The BBC reported today on the experiences of two care workers, suggesting the ‘care industry’ is constrained by budgetary issues. All very interesting but probably not telling many in health and social care anything new, however, what I found fascinating was the taken for granted use of language in which care provision is conceptualised as part of an ‘industry’. Arguably, care is now perceived by government as a product, much like baked beans and ipads, only less regulated! Could the vision of care as a ‘product’ be part of the reason we keep going around in circles on this issue?
The industrialisation of care as a commodity to be bought and sold, and profited from, fully emerged under Margaret Thatcher and the community care reforms of the 1980’s and 1990’s. Such an approach is now so firmly embedded within the health and social care sector it is difficult for anyone to conceptualize care as anything other than a product where “value” is equated to cost rather than any sense of ethical practice or notions of compassion for one another.
Maybe it is time for a different approach.
Can we shift the emphasis on a ‘care industry’ to providing compassionate care?
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 in the ‘care industry’. 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 individuals 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 and who is providing it?
Firstly, 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.
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, a private care home or in a care agency.
My feeling is the care sector requires inspirational leadership. Arguably the “care industry” 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, I feel, 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, along with high quality support and training and descent pay and working conditions are central to turning the system around. However, already I hear the voices out there ‘how do we afford this’? Arguably we have to afford it if we really want change.
Where our vision of care does not extend beyond a discourse of free markets and cost, a strong philosophical, moral, and ethical framework maybe required to guide the provision of care. For care to become more than a commodity reform is required at a structural and individual level, founded on a new discourse that emphasises dignity over price, compassion over cost.
We are at a moment in history where society is questioning our whole economic system. Whilst it has brought much in terms of material resources for some, the cost at a moral, ethical and philosophical level in the “care industry” leaves a lot to be desired, maybe it is time to say care is too valuable to be classed as a commodity.