By Bill Mumford | Guardian Professional
Compassion, respect and dignity are health and social care buzzwords, but are often expressed with such vagueness; it is assumed there is a common understanding about what they are. What's more, there appears to be little understanding of how to translate these values into action. The discussion of these values in national policy circles remains distant from reality. This can create an illusion of certainty or competence.
The recent scandals in health and social care tell us what is wrong; it is harder to know what is right. Even the judgment of the regulator, the Care Quality Commission, is being challenged: the Sunday Times quoted the owner of a care provider as saying:
"The CQC cared more about the temperature of his fridges than whether his staff were compassionate."
Yet there is a national movement for change. As a response to the inquiries into the neglect at Mid Staffs NHS and Winterbourne View, many of the reports, concordats and reviews have called for a review of how frontline health and social care staff are recruited, trained and supervised.
The Cavendish Review is the latest such piece of work. Launching the review, the health secretary, Jeremy Hunt, explained:
"We want everyone receiving treatment to get the most safe, effective and compassionate care. So we need to make sure that staff tasked with carrying out some of the most personal and fundamental jobs have the skills, values and behaviours needed to provide this."
Other important work includes the excellent joint Skills for Care and Skills for Health code of conduct, the National Skills Academy's new values-based recruitment tool, which will include the use of personality profiling for new applicants to frontline roles. These initiatives either help to define value-based behaviours, show how to recruit for those behaviours or show how to put a whole leadership system together to reinforce and sustain those behaviours.
Strip out the extraordinary, overbearing complexity of the health and social care sectors and the organisations within them and it is all about people – relationships and interactions between people. The core of good care and support is all about frontline workers and their engagement with individuals through their daily interactions.
Put simply, good interactions result in positive experiences for both individuals. It's what we all want. By working in a warm, attentive and engaged way, interactions will be good. The question is how do one's values impact on the likelihood of working in this way?
There are certain elements of our current care framework that undermine the movement for change: procurement and commissioning practices, for example, that reduce the workforce to a commodity to be bought, sold and deployed for the lowest price.
And there are care contracts being moved from one provider to another with almost total disregard to impact on relationships and workplace culture. I recently heard about the retendering of a longstanding contract from a fully compliant and trusted provider with a well-established track record of good care. The procurement process was a purely paper-based exercise, with no consultation with the people affected and, bizarrely, explicitly excluded consideration of past performance in its assessment. It was said that to take past performance (good or bad) into consideration would be unfair – to whom exactly?
In addition, there are other aspects that would help the movement for change, but are missing.
There is an important opportunity within the drafting of the care bill to place a formal duty of care on all workers to uphold a common standard of acceptable behaviour. This could include an obligation to incorporate the code of conduct, referred to above, in all job descriptions and be included in induction and training standards. The CQC has a regulatory duty to ensure that all people supported in regulated settings are treated with respect and dignity. This duty could be enhanced by adding a requirement on all employers and employees to satisfy some new standards of compliance with the code of conduct.
In terms of what else is missing, employers need to do more: there is no doubt that the financial squeeze and low wages are issues we face for the foreseeable future, but there is much that can and should be done to improve organisational culture and staff engagement.
The vast majority of people who come into care and nursing do so because they want to make a difference; they want to do a good job. Interacting well can be learned. Interactions can be broken down into specific behaviours – eye contact, smiling, listening. Each behaviour can be considered as a skill, and skills can be learned and developed.
So it is imperative that we effectively deliver the sometimes slippery concepts of compassion, dignity and respect. In our haste to chase these concepts, if we are not clear about how we put such values into action, and fail to spell out what they mean in reality, then all our good efforts will be ineffective.
We must stop assuming that there is an automatic understanding of how to transform value-based vocabulary into action. We need to start articulating the words at the heart of the value-based debate through our deeds. Only then will there be any real, lasting difference to the people we support.