What are the 6Cs in Care?

The 6Cs – care, compassion, courage, communication, commitment and competence – are the central set of values of the Compassion in Practice strategy, which was drawn up by NHS England Chief Nursing Officer Jane Cummings and launched in December 2012. These values and their associated behaviours underpin the high-quality care delivered by nurses, midwives and care staff.

However, putting them together in this way to define a vision is an opportunity to reinforce the enduring values and beliefs that underpin care wherever it takes place.

It gives us an easily understood and consistent way to explain our values as professionals and care staff and to hold ourselves to account for the care and services that we provide.”

The purpose of the 6Cs is to ensure people are looked after with care and compassion, by professionals who are competent, communicate well, have the courage to make changes that improve care and can deliver the best, and commit to delivering this all day, every day (NHS 6Cs England, 2012).

The 6Cs are all equally important and are essential to providing high-quality, compassionate care.

There are currently approximately 5.8 million people working in the Care sector. The Compassion in Practice strategy and the 6Cs apply to every care and support setting including:

• Care homes.
• Clinics.
• Community services.
• Dental surgeries.
• Doctors/GPs surgeries.
• Hospitals.
• Mental health services.
• Services in the home.
• Ambulances.
• Homecare agencies.
• Hospices.
• Phone/online advice.
• Prison healthcare.

And to all workers and volunteers within these care and support settings, for example:

• Carers.
• Disability support workers.
• Home care workers.
• Attendant care workers.
• Personal care workers/assistants.
• Volunteer carers.
• Occupational therapists.
• Community support and outreach workers.
• Doctors, GPs.
• Nurses.
• Dentists.
• Hygienists.
• Paramedics.

But what are the 6Cs and what do they mean in practice? Compassion in Practice defined the 6Cs as:

Care

“Care is our core business and that of our organisations and the care we deliver helps the individual person and improves the health of the whole community. Caring defines us and our work. People receiving care expect it to be right for them, consistently, throughout every stage of their life.”

This means that the prevention, early intervention and health promotion are as important as the treatment of ill health. It entails ensuring that people get both a positive experience and the best possible outcomes from care.

To make this happen has involved working across health and care boundaries to provide support and services which enable people to remain active, connected and independent in their own homes, or another place of their choice, for as long as they are able, and it means joining up health and care services to provide the integrated care that people want.

Care staff in the care sector have been central to achieving high-quality care for some of the most vulnerable people. People’s need for care and support is changing – and the provision of care is changing too. Demand for services for long-term care and support into very old age will grow and there is clear need to support people to stay as well as possible for as many of those years as possible. The 6Cs has caused care providers to think about health and care in new ways and deliver integrated services to people, families and communities. What people who use services want is a seamless high-quality service where people on the ground work well together in spite of different structures and systems.

Compassion

“Compassion is how care is given through relationships based on empathy, respect and dignity – it can also be described as intelligent kindness, and is central to how people perceive their care.”

The quality of care given is as important as the quality of the treatment. People receiving care want to be treated kindly, with respect and dignity. The don’t want to have to keep repeating their story and their details to every caregiver they meet with; they want to be listened to and to be heard. This means understanding individual needs, showing empathy and sensitivity and providing care that respects people’s diversity, dignity and individuality.

Demonstrating compassion also involves ensuring people are partners in their own care, and are at the heart of the decision-making process. People want their feedback and views to be listened to and acted upon, they want services to be designed to enable them to be involved in their care.

Some practical actions that those involved in providing care can take to ensure they are creating a compassionate environment include:

• Actively listening to recipients of care, their families and others involved in their care.
• Giving, inviting, affirming and learning from feedback.
• Collaborating across professional boundaries to ensure people receive quality care.
• Inter-professional/organisational working.
• Being mindful of behaviours that get in the way of human-to-human connection.
• Celebrating and sharing information, data, what works well, best practice.

Competence

“Competence means all those in caring roles must have the ability to understand an individual’s health and social needs and the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence.”

This begins with recruitment. The description of the 6Cs is a useful tool for recruiting into roles at all levels within the care sector – from senior management to frontline workers. They can be used to assess the values people are bringing to the role and are being included in person specifications and competency-based interview questions.

The 6Cs are also mapped across many care qualifications and leadership frameworks with the aim of empowering staff at all levels to work to improve the experience and outcomes of the people using their services. The 6Cs are being used as key competencies in performance management ensuring good practice is recognised and areas for development identified and supported.

Everyone in the care sector has a responsibility to reflect on their competence and practice and to maintain their CPD to ensure they are at the top of their game providing high-quality care.

Communication

“Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say and do and essential for ‘no decision about me without me’. Communication is the key to a good workplace with benefits for those in our care and staff alike.”

Frontline care staff are at the heart of the communication process as they assess, report and record the care and treatment of those in their care. They need to ensure that they are handling information sensitively and confidentially, actively listening to what they are being told by those they are caring for, co-workers, managers and other agencies and accurately passing on information where and when required. Detailed record-keeping is also crucial to ensure that care and treatment is co-ordinated and that others are made aware of any necessary information they need.

Communication involves a number of other skills that caregivers will need to use in providing high-quality care such as the skills involved in, for example, customer care, establishing needs or dealing effectively with complaints, and team working, working effectively with both internal co-workers and external agencies.

Courage

“Courage enables us to do the right thing for the people we care for, to speak up when we have concerns and to have the personal strength and vision to innovate and to embrace new ways of working.”

Working in the care sector is such a responsible occupation; care workers take responsibility for the care that they provide, for the safety of those in their care and for making judgement calls that affect others.

Amongst those judgement calls is having the courage to speak up when you notice that something could be done in a more effective way to improve the care you provide.

The 6Cs were designed to empower all staff to contribute to improvements in care and that includes “whistleblowing” when something is wrong, crucially if you have concerns over ill-treatment, abuse or bad practice. Care workers may find this uncomfortable, however, they need to move past this, to be honest and brave in order for change to happen.

Commitment

“A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients, to take action to make this vision and strategy a reality for all and meet the health, care and support challenges ahead.”

The commitment element of the 6Cs is not only the dedication to the role continually demonstrated by carers, but also a commitment to developing their own skills and knowledge, to sharing knowledge, to working effectively across all sector boundaries, to challenge malpractice or negative and discriminatory behaviours in order to continually improve the quality of care provided. It is also a commitment to embracing the 6Cs and embedding them into their everyday practice.

Case studies of the 6Cs in action

An elderly patient at Wrightington Hospital told the Quality and Safety Matron that her care was excellent, but also felt confident enough to say when it wasn’t. Whilst the patient felt her care was excellent, she confided that she missed home and family.

A nurse who was caring for her decided to pin a collection of photos to the wall. This simple act of compassion helped to boost the patient’s mood whenever she was feeling down. A good patient experience leads to a better recovery and in this case meant getting the patient home to her loving husband and family as soon as possible.

Croydon Health Services have done lots of things to improve the patient experience, including running a new weekly series in the internal e-newsletter for staff called: “What have you done today to improve care and patient experience?”

It’s just one way of improving staff engagement to create a culture of shared learning and good news stories. One nurse helped an anxious patient prepare for a colonoscopy by helping with her feelings of vulnerability about the gown and underwear she was given.

By talking to her at eye level, introducing herself and then helping the patient feel securely covered up, she helped the patient feel prepared. Maintaining a patient’s dignity is such a simple thing to do, and can change a patient’s experience in an instant.

By sharing examples of good news stories like this with the whole staff, the team can prove that they are listening to patients and demonstrating the 6Cs in their day-to-day tasks.

Sussex Partnership Foundation Trust is working with the Against Violence and Abuse Stella Project (a leading UK agency addressing the overlapping issues of substance use, poor mental health and domestic and sexual violence.) to help all staff ‘be aware of and respond to domestic and sexual abuse’.

The Stella Project spends two days a week with the Trust sharing expertise, which is then shared across the Trust through education and training. This helps to increase compassion and competence in all staff by ensuring practice is evidence based.

Up to 15 days training is provided to frontline services, to work with both survivors and perpetrators of domestic and sexual violence, as well as train-the-trainer training and development of a domestic and sexual violence competency framework to inform long-term workforce development.

There are also plans for mentor team managers and senior practitioners to become domestic and sexual violence champions. The project aims to achieve whole organisational change which makes sure staff feel confident, competent and knowledgeable enough to ask about domestic and sexual violence, and to make appropriate responses and referrals.

North Derbyshire Clinical Commissioning Group (NDCCG) is working with patients, acute and community providers, primary care, social care and the voluntary sector to make sure people are only admitted to hospital if it is absolutely necessary.

This includes a redesign of the urgent care pathway, an integrated model of care, and a greater focus on patient-centred care within commissioning. An acute reablement unit was created to make sure people are only admitted to an acute medical ward when absolutely necessary and when it’s in their best interests, with the most important place being home.

The changes to the care pathway, the commitment of the staff and the support of commissioners has enabled boundaries to be broken down, making sure that the right care is delivered in the right place at the right time.

Patients report how they have been supported to meet their personal goals and how staff, in demonstrating 6Cs values, are improving patients’ experience of care. This has included simple things which matter to patients – for example seeing a friendly face they know and trust, who has managed their care in both the acute and community environment, enabling a safe discharge back home.