Wednesday, 29 June 2011

Guest Blog from John Papworth, Senior Associate, CPEA: Rebirth or Stillbirth – Still Bedevilled

A decade ago SOLACE (Society of Local Authority Chief Executives) produced a document that looked at possible future scenarios for local government (Rebirth or Stillbirth?). It warned of an obsession with targets, processes, and inspections, which would result in the actual services experienced by the public being degraded, or worse not meeting its needs.

About a month ago I went to a care conference sponsored by Vanguard Consulting and the contributions from local authority guest speakers (both front line staff and managers) highlighted a number of key issues that bedevil both children’s and adult care services at the moment. The typical issues are:

• It is easier to give any service rather than what a client wants or needs. Staff are customer focused, but many current systems are not, and this is made worse by targets. For example a Midlands council discovered that when it checked 28 cases, 4 were new, and 24 were revisits of old cases, and they also discovered there is an alternative universe where staff are doing private deals to get things done and give the client what they want or need

• A tendency to try and “close” cases as soon as possible as it “reassures” managers, and ultimately politicians and the media, that things are alright

• There is simply too much information to process on a daily basis

• Too much work is failure demand (i.e. re-dealing with old cases, rather than new cases). And the system has too many stages in the process and hence is slow and fails to meet customer needs in a timely fashion. For example, a council set out the issues with its Disabled Facilities Grant system: preventable demand was 71% of the work and there were 291 steps to the grant process, of which only 20 were required

• The way to cope with failure demand to date has been to raise thresholds to make it more difficult to access services, ultimately leading to higher costs – as inevitably only the most difficult and expensive cases are handled. In other words, work focuses on crisis and not prevention

• Too much energy is spent on monitoring cases, and not solving problems

• The current situation is pre-occupied with assessment, which then unlocks care and treatment. This often results in people getting simple help too late, and particularly for the elderly, this means their quality of life deteriorates, and they then require more expensive interventions

• There is genuine confusion about the role and understanding of the skills the staff have. The current system asks them to carry out roles (e.g. IT based work) for which they are not trained professionally

All of which sounds terribly depressing and could confirm that SOLACE’s warnings were right, yet I believe there is considerable hope for the future.

Now we know the problems we can do something about it. I think there is now widespread acceptance that the top-down process and target-driven approach to running public services (usually steered from Whitehall), that has characterised the last 15 years or more, has not worked. If anything it has driven up costs, failed to deliver what people want and caused public service professionals much pain. There is a realisation that the public really do want services from high quality, highly trained professionals who spend time with them, rather than filling out forms or being on the end of a phone line. Consequently I think there is an increasing focus on the “front line” and what it is doing, rather than looking over the shoulder at inspectors and “the centre”. And services should be designed around the customer and led by inspired and motivated leaders, rather than designed around a target or process and driven by “back room” staff. As the ultimate test of any service (public or private) is that if the customer is happy and gets what s/he wants or needs, then that is all that should be delivered, not all the current “extra” paraphernalia that just gets in the way.

Tuesday, 21 June 2011

Guest Blog from Peter Evans: Children’s Home Leaders... United We Stand

In a week where public sector job cuts, pay freezes and pension changes has reached the tipping point of proposed strike action, Michael Gove seemingly ramped up the pressure on the poorest achieving primary and secondary schools. Yet beyond the headline grabbing threats to turn such schools into Academy status was an altogether different speech on educational reform, from which I found immediate resonance to the Residential Child Care Sector. There were two main focal points to deliver better schools: recognising the role, qualities and vision of leadership within the school and how schools can work together to share and develop best practice.

As a registered manager of a children’s home it is hardly surprising that I stand firm behind the mantra ‘a home is only as good as its manager’. I believe that understanding such rhetoric is a vital to fulfil my position of responsibility, particularly with regard to the leadership elements of our role. We set the tone, underpin the culture, share the vision, and continually drive the standards and practice to do the best we can for the children in our care. We are a role model for staff and children alike. The qualities we strive for from our staff teams we need ourselves in abundance – relationship skills, presence, personal drive, positive outlook, stickability and transparency. Often these aspects of registered manager’s role are disregarded or lost in our managerialist culture of systems establishment, monitoring, controlling risk, directing staff and measuring outcomes. I’m sure the latter focus strongly in the majority of our job descriptions and certainly did in my professional training.

Thankfully, the tide may be turning. Ofsted’s recently released ‘Outstanding Children’s Homes’ publication echoes the view expressed by Michael Gove of the importance of leadership, recognising the majority of the characteristics and qualities of good leaders that I outlined above. More importantly, potentially, it shares Gove’s second point for sector development and places the role of the leader at the heart of this. Its first recommendation is to ‘consider systematic ways in which the experience and skills of leaders in consistently outstanding children’s homes could be used to improve standards across the residential care sector.’ On the back of this is a challenge to find new ways to share best practice across the sector. I see this as a call to arms for passionate leaders; to realise that our responsibilities are not exclusive to the homes we manager or the organisations we work for. In times of increasing financial pressure, insecurity and vulnerability we need to work together to show the true value of residential child care and elevate its status. Also we need to help other’s to do the same – managers and staff teams alike. Yet when Mr Gove spoke from his platform at the National College for School Leadership I couldn’t help but think where is our platform? It’s time we started building.

Peter Evans
Group Organiser of the North West Residential Child Care Forum on the Residential Child Care Network.

Link/Reference
Outstanding Children’s Homes, Ofsted, 2011 available at www.ofsted.gov.uk/publications/100228

Thursday, 16 June 2011

Carers Direct

You know how it is on trains - snatches of conversations and mobile calls drifting across from neighbouring seats. Whatever - they were collecting souls - it was a comedy. He has an overactive thyroid - radiation therapy. There will be no trolley after York. Can you imagine if Graham was gay? You can't do that with the flexi. And then some trigger words make the ears go on alert - social worker.

I talked to the social worker. She had a good care package like and excellent carers. It was more the emotional stuff. She had already been to a counsellor - Relate and all. I says to her why don't you use the money to get something for yourself - with other women - Yoga or whatever. Disability or not you don't want to be stuck in the house do you?. It’s like bereavement - you know.

Good that social work is associated with assisting with emotional needs. Query - how well are social workers equipped to meet this expectation?

As they got off I noted they both carried Carers Direct bags

Sunday, 5 June 2011

Devils Workshop of Winterbourne View

A feature of the Winterbourne View, Castlebeck (Panorama) appalling saga that lingers most with me brings to mind the cliche that idle hands are the devils workshop. The programme left more than a suggestion that the staff behaved as they did because they had nothing better to do. Jim Mansell of the Tizard Centre effectively said this in his comments. That they made entertainment by provoking residents into responses that would justify 'restraint'. Escalation of verbal and physical goading amounting to torture leading to some sort of misguided sense of 'job done' by the shift. Is this what people do when they are bored at work - I don't think so?

This is what happens when management allow unsuitable persons to do the wrong tasks with inadequate training and leadership. Incidents of neglect or cruelty almost always occur in these circumstances as found by J.P. Martin in Hospitals in Trouble 1984. At the beginning of the book he quotes Sir Keith Joseph who said in 1971: 'I must tell you that one day somebody will write a book about the part that scandal has to play in procuring reform.' This is the book, and those who do not know the history it contains may be doomed to repeat it. Management at Castlebeck clearly did not know and thus the circumstances conspired to allow 'Wayne' and his cohort of approval seeking and bored bullies to perpetrate vicious abuse.

So let us be clear bored people are not bad people but they are susceptible to bad leaders. 'Wayne ' was characterised in the programme as typical of a long serving, unqualified and very 'strong' leader - the tattoos adding emphasis for the programme maker. What Winterbourne View, as a private hospital, was crying out for was professional leadership from a qualified and experienced manager (equivalent to the registered manager in a care or nursing home - are they exempt from Outcome 24 of the Essential Standards of Quality and Safety?) backed up by a vigilant and informed responsible person from Castlebeck - all reinforced by effective regulation from CQC. What did they get - disinterested charge nurses, organisation managers who seemed to think that if they had suspended staff when the whistle was first blown all would have been OK and a regulator that has been denuded of professional expertise.

Scandals like this in residential care are not about size of the home, they are not about private versus public care and they are not even about resources for training or better pay. They are about having the right professional leaders of social care practice at every level - care worker, (registered) manager, responsible person, commissioner and regulator. The residents of Winterbourne View suffered in the devils workshop because of a multiple failure of leadership at every level. Castlebeck need not pay Price Waterhouse Cooper to find that out when they can buy J.P. Martins book for £17.50.