One of the changes promised by the Care
Quality Commission in their “Fresh Start” document published yesterday (http://www.cqc.org.uk/public/news/new-approach-inspecting-social-care-services)
was that they will be “checking providers who apply to be registered have the
right values and motives, as well as ability and experience.”
This could be challenging!
Whether we like it or not the bulk of social
care provision, at present, is delivered by companies, large and small (and
every size in between!) who are out to make a profit, because without
profitability the business will fail. Therefore private company that applies to
register a care service has, naturally, to have the right business values and
motives to be profitable in order to be able to deliver the care service.
This fact highlights one of the issues with
social care in England and why integration seems such a difficult thing to
achieve.
The word ‘silos’ is often used to describe
the way in which different parts of the care system are isolated but, in
reality, we should see them as different cultures and, as often happens with
cultures, the existence of that particular culture is built on difference
rather than commonality and those within a culture will defend the values and
motives that underpin that culture.
So at the front line of social care provision
we have providers who have to make money, even charities and not for profit
companies have to ensure their income in order to carry on their business, so
they have to exist in a ‘market’ culture where income must exceed (or at least
match) expenditure, their actual provision of care is limited by the monies
they receive, however good their values and motives are in terms of wanting to
care they are constrained by economics. There are over 12,000 registered care
providers and each one will have a different organisational culture based on
the values and motives of the company owners.
Another culture within the system are the
Local Authorities, 152 with social services responsibilities. Each on will have
their own ‘corporate’ identity, influenced by working practices, senior
leadership and, importantly, politics. All local authorities are over seen by elected
councillors and this, obviously, impacts on the organisational culture.
Somewhat like the EU, the heads of social services departments gather together
to discuss overarching policy but, again like the EU, these can be implemented
slightly differently in each council because of the values and motives of those
who lead the council.
Within the local authority system are other
elements that those who need care services also need to access, e.g. housing.
In many areas these are located within a different authority than the one
responsible for social care which, again, has its own particular organisational
culture.
Then there is the NHS, another completely different
organisational culture, founded on a basis totally different from care
providers and local authorities. Health services (either NHS or private) have
grown from medical science with a fairly rigid hierarchy of who is allowed to
do what and developed a clinical culture that is different from other fields of
work. The NHS itself is more fragmented now, which is why individual hospitals
or trusts have failed because of inadequate leadership, but the overall
structure is the same. In this realm we have the Royal Colleges which underpin
the professional expertise of those who work in health, and which elevate the
roles they undertake, all of this creates the values and motives of the NHS and
other health services.
The problem for those who need care services
is that all of these different cultures have different languages and practices,
all have different values and motives that underpin their roles.
Because different cultures defend their
identity through maintaining difference with other cultures, the integration
needed by those who need care services is hampered and will continuously be so
unless we develop a culture which recognises that the individual is more
important than any of the organisational cultures involved.
To achieve connected services for people who
need care services all involved need to recognise the commonalities in their
services and who they benefit the individual.
Before care providers can be judged on their
values and motives we need to establish what those values and motives are and
how they benefit the individual rather than imposing values and motives that
cannot be achieved at the ‘market’ end of the system and which, ultimately,
impact negatively on the care service provided.
