Saving humans: have health and social care lost the ability to care?

East_Midlands_Ambulance_Service_NHS_Trust

Jon Glasby,Professor of Health and Social Care and Director of the Health Services Management Centre (HSMC).

Being asked to write about a theme like ‘saving humans’ feels daunting – and immediately suggests something big and dramatic (preventing international terrorism, stopping world conflict, eradicating major environmental hazards, and so on). Yet ‘saving humans’ is exactly what our health and social care system does, day in and day out. While the bits we see (in TV dramas at least) are often high tech and adrenaline-filled (in an ambulance and then a hospital operating theatre after a major traffic accident, for example), it’s often quiet, private and everyday (in someone’s home, in a GP surgery, in local communities). It’s also just as much about relationships and about compassion as it is about science and equipment.

And, of course, it matters. Health and social care touch our lives when we are at our most vulnerable and most need help – when we’re ill or frail or in pain; when we’re scared for a loved one; at moments of intense joy and huge distress (from the birth of a new baby to the death of a family member). Although we are rightly critical of services when they don’t deliver, we still value them hugely, and the NHS in particular has been described as the closest thing we have to a national religion. For this reason, every major politician has to portray what they do as being hugely supportive of (and designed to improve yet further) the NHS – from Thatcher’s ‘the NHS is safe with us’ to Blair’s ’24 hours to save the NHS’.

It’s because of all this that some of the recent care scandals at Mid-Staffordshire and elsewhere have been so shocking and have rightly provoked such a public response. It’s not just that people were harmed (although this is clearly bad enough) – it’s also that we feel betrayed by the very services that were meant to be there for us in our hour of need. As a result, many people are asking – how can this happen and ‘have health and social care lost the ability to care?’

For me, the answer is a resounding ‘no’ – but we do need to acknowledge that when things go wrong they can go spectacularly wrong. Somehow we’ve got ourselves stuck in a polarised position where some argue that health and social are dreadful, and some that they are amazing. In reality, of course, they’re both – and always will be: often miraculous, but also with scope to cause untold damage when mistakes occur.

Following on from some of these care scandals, the danger is that we develop more punitive approaches and inspection regimes which name and shame and which hang people out to dry. While this can be tempting when emotions are high, the ‘one rotten apple’ thesis (where everything would be ok if we could just identify and remove the ‘one rotten apple’) has never been very convincing for something as complex as health and social care. Instead, our work at HSMC has argued that care work is a form of ‘emotional labour’. It’s difficult, distressing and often disgusting – and it takes enormous resilience to see such terrible things every day and still stay compassionate and sane. All of us have an ‘emotional bank account’ that constantly gets depleted and we need to find ways of keeping this topped up.

In response, HSMC has been working with nurse leaders to look at new approaches to staff support and has partnered with the Samaritans to explore lessons we could learn from the way in which they support their volunteers to do such difficult, distressing work. However, much of this has had to work against the prevailing culture in many public services at present – which is very focused on the underlying finances and on often narrow measures of performance. Although these are clearly important, we need to spend equal time (if not more) on thinking about emotional support for staff. A former chair of the health and social care regulator has said that ‘giving someone a smile costs nothing.’ This might be true financially – but it certainly isn’t true emotionally (as anyone who has ever been involved in care work will attest).

The longer we cling to the ‘one rotten apple’ approach, the harder we’ll make it to fulfil our mission of ‘saving humans’.

Jon Glasby is Director of the Health Services Management Centre (HSMC) and Professor of Health and Social Care. For further information on HSMC, see www.hsmc.bham.ac.uk.

For more on health care as ‘emotional labour’ see the work of HSMC’s Yvonne Sawbridge via:

Further useful links:

Mid-staffordshire- lessons for commissioners: http://www.waag.co.uk/news/documents/Mid%20Staffordshire%20NHS%20Foundation%20Trust.pdf

Gillian Astbury death: Mid Staffordshire NHS Trust fined over patient death: http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-27192012

Hospices: The forgotten pillar of elderly care? http://www.bbc.co.uk/news/health-24626653

Image: Ambulances: By EMASNHSTrust (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

 

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