Health and social care have clients in common but not cultures

Plymouth Council has pooled its entire social care budget with the local NHS and transferred all of its adult social care workforce to a community health provider in a drive to develop integrated services.

Is this the future for social workers in adult social care?

Manchester is leading the way with local authorities and NHS trusts promoting the integration of health and social care services through joint commissioning. London local authorities have started discussions with London NHS trusts to follow Manchester’s lead. But don’t we need to choose our partners with a little less emphasis on expediency and a little more care? We may have clients/patients in common, we may have complementary and overlapping services, but we have very different organisational cultures.

Special measures

Would a local authority enter into a partnership with an organisation with a reputation for bullying? What if that organisation was an NHS trust? If the local authorities within London are seeking to copy Manchester and join with NHS trusts then this question will be asked. Barts Health Trust – England’s largest hospital trust which runs six hospitals in east London – has just been placed in special measures following a critical inspection at one hospital. A catalogue of problems were identified, including a culture of bullying, insufficient staffing levels, low morale among staff and too high bed occupancy.

This can have come as no surprise to the board, senior management team or wider NHS community since a report commissioned by the trust had previously found bullying to be widespread. From Mid Staffordshire and Morecambe Bay to the other trusts now in special measures, two disturbing facts emerge: the culture of management bulling is not unique to Barts Health Trust and management is unable or unwilling to stop it.

Imposing style

These are not new criticisms, but the modern NHS is supposed to have long since moved on from its ‘macho management’ past. Clearly it hasn’t. The culture persists despite the heavy investment in management and leadership development.

No doubt the extreme pressure that trusts have been put under to deliver demanding performance targets while meeting ambitious efficiency targets has reinforced a management style based on imposing rather than convincing. Those at the top continue to talk of leadership being about taking staff with you, while those responsible for management development emphasise good people management skills. But the culture of bullying remains. This is totally unacceptable.

The quality of management in the NHS is just not good enough. Say this to many chief executives and board members about their trust and they will say, “tell us who the poor managers are and we will get rid of them”, failing to appreciate that they themselves are part of the problem and that their solution is a typical macho response. To be a good manager, by which I mean someone who is effective and enjoyable to work for, you need insight into how your behaviour affects others and the willingness to change yourself.

Management coaching

Insight requires feedback and most people need help to change their behaviour. Rather than sending managers on courses to obtain management qualifications, or become leaders, have them observed in a range of work situations, give them feedback and then help them use that feedback to change the way they behave at work. In other words, a form of management coaching.

Allegations of a bullying management style go beyond those hospital trusts in special measures. Across the NHS frontline staff make the same complaints of feeling undervalued, ignored and disrespected by arrogant management.

The NHS is not the only part of the public sector where staff complain of management bullying. But it is the widespread nature, persistence and apparent inability of the NHS to change the management culture that should concern any local authority considering entering a formal partnership as part of integrating health and care services.

Blair McPherson is an author, blogger and former social worker and director of community services.