Ministers think Nicholson should stand aside, of course he should…..it’s about taking responsibility and being seen to take responsibility

Whilst Nicholsons retirement is announced The Telegraph reported earlier this year ministers secretly thought Nicholson should stand aside.  Of course he should have, does not government realise people in this country are actually terrified of going into hospital fearing for their lives, and rightly so it would seem.

I’m not calling for a witch hunt or scapegoating, but just plain old justice, justice for all those families that have been betrayed in the very worst way possible. They trusted the NHS to look after and care for their loved ones and the NHS betrayed them, broke that bond of trust and respect the public has had for the NHS. Once trust is gone from any relationship it’s a uphill struggle to get it back. I think it will take more than ‘re-organisation’.

The Francis Report is absolutely spot on in its findings and recommendations, however, if government wants the public to have trust again in the NHS we need to see leadership from the very top on this issue, not just talk of leadership but actual leadership, that means making those people who hold responsibility accountable. If that means senior figures losing their jobs, so be it. It’s a lot less drastic than losing a loved one afterall (forgive my tone, but I am angry this has dragged on for so long!).

I have worked in large public sector organisations over the last 25 years, indeed I left social work 8 years ago because of the state of the service, managers too focused on targets rather than people. Nothing appears to have changed. I would also hasten to add it’s not just in the public sector, lets not forget Winterbourne View and the myriad of cases in private residential care homes where carers have abused the most vulnerable.

The message being sent at the moment to the public, and potential whistleblowers, is that those at the top are untouchable, so don’t bother complaining or whistle blowing because those who have overall responsibility will be protected. Chief execs, board members ,leaders of public and private care provision across the country are breathing a sigh of relief, at least they know no matter how badly their organisation performs at least they will never lose their job!

This review apparently cost £13 million, this will only be money well spent if we see real change across the whole of the care sector, and in my opinion real change of culture will only occur if you change those at the top charged with leading the organisations that are charged with providing care to the most vulnerable in society. Is it realistic to expect the disempowered care assistant, nurse or porter who has raised concerns, and been ignored, to change an organisational culture? No, for real change we need change at the top.

Older people, abuse and mistreatment in health and social care: One year on………and still waiting for change

For many staying out of harm’s way is a matter of locking doors and windows and avoiding dangerous places, people and situations; however for some older people it is not quite so easy.  The threat of abuse is behind those closed doors, well hidden from public view and for those living in the midst of adult abuse violence and fear permeates many aspects of their lives, frequently perpetrated against them by those charged with providing their care.

My first blog was posted on the 27th February 2012 entitled “The elderly have fewer rights than animals“.  A week later another post followed entitled “Dignity in the care of older people“, and then “Have we reached the point of compassion fatigue when it comes to the abuse of older people?”, followed by “Hillcroft Nursing Home:Whilst for Cameron it’s about an ‘aspiration nation’ for older people it’s humiliation after humiliation“.  You may have noticed a theme developing here over the last year!

So one year on what has changed? Whilst many are working to improve the situation at a structural level not much it would seem, most recently we have had the Francis Report with the promise of more Francis type reports in the pipeline. It must be terrifying being an older person in need of care today.

Although government and society are increasingly aware of the abuse and maltreatment of older people in health and social care settings, it stills seems to persist.  The Government has identified the protection of adults at risk of harm as a key area requiring reform, recognising the current system is failing some older people. However, it is reluctant to intervene via the introduction of legislative reform, fearing this might compromise individual and family liberty to live lives free from state interference.  Instead, government is seeking to extend responsibility for protecting older people from abuse and maltreatment to the individuals and institutions that make up society, in effect “Big Society” (Independent: 2010), suggesting ‘people and communities have a part to play in preventing, recognizing and reporting neglect and abuse.  It is everyone’s responsibility to be vigilant whilst Government provides direction and leadership, ensuring the law is clear but not over intrusive’ (DoH, 2010, p.25).

However, is ‘Big Society’  (government, providers, professionals, you and I) able, and willing, to make the care and protection of  older people our business?

This is not a ‘happy anniversary’, how can it be when the abuse and mistreatment of older people still persists?  Many individuals and organisations are working to effect positive change, however, we need an  ‘active’ commitment from government to speed this process up. Change is required across society to improve the care of older people post Francis Report, the UK government also needs to look outside of  its political borders for new ideas on how to create an environment that transforms our care system  from one of abuse and mistreatment to one characterised by compassion and care.

I hope I will be writing something different for my second anniversary! 

How Feminine cultural values can develop compassion that endures in health & social care

Whilst change is required in the organisation and delivery of health and social care to prevent another ‘Francis Report’ Government must not see developing compassion in care as seperate from developing a culture of compassion across society

Whilst Ed Miliband eyes the delights of Swedens standard of living and David Cameron suggests Women have an important role in society and politics as leaders, evidence from Nordic countries suggests their model is worth giving serious consideration to the positive difference a more feminine culture might make in society. Could such an approach help develop a culture characterised by compassion for those most vulnerable in society, especially the elderly.  A form of compassion not learned from a manual, but enduring because it is ‘a way of being’.

There is clear evidence in the UK that poor levels of care, in both the private and public sector, is endemic in our care system.  Whilst the focus currently is on the leaders and professionals charged with developing and delivering care, wider society too has a role in ensuring compassion in care is the ‘norm’ and not the exception, as The Independent suggests

‘For a while we may pause to express outrage.  But we then move on to the urgent business of our daily lives. Spot checks and hit squads may arrest the worst practice…but they will not do much about a society that has hardened its heart against the elderly’

So how could we soften those hardened hearts?  Feminine values  in society play an important role in Nordic countries in shaping the culture of those countries.

Geert Hofstede cultural dimensions theory explores the impact a society’s culture has on the values of its members, and more importantly, how these values relate to individual behaviour, which in light of recent reports may offer lessons to us all on how we develop a culture of compassion that extends from society into hospitals and care homes.  One of the dimensions identified as important by Hofstede is the notion of masculinity vs. femininity, although the concept is not reduced to a male vs female dichotomy rather, this relates to communication and leadership styles underpinned by a particular culture.  Hofstede suggests masculine cultures place more emphasis on competitiveness, assertiveness, materialism, ambition and power, with success measured in terms of ‘winning’, i.e. meeting targets.  Whilst feminine cultures place more value on cooperation, consensus and caring relationships, where quality of life is the measure of success.  Sweden and Norway score highly as feminine societies.  This means valuing the ‘softer’ aspects of culture i.e. consensus and cooperation.

A culture of ‘masculinity’ arguably dominates government, and society in the UK, where ‘value’ is predominantly linked to ‘value for money’, unlike Nordic countries where values such as ‘equity’ and ‘cooperation’ are viewed as equally important.  This has been acheived by taking a whole systems approach to developing a balanced value base across society. This culture has been created by ensuring policy and legislation supports a broader understanding of ‘value’.

Arguably, the new Public Services (Social Value) Act 2012 is trying to ‘nudge’ public sector commissioners of care toward their ‘feminine’ side as  Patrick Butler of the Guardian suggests ‘the act requires public authorities to take into account social and environmental value when they choose between suppliers, rather than focusing solely on cost’.  The message appears to be: money is not everything!

For those not convinced, and who would argue money is everything, it’s worth considering the effect of Nordic policies on the competitiveness of their economy.  The Economist reports the World Economic Forum rate Sweden, Denmark, Finland and Norway as ‘top of the class’ as  well as being probably the best governed countries in the world.  How have they achieved this?  Well it is beyond the scope of this blog to explore this in detail, but it would appear they have somehow managed to successfully blend ‘big government’ with ‘big society’ without compromising either, and I wonder how much of this is to do with the active development of  ‘feminine’ cultural values where equity and egalitarianism over ride competition and choice.

A  previous blog looked at the potential lessons we could learn from Finland,  suggesting public sector provision may be improved if we change our focus from a  market/target driven culture in health and social care to one characterised by equity and responsibility.

The Nordic countries may not have all the answers, but they do provide an interesting alternative.  So interesting that Labour leader Ed Miliband has  visited Sweden to see for himself the Nordic model.  However, to learn from these would involve politicians moving away from addressing the problems identified in the care system in individual silos to taking an approach that focuses on a wider value base to develop a  compassionate society.

In Finland no targets = higher quality provision and attainment

Finlands education system is one of the best in the world, and it does not rely on tests, targets and league tables.  Could this show us a way forward across the public sector?

An interesting article  caught my eye a while ago and got me thinking about the’target’ culture that dominates the public sector.  Apparently Finland’s education system rejects targets and is the best in the world, although this has not always been the case.  Following failure in the 1970’s the whole system was reformed, and the reforms seemed to have worked, and even cost less than when the education system was failing.

Could we learn from this? So what did they do? Introduce additional tests, targets, performance indicators, outcomes, privatise the system to increase competition and consumer choice to drive up educational standards? Well, no, just the opposite really.

Firstly, there are no league tables in Finland, the main driver of education policy is a vision focused on ensuring all children have access to the same opportunities to learn in a good school, wherever the child lives and regardless of the childs economic background.  Cooperation between schools rather than competition underpins this ethos, as does a belief in the ability of individual schools to achieve this without centralised targets from government or regulation.

Teachers/academics are valued as professionals and as such are trusted to assess children in their classroom using independent tests they create themselves.  If they do not feel it is beneficial to the childs well-being they do not test the child. Inclusion in tests are determined by whether it positively affects the students learning, not whether it increases students scores or meets a performance indicator.

The bit that really caught my imaginaton when reading was when the interviewer asked about the accountability of the teachers and those who run the school. ‘Salberg shrugs. “There’s no word for accountability in Finnish” later on suggesting “Accountability is something that is left when responsibility has been subtracted” Whether this is true or not I do not know as I do not speak Finnish, however, it is an interesting notion that by acting responsibly accountability is not an issue.  In Finland teaching professionals are afforded prestige, decent pay, and a lot of responsibility, which they evidently fulfil with gusto.  So the question of ‘accountability’ seldom arises. If it does it is dealt with by the head locally. And believe it or not but all of this has been achieved by not privatising education, that’s right not privatising education.

There are no private schools in Finland, only a small number of independent schools exist in Finland but even these are publicly funded. None are allowed to charge fees, and there are no private universities either.  The focus in public sector provision of education is on equity and shared responsibility, not choice and competition.

Hmm can we learn anything from this? At present public trust and confidence in the public sector must be at an all time low, however, to regain trust we need to see real change, a change in direction that is new and imaginative.  One of Finlands key success factors has been a recognition that learning from past experiences can build a better future.  Can we do the same?

Post #Francis/Nicholson: We need leadership to develop compassion in care not blame

How do we put ‘compassion’ into the care system?

Firstly,  we do not know whether we have somehow ‘lost’ our compassion for others, or whether it has ever really existed.  However, we do know that over the past few years  ‘compassionate care’ is not something we can assume exists.   Whether the provider of care is from the public or private sector, we cannot take for granted that care will be provided with compassion, nor that patients will be treated with dignity and respect.

So how do we ensure ‘compassion’ becomes the ‘norm’ in the provision of care, regardless of the setting?

We need a change in approach from leaders across the sector, a change from a transactional style of leadership to one that is transformational. Transactional leadership is based on bureaucratic authority with an emphasis on task orientated goals. An organisation characterised by a transactional leadership fosters a management structure which leads to the development of a ‘defensive culture’ where members are expected to conform and follow rules without challenge.

However, transformational leadership is a process that motivates followers by appealing to higher ideals and moral values. Transformational leaders must be able to define and articulate a vision for their organisations, and the followers must accept the credibility of the leader. Organisations characterised by transformational leadership are more likely to have a ‘constructive culture’ where members experience constructive cultural norms, for example, organisations set challenging but realistic goals and manage in a participative manner where relationships are constructive and open so as to achieve agreed goals. This is not to suggest transactional management is not also required in some measure, however, the transactional approach seems to have carried greater emphasis across health and social care. This has been my experience working in the public sector.

Coming from a social care background my experience suggests a lot of the current problems across the health and social care system stems from poor leadership and management over the last 20 years. The introduction of performance indicators were meant to drive standards up, however, successive managers seem to think the purpose of an indicator is to meet the indicator! If the leadership and management of an organisation focuses on targets instead of care, that ethos frames every process within the organisation, leading to everyone no longer seeing the patient as a person, but a target to be met. Those who try and keep a patient focus soon find they cannot fight a system geared to targets alone.

An ethos of an organisation comes from the top, an ethic of care informing leadership and management practice would make a huge difference. You just have to think about the ethos of where you work to think about how it affects you in your day to day work. It’s no different on a hospital ward or in a private care home.

The care sector requires inspirational leadership.  Arguably the NHS is over managed and under led at present.  There is a difference between leadership and management, although, both are required, but leaders are central to how their managers perform.  When I think of  a ‘good’ leader I think of people like Gandhi or Lincoln, people who are humane, humble, who inspire you to engage, to strive to achieve change for the greater good.   They have a grand vision,  and  not a vision solely focused on targets and value for money, but higher values, such as compassion, dignity and respect is their motivation.  The type of values that are the foundation stones of a humane care system.

Another key factor involves ensuring the right people are in the workforce – we have to ask are we recruiting the right people into the care sector, whether as carers, leaders or managers?  Clearly there are many good carers/leaders/managers out there, but we need a lot more, however, this has to be based on suitability not availability.  On the ‘frontline’  care providers, whether public or private, have had real difficulty in attracting people into the workforce. This is not surprising when you consider how government and wider society not only undervalue such jobs, but also those being cared for, with the vulnerable being marginalised in society for being, well, vulnerable and in need of care!

Caring for people is a demanding, and rewarding job, but, carries little status and is seen as something ‘anyone’ can do.  Believe me it is not. From my professional experience I’d say the best front line carers are those who have a deeply ingrained respect for others, and who genuinely like people.  This is not something that can be taught, but they are the characteristics required to develop a professional, and caring, workforce.  Recruitment of the right people is central to turning the system around.

Our current system of care provision leave many  people mistreated and without support.  Arguably where leadership is insufficient or weak, a strong philosophical, moral, and ethical framework maybe required to guide the workforce in meeting any responsibility to ensure vulnerable people are not mistreated.  Where both are weak those most vulnerable will continue to suffer.

Ministers privately think Nicholson should stand aside; of course he should it’s about showing there are consequences when you fail to take repsonsibility

The Telegraph reports ministers secretly think Nicholson should stand aside.  Of course he should, does not government realise people in this country are actually terrified of going into hospital fearing for their lives, and rightly so it would seem.

I’m not calling for a witch hunt or scapegoating, but just plain old justice, justice for all those families that have been betrayed in the very worst way possible. They trusted the NHS to look after and care for their loved ones and the NHS betrayed them, broke that bond of trust and respect the public has had for the NHS. Once trust is gone from any relationship it’s a uphill struggle to get it back. I think it will take more than ‘re-organisation’.

The Francis Report is absolutely spot on in its findings and recommendations, however, if government wants the public to have trust again in the NHS we need to see leadership from the very top on this issue, not just talk of leadership but actual leadership, that means making those people who hold responsibility accountable. If that means senior figures losing their jobs, so be it. It’s a lot less drastic than losing a loved one afterall (forgive my tone, but I am angry!).

I have worked in large public sector organisations over the last 25 years, indeed I left social work 8 years ago because of the state of the service, managers too focused on targets rather than people. Nothing appears to have changed. I would also hasten to add it’s not just in the public sector, lets not forget Winterbourne View and the myriad of cases in private residential care homes where carers have abused the most vulnerable.

The message being sent at the moment to the public, and potential whistleblowers, is that those at the top are untouchable, so don’t bother complaining or whistle blowing because those who have overall responsibility will be protected. Chief execs, board members ,leaders of public and private care provision across the country are breathing a sigh of relief, at least they know no matter how badly their organisation performs at least they will never lose their job!

This review apparently cost £13 million, this will only be money well spent if we see real change across the whole of the care sector, and in my opinion real change of culture will only occur if you change those at the top charged with leading the organisations that are charged with providing care to the most vulnerable in society. Is it realistic to expect the disempowered care assistant, nurse or porter who has raised concerns, and been ignored, to change an organisational culture? No, for real change we need change at the top.

Mixed race adoptions …..does Mr Gove have a point?

As a Guardian/Observer reading ex social worker it pains me to even type this, let alone say it out aloud….but, could Mr Gove have a point?

This is an area of personal interest to me as someone who was adopted in the 1960’s and who is of mixed race, although not obviously so. My birth mother is Anglo Indian but I am ‘white’ in appearance. The Observer discusses recent research published by the British Association for Adoption and Fostering, which examined the experiences of children who had been adopted in the 1960‘s from Hong Kong. The report suggests racial and cultural differences can have a significantly negative impact on children from ethnic minorities when adopted by white families. Many of the feelings the adoptees reported I too have felt, especially feelings of not belonging and difference within their adoptive families and wider communities. I too experienced such feelings even though we were an all ‘white’ family. This suggests, to me, that whilst ethnicity is an important factor, it is not the only factor that needs to be borne in mine when selecting potential adoptive parents and matching them to adoptees, hence the need for a rigorous screening process undertaken professionally.

For me it boils down to an adoptive parents ability to demonstrate unconditional love and acceptance of difference, whatever those ‘differences’ might be.

However, there is a bigger picture here that needs to be addressed because being ‘different’ is not the problem, being accepted is the problem. It is the way others react to such differences that causes problems. The way some in wider society perceive, and treat, individuals from minority ethnic groups is the problem because

“ We are all apt to believe what the world believes about us” (George Eliot)

If the world of the child tells them there is something wrong with them, they are apt to believe there is something wrong with them!

So do the Tories have a point? This report is written about children adopted in the 1960’s when our cultural values and ‘norms’ were very different, and of course much has changed in respect of discrimination and ethnicity, although not thanks to Tory governments in my opinion. However, this is not really about the colour of adoptive parents skin is it. It is about the values of society, about societies inability to accept ‘difference’ , whether that might be due to ethnicity, sexuality or a multitude of other things that might not conform to the ‘norm’, and of course the ‘norm’ is reinforced by policy and legislation handed down by government.

Maybe the Tory government should focus on ridding society of it’s intolerance to difference first, before blaming social workers. Whilst not a perfect profession Mr Gove, maybe it is because social workers are already aware of the reports findings that the adoption process for children from ethnic minority groups is slower.

There is much more to this issue to be considered, maybe Mr Gove needs to listen more closely to those working in the system on a day to day basis, rather than base his reform of adoption services on his personal experience. It is good to have a personal perspective, but please do not let this get in the way of getting reform right.

Phew back on safe Guardian/Observer reading ex social worker ground now, thank goodness. If you would like to read about my experience of adoption and the search for my birth mother please click here for a free short ibook.