By John Burton, social care consultant and author of Leading Good Care: the task, heart and art of managing social care
Managing a care home can be challenging, exciting and very creative. The manager leads a vital service and builds and maintains a caring community. There really are places and people like that, but we are not likely to hear about them in the national news.
Instead, our social care system is dominated by the demands of regulation and inspection and it is bad care that makes the headlines. Being non-compliant with the regulator’s rules is a serious failure, and managers feel compelled to spend their time guarding against it.
For many managers, work becomes merely a matter of obeying the rules and they spend more and more time in the office, instead of where they are needed with staff and residents. This is a universal problem and it can only be tackled by disrupting the system.
Core task
I know this because thirty-three years ago I was appointed ‘officer in charge’ of a care home. It was a dreadful place but five years later, it was widely appreciated among residents, relatives and staff as a good place to live and work in. We were proud of it.
However, we didn’t get an excellent local reputation and that sense of ‘our home’ by just obeying the rules. The core task for managers must be good care and we focused on the needs of our residents, anything else was a distraction.
Good care is achieved through relationships, teamwork, community action and through being part of your neighbourhood. Undoubtedly care home management is hard, disciplined work and it is not well paid, but it is also immensely satisfying.
Diversion of rules
So if good care is our core task, where did we get the idea that care homes can be improved by inventing a new set of rules for managers to obey? How is it that we’ve accepted rules and standards imposed by people who don’t do the work, don’t live in care homes, and don’t understand how good care is created?
All but the best and most confident managers feel they have to ‘evidence’ that they’ve complied with the rules and this is not the same as giving the best care. Employers judge their managers by the rating they get in their inspection report, hire expensive consultants to rewrite paperwork and employ quality managers to check homes are compliant.
What lies ahead?
The problem with the system is it is upside down. I see provider organisations and care home managers desperately trying to please the regulator and avoid getting a poor rating. I see the regulator desperately trying to please the government and avoid more bad publicity. But both should be totally focused on the people they are meant to be serving.
Good care is led by managers who always put it first and we need a professional body to support learning and development, set professional standards and provide accreditation. This would allow our care home managers to lead with authority, pride and confidence. A well-led service is after all a social good, and surely good care is something our society should recognise.
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While I don’t think we should get rid of standards and performance indicators entirely as they can underpin safe basic practice, I agree that they distort the work that people do and the way they do it. Meeting a whole range of PIs does not necessarily make for good practice – it’s a more holistic thing with the whole attitude of the person to those for whom they are caring being the most important element.
Absolutely agree about the end of 15 minute care visits (unless literally for admin of medication or some other very straightforward task). Carrying out essential tasks for and with somebody in a rushed way is disrespectful in the extreme. Also pleased to see end of zero hours contracts for the much exploited care workforce. Not sure about care agencies paying for hospital admissions – often people are discharged from hospital unsafely and in these cases the hospital should be penalised for a readmission.
NB My previous comment was on a different article – the submission system doesn’t work very well as I had typed out and submitted a different response to this one!
Totally agree with every word John has written, in fact he has not gone far enough as he doesn’t mention the effects of years of underfunding by councils which we have all been subject to .These cuts have been imposed on Council Officer by their Political Masters at every opportunity with the sole intent of “getting at” the Private Sector and often against the advise of the Officer dealing with the matter. This , to say the least, is demorolising for everyone concerned, for the sake of our clients , the general public, we need to work together and stop bringing Politics into Care ( Just dreaming)