Leadership and Management in Social Care – Some thoughts

The interplay between management and leadership is one that has been milling around in my mind for a while but in the light of the next ‘Twitter Debate’ by SWSCmedia on 1st November (8pm GMT) and the opinion piece written on that same site about Leadership in Social Work I thought it would be a good opportunity to crystallise some of my thoughts on the topic as sometimes 140 characters just isn’t enough.

As an introduction, the piece above is fantastic. I will state very clearly that I am neither a manager nor a leader and am not desperately keen to identify myself as either.

I asked on Twitter for responses to the question about the differences between Management and Leadership in Social Care because I had been concerned that all too often the two have been intertwined in  unhelpful ways.

The responses tended along the lines of ‘Managers Do and Leaders See’.
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This Not So Big Society in Mentalists

This Week in Mentalists is a weekly digest of the best of mental health blogging. It was originally started on the now-defunct Mental Nurse website, but is now on its own dedicated blog.

Each week a different blogger takes it in turns to compile an edition. This week’s edition is by….oh wait, it’s me!

Go have a read.

Reasons to be Livid #5738

Back last year, the following conversation must have taken place somewhere in Conservative Party Central Office.

“Okay, guys. We need a catchy slogan to get the nation through the austerities ahead.”

“Sure. How about, ‘Batten down the hatches, here comes Armageddon’?”

“Haven’t you got anything a little more upbeat?”

“Well, I was thinking about ‘We’re all in this together’.”

“That’s excellent. Positive, catchy…and you know what? I reckon that’ll never come back to haunt us in any way shape or form whatsoever.”

On today’s news, it certainly looks like somebody forgot to send the memo to our bosses.

Pay for the directors of the UK’s top businesses rose 50% over the past year, a pay research company has said.

Incomes Data Services (IDS) said this took the average pay for a director of a FTSE 100 company to just short of £2.7m.

The rise, covering salary, benefits and bonuses, was higher than that recorded for the main person running the company, the chief executive.

Frankly, it doesn’t so much give a sense of “all in this together” as “haul up the drawbridge while all goes to Hell for the commoners.” Not even the Daily Mail feels inclined to defend this one.

I suspect many of the readers of this blog will have already seen this video, but today’s news reminded me of another recent example of out-of-touch arrogance from our financial elites.

For those of you who haven’t seen it before, the “let them eat cake” moment (and glorious slapdown from Polly Toynbee) is at 3.40.

On the YouTube page, the top comment is “Tax Payers Alliance, I think it might help if your spokespeople didn’t look like cartoons of overfed capitalist scumbags.” Frankly, it’s hard to disagree. The TPA couldn’t have been fronted by more of a cliche if he was wearing a crown and quaffing from a ruby-encrusted goblet. Perhaps while also waving a chicken drumstick as jesters capered around his feet.

Also in the video, Toynbee described the current situation as “a dysfunction like the last days of the Roman Empire”. When I first watched this a couple of weeks ago, that comment seemed like hyperbole. Given today’s news, I’m no longer so sure.

‘The Future State of Welfare’ with John Humphrys – A Review

Despite my hopes, dreams and wishes, I don’t think I’ll ever be able to switch professions and hold down a career as a TV critic although I’d lay claim to much ‘television watching’ experience. I sat down to watch ‘The Future State of Welfare’ last night  but after a very busy day and week covering ‘duty’, I may have nodded off one or two times during the programme so while I want to give my thoughts and feelings about the programme, I must mention that as a rider.

OT on Wheels has a great analysis of some of the figures that Humphrys presented. Left Foot Forward also analysed the figures. My response is more emotional than cerebral.

I knew from the advance information that this was a programme which was going to be challenging for me to watch. I take great offence at the way this government (and the opposition) stigmatise people who are out of work and who need to rely on the provisions of the welfare state to exist.

Humphrys had a very firm view on playing on the ‘idleness’ of the workless and feckless and seemed staggered that there wasn’t the old style stigma related to unemployment, recalling with some mirth and incredulity the ‘one man on the street who never worked’ and who everyone else on the street stigmatised.

That made uncomfortable viewing for me. When I was growing up, you see, my father was unemployed for periods of time and I remember that projected shame and stigma. It hasn’t left me. I genuinely wouldn’t want another child or family to feel that.  The way to ‘solve’ the benefits ‘crisis’ is to shame people into work? Really? Is there no more human way to promote and encourage the right environments to work in?

So from that premise, Humphrys casts a glance at some of the worst ‘offenders’ in his view.

But the people who Humphrys spoke to, I’d argue were hardly typical although that’s what he would want us to believe. The panned shots of young men hanging around on street corners makes too many assumptions about types of work or the fact that work is something that is undertaken from 9am – 5pm on workdays therefore (he seems to imply) anyone out and about at 2pm on the Wednesday afternoon, must be workless.

Not having a job does not make someone ‘different’ except by luck and opportunity. We had a constant undertone of ‘paid work’ = good  ‘not paid work’ = bad/feckless/idle

He even raised the ‘deserving and undeserving’ poor which is more than patronising and pans across to a group of people who are looking for work and therefore ‘good’ in his very judgemental eyes.

The part filmed in the private training centre run by a private company that have been contracted on a ‘payment by results’ basis illustrated some of the patronising talk and ‘lessons’ that the people attending receive. Adults designing cupcakes? Really? I do wonder about what is actually taught and how.

There was a glance across the Atlantic to the workfare schemes initiated there and I felt the tone was almost admiring. Certainly there’s no doubt that Humphrys was scornful of those who needed to rely on state benefits to exist.

The family on housing benefit, he implied should not be helped with rent because they live in central London and bafflingly he raised their nationality both in the voiceover and directly to the family when there was no question that as a Spanish citizen, the man had the right to live and work in the UK. I am unclear why the nationality was even raised as an issue.

There was an overtone of disdain regarding the high rates of claimants for ‘Employment and Support Allowance’ which seemed to emphasise a high rate of ‘fraud’ and yet the programme consistently referred to ‘Disability Benefits’ without mentioning Disability Living Allowance at all – probably because it has such low rates of fraud.

Of course I think that work should be encouraged but decent paying dignified work as well as support for appropriate child care should also be encouraged.

Stigmatising groups of people will not build a cohesive society but more and more this government and moreover the governing classes seem to depend on a ‘divide and rule’ type way to build gaps between those who have and those are have-nots.

Humphrys’ skewed and rather unpleasant programme exacerbated this. I look forward to the BBC putting together a programme exploring the realities between the ‘benefits’ myths that it has enjoyed perpetrating through this programme.

Unannounced Inspections

I can spend a fair amount of time in residential and nursing homes because a part of my role is about both making placements in them and reviewing ongoing placements in them.

Over the years, I’ve seen many different types and different quality care homes and there are a couple of observations I can make very broadly.

Firstly that the quality of the inspection reports (as well as the frequency of inspections) has nosedived over the last few years. This isn’t all down to the death of CSCI and the arrival of the CQC as it was a pattern that was already happening but it does seem to have got worse progressively and unsurprisingly, this is linked to job losses and a reduction of resources allocated to the CQC. The reports seem to speak their own jargon-like language and sometimes looking at one it is hard to know (unless it is incredibly good or bad) what the issues actually are.

Secondly, there are many perceptions that people have of residential and nursing homes – not helped by media (don’t get me wrong though, I think the programmes that unearth poor and abusive practice have been very helpful to the sector) – that poor care abounds. While there is much more poor practice than there should be, there are also some gems which exist out there and provide very high quality and ‘caring’ care although the impression I get is that it is sometimes in spite of, rather than because of the way that care is organised.

Often the best care is down to individual home managers, individual care staff who have a particular approach rather than large, imposed management styles.

Yesterday, Lansley announced that there would be a rise in unannounced inspections in care homes. It’s important to note that the amount of inspections carried out will not increase but the amount of unannounced as opposed to planned inspections will.

Does regulation improve an industry and a culture? Well, not necessarily. I think there is something more deep-seated in the way that the care sector has been turned into profit-making businesses where individualised care is more expensive than warehousing of older adults in particular in very large institutions but that’s another story for another day.

Regulation can at least help to monitor some of the issues that may arise and while it is far from a panacea to cure all ills, I think that better and more frequent (unannounced) inspections are better than fewer, announced inspections as long as the inspectors are both knowledgeable about the legal aspects of the requirements of the home (I’m particularly thinking about the Mental Capacity Act and Deprivation of Liberty Safeguards here where I’ve found very little attention/knowledge from the CQC reports) and the inspectors aren’t afraid of pressure from providers.

It’s a step of course and while I can think of niggles/problems/answers – most of them involve more resources but the current situation where inspections are so rare as to be happening once every two years or less in some circumstances, does not provide a level of regulation that should be expected in such an important area.

I’ll certainly be keeping my eyes peeled for the results of these changes and I hope they will make things better.


CQC  – Care Quality Commission

CSCI – Commission for Social Care Inspection (predates the CQC which took over in 2009)

Deprivation of Liberty Safeguards – particular legal tenets relating to adults without capacity who are detained and deprived of their liberty in care homes or hospitals.

Reflective Practice aka The Cosmic Schmuck Principle

The philosopher, mystic and sci-fi author Robert Anton Wilson used to expound what he called the Cosmic Schmuck Principle.

The Cosmic Schmuck Principle holds that if you don’t wake up, once a month at least, and realize that you have been acting like a Cosmic Schmuck again then you will probably go on acting like a cosmic schmuck forever; but if you do, occasionally, recognize your Cosmic Schmuckiness, then you might begin to become a little less Schmucky than the general human average at this primitive stage of terrestrial evolution.

In nurse training, they’re pretty big on the Cosmic Schmuck Principle. Of course, they don’t call it that. They call it reflective practice. The idea being that by regularly reflecting on your own actions and those of your colleagues, you’ll become a “reflective practitioner”, which is kind of the opposite of a Cosmic Schmuck.

Due to certain things going on in my family at the moment, I’m having to spend a certain amount of time visiting relatives on medical and surgical wards. Coming from a nursing background myself, I’ve found myself reflecting a lot on the actions of the nurses scurrying around them, and on my own attitudes to them.

On my last trip to hospital, the nursing care was actually pretty good. As is so often the case in nursing, it’s the little things that were most appreciated. Such as the ITU nurse who helpfully explained that the decision to move my relative to ITU was a routine one for observation, and by the way, I shouldn’t be too worried if the machines start making random beeps and bongs, because they do that anyway. Later on, I had an explanation of what would be happening from a consultant surgeon. He was a bit of a walking surgical cliche, so his explanation basically amounted to, “Slashy! I am a slasher and I like to slash! Slash slash slashy!” The same helpful ITU nurse hung around after he’d left to make sure I wasn’t too vexed or freaked-out by his explanation.

Later on, my relative was moved from the ITU back to the ward. This will disappoint the Daily Mail types who like to lambast the new generation of student nurses as a bunch of too-posh-to-wash essay-scribblers, but while there I found myself quite impressed by a young student nurse who was running around. Eager to help, keen as mustard, good communication style. I imagined the positive feedback I’d have been giving him if I was his mentor.

While experiencing the worries and frustrations that most visiting relatives go through, I wound up thinking a few Daily Mail-esque thoughts of my own. “Why hasn’t that call bell been answered yet? Just what are these lazy cowbags up to? Don’t they care?” Then I took a peek at what the nurses were doing, and realised that they were rushing around doing 101 essential tasks. They were not sitting around the nurses station reading Bella, much as it would have satisfied my indignation if they were.

On other visits I’ve encountered some outright Cosmic Schmuckery. This may be due to me being an RMN, but it’s often the way confused patients are dealt with that I tend to notice. On one visit I wound up having a word with the ward sister because a nurse had dished out the meds for my confused relative, signed for them, then just left them in a pot and assumed he’d take them. When I got to the ward the meds were sitting exactly where she’d left them.

On the subject of confused people, I’m regularly amazed by the number of medical nurses who seem to think the best way to handle an aggressive patient with dementia is to give them a telling-off. For some reason, they then act surprised when they get thumped.

Like I said, it’s the little things that can make the difference in nursing care, and those little things need time. Time to offer reassurance. Time to explain things properly and make sure somebody understands. A little bit of extra time when dealing with somebody who’s confused or has learning disabilities. And of course, that occasional bit of time to reflect on your own practice and make sure you’re not acting like a Cosmic Schmuck.

My worry is that as the cuts go deeper and the wards become more overstretched, that little bit of time may wind up in short supply.