In this guest blog, Rashmi Becker, PhD researcher at the Department of Psychiatry, University of Cambridge, sets out to understand the role of the support worker in improving quality of life for adults with learning disabilities.
In the wake of a number of high-profile failings in social care, most notably the abuse of people with severe learning disabilities at Winterbourne View in 2011, there has been widespread recognition of the need to address the lack of care and compassion afforded to people in need of support. The 2013 Cavendish Review highlighted “how disconnected systems are which care for the public”. In 2015, the National Audit Office reported the government’s failure to deliver on its promise to move people with learning disabilities out of hospitals and into more appropriate settings in the community.
Anecdotal evidence demonstrates improvements in quality of life when people are enabled to have choice and control in their lives, underpinned by the concept of ‘personalisation’, which was first developed in Putting People First in 2007. However, rather than seeing the widespread adoption of the personalisation agenda, the economic crisis in 2008 exacerbated the ‘one-size-fits-all’ approach with local authorities and the NHS remaining in control and focused on implementing government savings against a backdrop of rising demand and an increasing inability to meet it. In this context, care can become a commodity purchased by commissioners, with little scope for the people receiving care to express and develop their own interests.
Nonetheless, the importance of wellbeing and enabling choice and control has continued to be recognised and advocated within government policy. But this presents numerous challenges, not just financial during times of austerity but also the day-to-day practicalities of how to balance the aspirations around empowerment with the need to protect and safeguard individuals from risk and neglect.
Despite the ambitions set out in policy of shifting control from support provider to the person receiving support, such as through the introduction of personal budgets, the quality of support has been variable. Although there are case examples, there is little operational detail or a clear model for turning the ambitions set out in policy into delivery on the ground.
For the past three years I have worked with national learning disability charities where I have been immersed in the challenges facing people with learning disabilities and the people supporting them as they try to navigate the social care system, against the backdrop of the continuous squeeze on resources and increased demands accompanying new legislation and regulations. Yet I have also been inspired by the dedication and commitment in many support staff to make a difference. I have observed the interactions between support workers and the people they support and the positive impact on wellbeing when support workers build empowering relations that enable people to achieve their potential.
During my work, the interpersonal aspect of support and its impact on quality of life is striking. However, there is little research or analysis of the approaches frontline staff use in delivering support and the impact and effectiveness of these approaches.
Having secured funding from NIHR CLAHRC East of England for PhD research at the University of Cambridge, I will spend the next three years examining the role of the support worker in bridging the gap between policy aspirations and actual support on the ground for adults with a learning disability. I will be engaging with support workers and the people they support as well as decision-makers who influence social care policy and practice. My hope is that this research will help inform future social care policy and practice so that it enables more people with a learning disability to enjoy a better quality of life and wellbeing.
