Implementing Total Communication in Day-to-Day Care Delivery
Total communication is often described well in policy but inconsistently applied in practice. Within communication, accessible information and total communication, the real test is whether staff use multiple communication methods instinctively during routine support, rather than only during formal planning. This reflects whether services have truly embedded core principles and values into operational delivery.
Where total communication is superficial, people experience misunderstandings, increased distress and reduced autonomy. Where it is embedded, staff respond earlier to need, risks reduce, and outcomes become clearer.
What total communication looks like in real delivery
Total communication means using every appropriate method to understand and be understood. In daily practice this includes:
- Speech, tone and pacing
- Visual aids, symbols and written prompts
- Gestures, objects and demonstration
- Behavioural observation and interpretation
The emphasis is not on specialist tools, but on responsive, individualised interaction.
Operational example 1: embedding communication into personal care routines
Context: Staff reported frequent resistance during personal care, often escalating into behavioural incidents.
Support approach: The provider reviewed personal care routines through a communication lens. Visual sequences, choice boards and anticipatory prompts were introduced.
Day-to-day delivery detail: Staff used step-by-step visual prompts before each stage, checked understanding, and offered genuine choices. Supervisors observed practice and provided coaching rather than relying on written guidance.
Evidencing effectiveness: Incidents reduced, care tasks took less time, and daily notes showed fewer refusals and more positive engagement.
Operational example 2: communication-led support during distress
Context: A person experiencing distress would shout and push staff away. Behaviour support plans focused on control rather than understanding.
Support approach: Staff were trained to recognise early communication cues and respond using calm visuals, emotion symbols and reduced verbal input.
Day-to-day delivery detail: Distress responses were practised during team meetings. Staff logged which communication methods reduced escalation, and these were reviewed weekly by the manager.
Evidencing effectiveness: Episodes shortened, physical intervention reduced, and staff confidence increased. Governance reports showed reduced restrictive practice.
Operational example 3: supervision and competence assurance
Context: Managers assumed staff were “good communicators” but had no structured way to evidence competence.
Support approach: Communication competence became a supervision standard. Observed practice was mandatory.
Day-to-day delivery detail: Supervisors observed interactions, assessed use of individual communication methods, and provided targeted feedback. Learning needs informed training plans.
Evidencing effectiveness: Staff practice became more consistent, and inspection feedback highlighted confident, responsive communication.
Commissioner expectation
Commissioner expectation: Commissioners expect providers to demonstrate that communication approaches are consistently applied by all staff, not dependent on individual experience or confidence. Evidence should show impact on engagement, behaviour and outcomes.
Regulator expectation (CQC)
Regulator / Inspector expectation (CQC): The CQC will assess whether people are supported to communicate in ways that work for them throughout daily care. Inspectors will observe interactions and test staff understanding of individual communication needs.
Governance systems that sustain total communication
- Observed practice embedded in supervision
- Communication-specific audit prompts
- Incident reviews that consider communication failure
- Training linked directly to individual needs
Total communication becomes effective when it is lived in every interaction, not written into policy and forgotten.