Thursday, 7 February 2013

The Culture of Culture Blame

            Many of the failings of Mid Staffordshire NHS trust were blamed on the culture within the service, similarly the abuse at Winterbourne View saw the culture word used to describe how and why abuse was allowed to happen. Blame on ‘culture’ is not limited to health and social care. The rail franchise fiasco last year was blamed on a culture of fear, and the banking crisis which sparked the current financial crisis is often blamed on the culture within those institutions.

            Yet does blaming the culture in an organisation really solve the issue and what does it really mean?

            The culture within an organisation is the result of the leadership, or lack of, and the way those in the organisation react to that leadership. What ensues is a group mentality that becomes self-perpetuating and, if it goes unchecked, something that descends to the lowest possible denominator and is often directed by dominance rather than leadership. Once embroiled within the group mentality it is far easier for members to dismiss personal responsibility and place all responsibility on the culture within the organisation.

            It also makes it harder to challenge the group mentality. People fear being ostracised by colleagues, fear they may lose their job or, in extreme circumstances, fear particularly dominant individuals. Those who believe that something is wrong but fear to speak up eventually feel they have become complicate in the wrong doing, “I will be blamed because I did not speak up earlier”. Others will just ignore what they believe is wrong and reconcile it in their own minds by saying to themselves “that is just the way it is done here”.

            The real blame is not on the culture of the organisation but on the leadership of the organisation and the lack of responsibility and accountability throughout the organisation. People in such cultures prefer to pass the buck about failings, blaming others or the policy framework they have to work in or, indeed, the culture of the organisation rather than being prepared to stand up and say I got this wrong. Those who set the tone for the organisational culture, including those in Westminster, must start to take responsibility for the organisations under their control, they must encourage accountability and they must ensure the culture of responsibility and accountability reaches right down through the organisation.

            In social care we must be aware of and ward against the possibility of a lack of responsibility and accountability and promote effective leadership.

            For example, multi-disciplinary working is common place now but we often hear of ineffectiveness because of people working ‘in silos’ (a jargon term I don’t really like) and the danger is everyone trying to work together defers leadership and responsibility to other agencies with the result nothing gets achieved and the only person to lose out is the person who needs joined up services.

            Effective leadership, responsibility and accountability are the best ways to promote good practice and if we are to provide the best possible care services they are the things that need to be at the top of the Health & Social Care agenda.

Wednesday, 6 February 2013

Radically Rethinking Social Care Policy

Naturally many people who need social care services also need health services, but not all of them. Increasingly many may also need housing services, welfare and benefit support or employment support. Obviously for many transportation support is also an issue and we must not completely forget that most social care services are delivered in communities through local government.

For those who need social care support the range of support they need is a combination of many services all delivered by different sectors of local and national Government.

Unfortunately when we hear talk of integrated services the focus is on the link between health and social care.

Hardly a surprise considering that social care is currently under the remit of the Department of Health and the current focus on integrated services has largely been led by the responses to various reports that have highlighted the frankly appalling treatment of social care users in both health and social care settings.

The latest proposal from the Labour Party is to push social care under the immediate remit of the NHS but this fails to take into account individual need as not all social care users need health services and those that do only need health as a part of their overall package.

Unfortunately the proposal is firmly and unequivocally stuck in the current mindset of thinking where social care is subservient to all other services as reflected in its placement within the Department of Health.

Like it or not social care is not a minor area public policy any more. The rapidly ageing population means that social care is ever more important in our society and the services many need are of greater importance that such services 40 or 50 years ago. Those with disabilities are also living longer and those on top of the service delivery chain need to recognise the changing needs of all people who need care and support as they age. They also need to consider the younger population who need care and support from society, including employment and benefit support.

Essentially the primary service is now social care and all other services should be integrated with it for the benefit of every individual who needs social care services. It should also be focused on those who care for those who need social care services, whether or not they are entitled to funded social care support.

It is essential we radically and thoroughly rethink social care and recognise its importance in society today. Naturally this will be difficult, creating change in a firmly entrenched system is not easy but if we are to create a society that truly provides the best care and support then we must try. The first challenge is to put social care first, to completely and swiftly change the outdated mindset that currently exists.

Millions of people need social care services, not all get them funded but that does not mean they should be excluded from social care policy, more than a million people work in social care and how they perform and are managed has an impact on the lives of millions and the workforce must have effective policy in place to ensure high quality care and effective management. Billions of pounds are spent on social care every year and there must be proper leadership nationally to ensure that money is spent effectively for the benefit of those who use care and support services.

There is, undoubtedly, a need now to change the way we think about social care, a need now to radically change how social care policy is created and, probably, most importantly a need to place social care on top of, or alongside, other major areas of social policy which impact on the lives of social care users.