Who Cares?


Whatever untold strife there is in Syria, Egypt, Afghanistan and Iraq, the undeniable and continuing news story at home is our national health service – the NHS itself and (in the wider community) social care services – especially care homes exacerbated by the government’s desire to cut costs and benefits as a result of government debts from the bank-induced recession.

In recent years, the intolerable conditions under which elderly and mentally challenged residents of social care homes were treated became clear. Attacks by staff on residents have been detailed and prison sentences resulted.

Then, in the last 12 months, publicity has focused on NHS hospitals – amongst them Mid-Staffs, Trafford and now University College in Wales. Poor standards appear to have led to deaths and misery and then a debate about how nurses, for example, spend too much time training and not enough caring, while week-ends are suddenly revealed to be understaffed and A&E (Accident and Emergency) services are under enormous strain.

So, Who Cares?

This is not just a sad reflection on critical institutions but appears to reflect very badly on ourselves as caring human beings and on whatever society we have created. Our demands are for low government spending and for maximum services as long as someone else pays. What has happened that makes us so uncaring? While this may not be on a scale like what has happened in recent years in Bosnia or Somalia or now in Syria, Afghanistan and Iraq, our insensitivities to other people have reached a sorry state – the governing State and its inability to provide the answer and the civil state that appears to be no better.

Quality of life has been subsumed in the message of “quantity of life” for so long – the pursuit of wealth as recorded in terms of money and goods – that we are failing to reconcile ourselves with the softer issues of existence. The pursuit of economic benefits has seems to have clouded out all else as we pursue ever higher GDP.

We blame government for this – but, government represent us, civil society, citizens and we get what, I guess, we deserve. David Cameron and his happiness index is a measure of the difficulties we are in – where we have to measure things before we do anything.

Measurement is a quantitative outcome of real activities. Hospital failures are deemed to be the outcome of rigid focus on targets and it is clear that we have, as a society, been totally brainwashed by the success of business and used its targeting approach to success in all other areas.

So, we set up targets for hospitals without understanding the qualitative targets that need to be set. This is the same as the setting up of government departments to quantify the value of natural capital (Natural Capital Committee at DEFRA) as that, seemingly, is the only way to guard against the complete destruction of our ecology. As a minor example, the only delight that most have in watching Antiques Roadshow is the valuation for each item – the genuine beauty of the item is sidelined as we wait for the valuer to tell us how much an item is “worth”.

We seem completely uncaring as human beings – sacrificed on the altar of quantity and unable any more to see the real quality of life.

Where is the Care?

Yet, not all NHS hospitals are death traps and by no means all medical professionals are uncaring – most aren’t. Indeed, it is likely to be a small minority that exhibits such immoralities. However, we have a developed a structure built on sand where managerialism and devotion to numbers and targets exist throughout and our obsession with quantity overrules quality.

This is why MRSA took such hold in British hospitals for so many years – because other obsessions took firmer hold.

So, where is the care? Will it come from the new agenda that is being pushed  – the wellbeing agenda? Will the Health and Wellbeing Boards (around 150 have been set-up throughout England) result in an infection of caring and quality? Will top-down direction result in a change in culture that is professed throughout.  Will the CQC be suddenly changed into a care organization? Will expert inspections be the savior? Or will the whole be an edifice, behind which politicians hide proclaiming that they did their job and it was the professionals that failed – or are we simply kidding ourselves that top-down, outside inspection and control can fix the problem.

The Caring Sectors? Chaos in Conformity.

The NHS and Care homes suffer from a culture problem and a procedures-driven mentality that eschews common feelings. NHS facilities are procedures-focused to the extent that it is amazing that breathing can be undertaken without supervision. Everything is policy-controlled and process. It is no wonder that care is forgotten. All who have it are in danger of losing it once they enter the profession – those that retain their care mentality are fighters and have to be for their morality to survive.

I have seen the evidence of this, not in a hospital but in the charity sector. – the so-called Third Sector. Charities are centres of care where the whole focus is on the cause. This key focus is driven by founders with vision and caring and with funders who buy into that care and cause agenda.

Sometimes, well-meaning Trustees bring in NHS or NHS-related people to run a charity – thinking that one non-profit is much like another. So wrong!

What often happens is that the charity is swarmed over by policies and procedures and directives and by new people brought in from outside (often the NHS) who “get” the new mantra. Soon, the charity is losing its way and its cause is forgotten in the chaos of conformity that ensues.

I believe that the charity sector (really the second sector in the caring sector as it was the precursor to government involvement) is where real compassion and caring still resides. Like a treasure-box of solace for humanity, the charity sector is built on causes and full of people that care – quality of caring and not quantities of statistics.

I have myself spent many years in the business sector, where care for customers is paramount but so is the quantifiable bottom line. Customer care leads to better profits and well-run companies know that their profits will be hit hard if customers suffer. However, care for customers means doing business well – good design, well priced goods and services, good after-sales, better call centres, smiles and the like. The aim is to make profits – one bottom line – but thorugh a complex array of inputs, outputs and outcomes.

In the charity sector, there are two bottom lines and two customers. The main one is the cause – the caring for the beneficiaries of the charity. The second is the funder – the provider of the funds for the cause and a way to break-even and grow the charity to satisfy the needs of the beneficiaries.

This balancing of the two bottom lines is crucial to the success of any charity and the care side is just as important as the funding. It comes first but is dependent on the other. Two sides of the bargain.

I continue to be overwhelmed by the people that work in and volunteer for and fund charities. From the largest like Macmillan Cancer Care and Cancer Research and WWF to the smaller ones like Willow (where I am CEO) to campaigning charities to health charities, the vast majority are focused, and relentlessly determined to make their charity successful. To do that, they have to positively impact their cause.

This is a learning tool for the national health sector (both public sector and private sector) in the UK. The challenge of wellbeing is to harness real caring into the morass of policies and procedures that entangle the NHS and the profit-motive that engulfs the care homes. Amongst the top-down rules and strategies that the Health and Wellbeing Boards adopt should be the adoption of the basic tenets of the charity sector.

The Third Sector Infiltration

What does this mean? Well, first, ensure that there are charity people on the Health and Wellbeing Boards. This means real, caring people that understand the challenges of the two bottom lines and have shown some success. Such people run and work in hospices across the country as well as service-type charities like MacMillan and many others.

Second, adopt the two bottom lines. Understand that the cause is as crucial as the finances. Just because in the public sector there is only one funder does not mean that that monopoly funder should run the organization. Being “funder led” is a sign of disaster in the charity sector. It should also be in the public sector. Sure, we want effective use of taxation in every public sector area but the balance should be in place and the only area where that balance is in place is in the charity sector.

Third, Government must take the role of the interested funder – not the shareholder. This is civil society money raised from taxation but to be used for a good cause. It is the wrong balance if the Treasury is the only arbiter. The Department of Health (and wellbeing?) is the funder and the CCG (Clinical Commissioning Groups) are the funders – can we trust them (the General Practitioners and members of other NHS organisations) to provide care objectives when they are the “commissioners” – the buyers? Who represents the citizens – civil society – the patients? Where are the patients represented anywhere? Who demands that care forms the agenda – the Health and Wellbeing Boards?

Yet, they are mainly formed of our representatives – local councilors and the like. Where is the care sector involved? The “caring professions” have, unfortunately, been tainted by the recent past – it is now a good time for the Third Sector to be properly represented in the world of care to a far higher extent than David Cameron’s vision of a caring Britain (his Big Society) where charities were lumbered with being low-cost alternatives to local authorities and hospitals. It is time for a reverse takeover – with caring in the lead.

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