

An open-ended question is a question that requires a full answer using a person’s own knowledge or feelings. These questions are objective and will be answered in many words. Examples: ‘Why did Jim leave before Susan?’, ‘How did everyone like the cake?’

Circle equally divided into 9 sections, each with a word which helps start an open-ended question: Give, Why, Tell Describe, Who, Where, When, Explain and How

One of the main reasons to use open-ended questions is to obtain deep, meaningful and thoughtful answers. Asking questions in this way invites people to open up, because you are showing that you are interested in what they have to say.

Open-ended questions begin with the following words: ‘why, how, what, describe, tell me about’ or ‘what do you think about’. Although ‘tell me about’ does not begin a question, the result is the same as asking an open-ended question.

Closed questions also have a specific language. If you want to avoid closed questions, try not to start questions with the following verbs: ‘are, was, did, will, won’t, didn’t, aren’t, would’ or ‘if’.

You can find out more about asking open-ended questions in this SSSC Facilitation Resource, in particular pages 33-35

In your job it’s highly likely you come into direct contact with carers. Please remember that carers can include young people who also provide care for parents or other family members. By carers we mean people who provide unpaid support and care to another person. They are the family, friends, partners, neighbours and colleagues of the people you support and the role they play is vital.

Carers may be concerned about exposing the person they care for to COVID-19. You have an important role in discussing their concerns, including re-accessing services that have been closed due to COVID-19.

The Equal Partners in Care (EPiC) learning resources can help you have better conversations and interactions with carers.

Content of the Equal Partners in Care learning resource, videos coming soon, How to use the resource, EPiC principles, who the intended audience is for the resource and intended outcomes.

The aim is to make a positive difference and improve outcomes for carers and the people they care for.

Hexagon showing the EPiC core principles, Carers are idenditified, Carers are supported, Carers are enabled to have a life outside of caring, Carers are fully engaged in the planning and shaping of services, Carers are free from disadvantas or discrimination related to their caring role and Carers are recognised and valued as equal partners in care.

The resource can support you to:

recognise there is always value in engaging with carers and ways to do this
identify and have good conversations with carers
involve carers in the planning and delivery of services.

EPiC will help you to make a positive difference and improve outcomes for carers and the people they care for.

Here are some further resources if you wish to learn more about the importance of good conversations and personal outcomes approaches.

SSSC Learning Zone

The SSSC Learning Zone hosts a suite of resources to support you to understand personal outcomes and practice in this way. These include:

Understanding Personal Outcomes booklet

Free eBook on Personal Outcomes Planning

Jason Leitch TED Talk

This is a 16-minute TED talk by Jason Leitch on why it is important for all health and social care workers to ask ‘What Matters to You?’

‘What Matters to You’ website

The international ‘What Matters to You’ movement has launched a website and Montiefiore in NY has also developed a toolkit.

NHS Education for Scotland

NES has produced other resources that may be useful for helping you understand these communication needs and to explain COVID-19 information to people you support who have a learning disability, autism, dementia and other additional support needs.

NHS Inform

NHS Inform has produced a range of easy-read versions of its COVID-19 advice for the public, including stay at home advice, social distancing, shielding, testing and frequently asked questions.

Health and Social Care Alliance

The Health and Social Care Alliance website provides a practical advice note for health and social care staff on communication for people with sensory loss during the COVID-19 pandemic.

Understanding people’s rights Why people's rights are important and how your person-centred practice can support them

Human rights are integral to person-centred working. Human rights principles underpin the national Health and Social Care Standards and the SSSC’s Codes of Practice.

Human rights are based on the principle that people should be equal and free to take part as full and active members of society. They belong to us all and are the basic rights and freedoms that we have as human beings, which allow us to live with dignity and take part in our communities equally.

A human rights-based approach is a way of empowering people to know and claim their rights. It increases the ability and accountability of individuals, organisations and the relevant professionals who are responsible for respecting, protecting and fulfilling rights. Family carers also have rights and you could play a key role in identifying carers and helping them access the services that can support them in their role.

This means giving people greater opportunities to shape the decisions that impact on their human rights. Human rights are closely aligned to the National Health and Wellbeing Outcomes.

There are some underlying principles which are important in applying a human rights-based approach in practice, known as the PANEL principles. The principles are one way of breaking down what a human rights-based approach means in practice to inform the design, delivery and assessment of care and support.

PANEL circle showing the human rights based approach of Participation, Accountability, Non-Discrimination, Empowerment and Legality

PANEL stands for:

Participation - people should be involved in decisions that affect their rights
Accountability – there should be monitoring of how people’s rights are being affected, as well as remedies when things go wrong
Non-Discrimination - all forms of discrimination must be prohibited, prevented and eliminated
Empowerment – everyone should understand their rights and be fully supported to take part in developing policy and practices which affect their lives
Legality – approaches should be grounded in the legal rights that are set out in law

The Scottish Human Rights Commission Care about Rights project helps realise the human rights of older people using care and support services.

Click on each category below to learn more.

The Health and Social Care Standards have been developed using human rights and wellbeing principles.

This means empowering people to know and claim their rights and increasing the ability and accountability of individuals and institutions who are responsible for respecting, protecting and fulfilling rights.

The new Health and Social Care Standards came into effect in April 2018. The new Standards replace the National Care Standards and are now relevant across all health and social care provision. They are no longer just focused on regulated care settings, but for use in social care, early learning and childcare, children’s services, social work, health provision, and community justice.

The Health and Social Care Standards video

The values and principles of person-centred care are highlighted in the Codes of Practice you work to.

Remember that you already have valuable existing skills and knowledge that you can draw on to develop person-centred care during the COVID-19 pandemic.

SSSC Codes of Practice video

How can I be sure my person-centred is a rights-based approach?

Listen and hear what the person says and act on that.
Get to know the person behind the diagnosis, problem or need.
Make decisions with people, families and carers rather than for them.
Notice and pay attention to things that might appear quite small but which can make a big difference.
Ask about the person’s feeling and emotions.
Show empathy by listening, not making a negative judgment, paying attention and showing that you are treating what they say as important.
Hold a belief that people are capable and support them.
Work collaboratively and build relationships with colleagues and other services.
People react in different ways to situations, which will be reflected in their behaviours and communication. Take a second to ask yourself what is their underlying, intention or need.
Think about the needs of unpaid carers who are supporting the person and signpost carers to organisations such as local carer centres that can help.

Points to think about:

person-centred care will look different depending on the needs and circumstances of the person
it is more than ‘walking in another person’s shoes
you won’t know if you don’t ask
always remember that a person-centred approach means you should consider the person’s culture, preferences and personal history.

In this video from the Health and Social Care Action Group of SNAP (Scottish National Action Plan for Human Rights website, a practice example from Scottish Care illustrates how using a human rights based approach enhances person-centred care with care home residents.

The SNAP Health and Social Care - Scottish Care video

Here are a few resources which you may also find helpful.

Health and Social Care Alliance

The Health and Social Care Alliance produced this report ‘Being Human: A human rights-based approach to health and social care in Scotland'. The report covers the development and importance of embedding human rights in health and social care, particularly for people who are disabled and living with long term conditions. It also includes several case studies

Scottish Human Rights Commission

This short leaflet, 'A human rights-based approach: an introduction' by the Scottish Human Rights Commission provides a brief overview of the PANEL principles and how the ‘FAIR’ flowchart can help you translate the principles into practice.

Here are three videos to help you think about emotional support for others.

SNAP Health and Social Care - Dementia Carer Voices

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SNAP Health and Social Care - C-Change

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SNAP Health and Social Care - The Advocacy Project

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