Leadership For Change

{mosimage}Belinda Dewar, Scotland’s first ever Nurse Consultant for Older People, spoke with Care Appointments about the challenges of her new role and her vision for the future of the care home sector…

Prior to taking up her new Scottish Executive funded post with the Care Commission, Belinda Dewar’s background had been centered round teaching, practice education and research.

After a prolonged spell living and working in London she returned home to Scotland to join the teaching staff at Queen Margaret University College in Edinburgh and was seconded to set up a centre dealing with the Older Person’s agenda.

“We felt there was a real gap – a lot of academic centres were doing older person’s research but we wanted to work with practitioners and do practice based research.”

The obvious question then becomes, what attracted Belinda Dewar to the newly created position of Nurse Consultant for Older People with the Care Commission?

“I’m unsure as to whether or not it’s unusual for a Senior Research Fellow from academia to come into a post like this, but it was a big shift for me. However, I do like to be in jobs where the project is brand new, at set-up stage – there’s something very exciting about that. Also, I had become increasingly interested in the care home sector and felt there were particular challenges in that area, especially as many care home staff are devalued in some ways.”

Having now made the transition from academia into a more operational role, Dewar is clear as to what the primary goals of the position will be.

“Currently the post is only funded for two years, so one of the key aspects of my job is going be strategically putting systems in place that will ensure that the work carries on when my post is no longer there.

“A primary example of this will be supporting and developing leadership. We don’t know who the leaders are in the sector. We don’t know what the educational standing is of the people out there. We need to find out who these leaders are and enable them to become key champions, working with me, to take forward developments and improvements.

“The post is Scotland-wide so we’re talking in terms of around 50 of these key champions being supported with leadership development and then role-modelling that for others. So leadership will be a big thing.

“At the moment there isn’t one place where care home staff can go to get hold of information about best practice, or to discuss practice issues with others, so I’d like to develop a learning network with a web-based element as well as regional meetings and forums across the country for all care home staff, not just nurses.” {mospagebreak}

There are of course many examples of this type of initiative across the wider care sector, with The Learning Exchange and The Scottish Practice Learning Project being prominent success stories in terms of workforce development and the sharing of best practice. Dewar believes that the benefits of such a scheme for the care home sector would be far reaching.

“Promoting leadership will, of course, lead to an increase in the quality of the care provided and there are other benefits to be reaped in terms of increasing staff motivation, better recruitment and retention, staff feeling more valued in their work.

“I see the role of the older person in this process as being crucial to its overall success. Much of my work at Queen Margaret University College was based around really hearing the older person’s voice. We provided training for older people to work in partnership with staff so they could develop services together. That’s very much been part of my background and I don’t want to lose that.

“The plan is to split the country up into regions and within each region we will be taking forward an action project and older people will play a part in that project. We will be setting up resident forums within each region and encouraging staff to involve older people in new practice development. (Service user) involvement tends to be quite tokenistic, not just in the care home sector but across all sectors – however, older people will play a key part in the shaping of this agenda.”

It goes without saying that a newly created role with nationwide responsibility such as the one Belinda Dewar has taken on represents a mammoth challenge. She envisages spending much of her time devising and putting in place systems that will deliver improved care to Scotland’s older people resident in care homes. When asked for an example of how this may manifest itself in practice, Dewar highlights the area of palliative and end of life care.

“New national statements on palliative care and end of life care in the care home setting have just been issued. It may be that we set up a showcase project that will map out how we put these statements into practice – this would be done in conjunction with higher education institutions, voluntary organisations, volunteers, to help us understand what the barriers are and to perhaps create a model that we can then roll out to other areas.

“One of key elements of both the Kerr Report and Delivering For Health was to reduce the number of inappropriate hospital admissions. Perhaps by focusing on an issue like end of life care and building the confidence of care home staff in areas such as the management of pain, we can meet some of the targets of these reports.”

Dewar is clear about what she wants to achieve during her two year tenure as Nurse Consultant for Older People, and the positive changes and improvements she would like to effect.
“I would like to think that there would be a mindset change whereby older people in care homes receive all the different services they need, just as they would if they were living in hospital or in the community.

“I’d like to see the National Standards that the Care Commission regulates against being really used by the care home residents themselves. They were written from the perspective of the residents, but they don’t necessarily know how to use them. If they were able to use these Standards in terms of having partnerships with staff to develop their care and drive up the quality of the care they receive, that would be a very positive change.

“A key for me is to promote the image of the sector – it would be great to raise awareness of the fact that the care home sector is an exciting and rewarding place to work. I want to develop a culture of learning, of sharing, of celebrating achievement.

“I’d also like to see the development of nursing in Scotland to include the nursing staff working in care homes.”