Improving NHS care is about more than leadership and management, it’s also about values…..

As Mr Hunt attended the King’s Fund annual NHS Leadership and Management Summit I wonder if discussion focused on the ‘values’ that will shape our future health and social care system?

There is clear evidence that many older people receive good quality care provision in both the private and public sector, however, sadly poor levels of care is also a feature of 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?

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. compassion,consensus and cooperation. The focus from this perspective does not suggest one set of values is superior to another, rather that both are of equal importance to society, both should be viewed as of significant value in society. The suggestion is the embedding of both of these perspectives in a more balanced manner could provide the conditions to support the change so many would like to see in our care system.

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 achieved by taking a whole systems approach to developing a balanced value base across society. 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 are viewed as equally as important as competition and choice.

My 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 recently 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.

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About digalpin

I gained my social work qualification from the University of Southampton and worked for 14 years in mental health, disability and older people services. I am currently a senior lecturer in post-qualifying social work at Bournemouth University and am conducting research on government and societal attitudes and responses to the mistreatment of older people in health and social care provision for my doctorate. My views are my own.

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