Last month’s health ombudsman’s report revealed how the NHS has the potential to fall dramatically short of its values and commitments when the principles of care are forgotten. Leadership needs to step in now, suggests Gemma Pearson, to create a culture of care that will ensure repeat incidents are avoided.
The NHS has come under severe criticism in a report released by the health service ombudsman. Highlighting ten cases of deplorable treatment of older people in the care of NHS staff, Ann Abraham’s report is a shocking revelation of how the NHS has, on many occasions, fallen dramatically short of its values and commitments.
Some of the indignities older patients have suffered: one was left lying in their soiled clothes, another allowed to die alone while their spouse sat forgotten in a nearby waiting room. One patient was so dehydrated he was unable to speak while another was not bathed or showered once during a 13-week stay in hospital.
Describing these experiences as neither exceptional nor isolated, Ms Abraham points to “an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism.”
For Ms Abraham, this is an issue of culture, not cost. Even if this “attitude” is not shared by all NHS staff, tolerating a lack of respect and compassion for the most vulnerable in our society allows this appalling behaviour to pervade the quality of care the public can expect.
This is where leadership needs to step in. Research into outstanding leadership in the social care sector conducted by The Work Foundation for the National Skills Academy for Social Care highlights the instrumental role leaders play in creating a culture of care and compassion.
The report suggests NHS leadership might benefit from looking to exemplary leaders in its sister service for an alternative approach to delivering care.
It starts with a vision that is centred around delivering a quality of care that is unique to every service user, depending on their health and wellbeing needs. One care home owner describes the attention to detail they give to the sensitive issue of end-of-life care:
“Our home is driven by their needs so that it feels like their home, so things like end of life care, we know with our residents that if they got to a stage where we’re talking about end of life care which could be days or perhaps a month, we know what sort of music [they want], if they want music in their room, or what flowers because we’ve gone through that at a time when they were well and could make informed decisions.”
It’s not enough to be clear on the vision; outstanding leadership also requires the ability to convey passion for the vision and purpose and to help others emotionally connect to it. Most people sign up for a career in care out of a personal desire to help others improve their health and wellbeing. Leadership needs to keep that spirit alive, no matter how difficult it can get.
“What I set out to be is to be passionate. Passion is really important to me because I think there’s nothing worse than somebody in [a position of] leadership and clearly not caring about it, so if I didn’t care about it I would have to stop doing it … I think it’s important, particularly as the nature of what we do as an organisation is emotional stuff and there’s a lot of emotion in the organisation and I think that has to be acknowledged and recognised.”
The leaders in this study have high expectations of their carers and make it explicitly clear what standards they need to achieve. Of course the care standards, as laid out by the CQC, are important but for these leaders they provide the absolute minimum. How they differentiate their care service from others is through a focus on, and investment in, relationship.
“Is our product day care, is it domiciliary care, is it nursing, what’s our product? We believe, and I believe, that our product is relationship. Without relationship those things are empty, they’re meaningless. So if we’re selling relationship that tells us where we need to put our investment.”
This requires attracting carers to the role who take joy from developing relationships and for whom providing a personal service is a perk to the job, not a distraction.
Leaders have a role in enabling their staff to give quality care. This means giving them the time and space to devote to their patients/residents as well as recognising their efforts when they do:
“The way in which it works really is that [the care manager] is the expert on delivering the care, so I try and keep as much of the dross away from her with regard to health and safety legislation. Obviously she needs to know about it but not to be involved in administering it, and that frees her up to concentrate on what she’s best at which is delivering the care to our residents.”
“When I walk through the home … [I am] acknowledging everybody, saying hi to everybody, asking how they are, knowing a little bit about them, how they’re getting on with their job, are they finding anything difficult, and not watching them but acknowledging everybody and what they do. Trying to notice things, whether it’s noticing that someone’s had a hair cut to noticing that actually they’ve just really cleaned the stairs very well or the patient it looking absolutely fantastic today. Going and sitting in the dining room and eating lunch with them, so being visible, being around and noticing what people do.”
Finally, creating a culture of care means starting with the people closest to you. As Gandhi so eloquently put it: “be the change you wish to see in the world”. A question to leaders within care services of all kinds is how cared for and respected do your staff feel? Those who work in the caring professions have the same basic human needs too; for respect, dignity at work and compassion in what can be an emotionally, mentally, physically challenging yet rewarding role.
One leader is keenly aware of this and is taking steps to put in place a structured but informal sharing forum where staff can talk about the emotional aspects of their work.
“What I’ve seen in our sector is a lot of carers moving on. And I think one of the reasons they do that is that after a number of years in a place seeing so many people they love die, a change is as good as a rest. And actually we don’t allow people the space to emote. So circle time, pow wow, whatever it is, whatever we do, whatever we choose to call it, is absolutely not a staff management committee … It’s about saying what’s in your heart and having somebody there that can hold everybody safe and do difficult stuff too.”
The health ombudsman acknowledged there are many NHS professionals who deliver a fantastic service, but there are far too many instances where the principles of care and compassion have been abandoned – and those are just the families who felt strong enough about the ill-treatment to complain.
The examples of outstanding leadership featured in the social care report suggest leadership in the NHS needs to orient staff back towards purpose and values; it needs to recognise and celebrate quality care provision and make it clear inappropriate behaviour will not be tolerated; and it needs to reignite a passion for care, that is demonstrated in the actions, behaviours and attitudes of every member of staff at all times.
Gemma Pearson is co-author of Outstanding Leadership in Social Care and Learning and Living the Principles of Outstanding Leadership