Is there a law that says if you’re a senior manager you must always look on the bright side? You would have thought even the most optimistic of those working in health and social care would have found little scope for positive messages lately. So I was surprised at the relentless optimism from the leaders children and adult services coming from their recent conference.
‘Why this relentless optimism in the face of the experience of the last five years?’
Directors are keen to tell us things have never been so tough and we believe them, what with rising demand, increased expectations and budgets that will in many cases have been cut by 50 per cent by the next election. So why are leaders of children’s and adult’s services using the government’s language of austerity − the lines about necessity being the mother of invention and that every budget cut is a challenge but also an opportunity.
Why persist in the rhetoric that cuts forces us to be inventive; we need to be more efficient (code for pay cuts and lower staffing levels); financial pressure will break down historic silos between health and social care, between children and adults services and between the public sector and the private sector; and that no longer being able to afford services will result in us coming up with new better services?
Pragmatism or optimism?
Why this relentless optimism in the face of the experience of the last five years?
First, I think they would call it pragmatism rather than optimism: “Yes it’s tough but we will find a way through.” I suspect their speeches weren’t aimed at the social workers, care staff or nurses back home or their fellow directors in the audience but their political masters: “You can trust us to get the job done”. This is the approach directors take with cabinet members in local government and chief executives in the NHS do the same thing with their boards.
‘Looking on the bright side, there may be someone else making the conference speeches next year’
What would happen if instead of sticking to the senior management script the director told it how it was? What do you thing would happen to a director of children’s services who told the board that as a result of year on year cuts services were no longer safe? What if the director of nursing told the board budget cuts, a ban on over time and the use of agency staff meant that staffing levels particularly at the weekends was dangerously low? Would they be applauded for their honesty or would the chair turn to the chief executive and demand to know how they had let this situation happen? Would the board care to make a decision on staying within budget but further eroding standards of care or would they be prepared to have wards fully staffed and go over budget?
More cuts planned
Isn’t this the real reason the government won’t adopt minimum staffing levels because to do so would have budget implications they would be forced to recognise? To hold on to your job as a senior manager you need to reassure the board that you can find ways to stay within budget, maintain care standards and hit performance targets. This will at times involve the ability to simultaneously hold two contradictory opinions.
This explains how social service leaders at their conference could say that the growing budget trend of combining children and adult services under one director provided opportunities just as they previously said the splitting up of social service departments into children’s and adult service provided opportunities.
It also explains how they can believe that the changes forced on them by budget cuts can result in better services whilst reading inspection reports that confirm cuts have made services less able to safeguard children and adults, services are of a poorer quality and are available to fewer people. The situation can only get worse as further budget cuts are planned.
Looking on the bright side, there may be someone else making the conference speeches next year.