Internal relationships and working practices

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Trustee make-up

“[We hope] to get more people with different skill sets involved in the running of the organisation itself and putting people, like financial people, legal people, administrative people into those roles on the trustees.” – Meeting Centre trustee

“You need those passionate people at the top, that are going to want to keep it going, and it’s quite draining of energy.” – Health care professional

Most organisations that run Meeting Centres have governance boards made up of individuals from diverse backgrounds, who oversee things. These individuals – often called trustees – can be crucial to a Meeting Centre’s ability to sustain.

Ideally trustees will include people with dementia and people who support them. Trustees will have a range of skills, experience and connections between them that they can use to support the Meeting Centre. These might include experience of running an organisation, managing finances or contacts in the care pathway. If there are gaps in their collective experience, there are not enough trustees or they do not have the time or capacity to apply their skills, then a Meeting Centre may struggle.

Recommendations:

Try to ensure the skills and experience of individuals on any governance board covers the full range necessary to support the functioning and sustainability of the Meeting Centre. Responsibility for different aspects of the Meeting Centre can then be distributed between board members. Where there are gaps, seek new board members.
Ensure the members of any trustee or governance board have the time and capacity to apply their skills and experience.

Personnel recruitment and practice

“It doesn’t matter what the space is, it’s the people that make it work or not, they influence how it works… We really have to look after the people who are running them.” – Arts practitioner working with Meeting Centres

“That strong team with everyone on the same page is critical… it’s the people, it’s the team, it’s the ethos, they are the key things.” – Meeting Centre staff member

“If you’ve got a lot of resources, in terms of strong volunteers, then you just keep going wow, we can do, we can do, we can do. But when it goes the opposite way then it’s harder and harder and you have to think about bringing extra people in.” – Meeting Centre staff member

“We are really lucky with the staff that we’ve got that, for their own individual reasons, they’re okay with this very uncertain future in their job.… the lack of certainty is not just a problem for the members and carers, it’s a problem for the organisation and staff recruitment as well.” – Meeting Centre staff member

Having a variety of skilled, motivated individuals with the right ethos and approach to run Meeting Centres is key to their quality and sustainability – whether that is managers, staff, volunteers or trustees.

Meeting Centres run in a challenging landscape. Without key, highly driven, individuals consistently putting in time and hard work, they would often not get started nor continue to run. Meeting Centres also often rely on the skills of one or two individuals to manage them day-to-day. This reliance on key individuals is a strength and a weakness. As long as those individuals are with the Meeting Centre and have capacity, it boosts their chances of sustaining. If they leave or become exhausted from the pressure, the Meeting Centre may be in trouble.

Running a Meeting Centre primarily with volunteers is possible, but risky. While it may seem more sustainable as staffing costs are low, it may be difficult to find volunteers willing to take on such responsibility. It will be hard to guarantee skills and experience, and unfair to demand long term commitment.

Recruiting and keeping skilled and experienced staff can be a problem if there is no long term job security. Larger organisations could potentially offer better job prospects. They may also have a wider reach in finding staff and volunteers, and more flexibility in deploying them.

It’s not just members who may have travel challenges getting to a Meeting Centre. Staff and volunteers may do too. When an organisation is running multiple Meeting Centres, sharing staff and volunteers between sites may seem an obvious way to work efficiently. However, this may not always be possible due to the travel involved, which can be an issue both in rural and urban areas.

Volunteers can come from various backgrounds, but often have experience of working in health and social care, or caring for a family member or friend. Carers of existing or previous members often go on to volunteer. People living with dementia with milder symptoms may also take on a volunteering role with some support. Whatever their background, it is important that volunteers feel welcome and valued if you want to retain them.

Recommendations:

Seek highly-motivated people to drive your Meeting Centre, but ensure responsibilities are spread between personnel and do not all fall upon one person.
If possible, employ skilled and experienced staff to run your Meeting Centre, but be clear about job security.
Consider partnering with a larger, outside organisation that might be able to help with staffing and job security.
If running multiple Meeting Centres consider sharing staff and volunteers between sites – but check with them that this will be possible.
Do not overburden volunteers with responsibilities and workload. Try to create a friendly, flexible working environment for them where they feel valued and rewarded for their time.
If appropriate, suggest to family carers, ex-carers, and people living with dementia who are active and willing, that they could consider a volunteering role.
Seek volunteers who have a background in supporting people with dementia or other care needs.

Person-centred and ability-focussed practice

“People are coming for different reasons and we need to meet those needs that they’re coming to us for… it has to be flexible enough to respond to those individual needs. Even within a group setting, and that’s a challenge.” – Meeting Centre staff member

“This is all about what the people want to do… they get to choose what they particate in. You know, if they don’t want to do something they don’t have to do it, there is no question.” – Meeting Centre staff member

“That’s what’s needed, both the time to think and to consult and say what are you interested in, you know… I think there’s some attempt made at doing that but it’s not as much as it should be.” – Meeting Centre staff member

“For me, personally, putting me off would be sometimes it feels quite formal, as we’re all sat around a table and we all have to follow the same theme… And there’s no other options available. There’s no other activities available.” – Family carer

A person-centred ethos is at the heart of Meeting Centres. By ‘person-centred’ we mean valuing people with dementia and those that care for them, treating them as individuals, paying attention to their perspective and creating a positive social environment for them. Person-centredness is central to a high quality experience that meets the needs of everyone.

In order to deliver high quality person-centred practice, Meeting Centres, their staff and volunteers need to have the capacity to do so. A lack of flexibility, staff time or consultation with members can mean provision is not as person-centred as it could be.

Recommendations:

Remember to consult with all members on what they would like to do and how you can meet their needs. Consultation is key to planning and delivering sessions.
Allow for a high degree of flexibility regarding the activities and plans for any given day. This means that changes can then be made in response people’s needs and preferences in the moment.

Mission drift

“Volunteers that have got a totally different mindset to a paid member of staff, that can be difficult. And obviously, some members of staff don’t always believe in the model that they’re working to either. So it has to be managed really tightly, I think… the initial training and everything, you know, should be on offer to everybody. But, that can be lost as well, because people just get so busy.” – Health care professional

“We tried very much, back in the day, to involve family members as much as we could, coming to the Meeting Centre, getting support from the Meeting Centre, helping to operate the Meeting Centre. I don’t know if that still happens now.” – Former Meeting Centre manager

“The Meeting Centre since COVID has changed in a way. Because we set out to be a Meeting Centre for people early diagnosed and now because there are people here that really should have moved on but there isn’t anywhere to go on to.” – Meeting Centre staff member

“I think the last six months we’ve been pretty at the beck and call of funding streams and it’s quite easy to get sucked down the route of well, this is what government want, so what can we do to tick that box to get their money?… Sometimes you feel it’s the tail that’s wagging the dog with funding, don’t you?” – Meeting Centre staff member

“I have a slight concern that some Meeting Centres are being pushed into a role which is not actually what the Meeting Centres were intended to be set up as.” – Meeting Centre trustee

“I would hate it to become a [respite] day care centre. And you could easily go down that road unfortunately.” – Meeting Centre trustee

Meeting Centres have a clear ethos, purpose and place in the dementia support pathway. That is to help people living with mild to moderate dementia and their families to adjust to change together. This is achieved via a social model of support that can connect people with their communities, while delivering stimulating and meaningful activities in a person-centred way. However, there are various pressures that may drive Meeting Centres to veer away from one or more of these elements.

Some areas of the health and social care system around Meeting Centres have different priorities and therefore might encourage something different to what Meeting Centres are designed to offer – for example, day care-stye respite provision for people with more advanced dementia. This can lead to unwanted or unintentional “mission drift”. Mission drift can also result from a lack of training and different agendas in staff and volunteers.

Recommendations:

Ensure that they are run as intended according to the Essential Features of a Meeting Centre booklet. Stay vigilant to unintended or undesired “mission drift”.
It is important for staff and volunteers to have Meeting Centre training. This helps them to understand the purpose and ethos of Meeting Centres, and ensure quality and consistency of delivery.

Suggestion for health and social care professionals:

Ensure that the Meeting Centre offer is clearly understood so that referrals, and the expectations your patients and service users, are appropriate.

Suggestion for potential commissioners or funders of Meeting Centres:

Ensure the Meeting Centre offer, and how it differs from other forms of dementia support, is clearly understood. You can then decide if this fits with your funding aims and objectives without having to change the Meeting Centre model.

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