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.