Lessons from Francis Culture Change? 12 February 2013 Professor Keith Brown Director

1. Lessons from Francis Culture Change? 12 February 2013 Professor Keith Brown Director National Centre for Post Qualifying Social Work

2. Management A man in a hot air balloon realised he was lost. He reduced altitude and spotted a woman below. He descended a bit more and shouted, “Excuse me, can you help me? I promised a friend I would meet him an hour ago, but I don’t know where I am.” The woman below replied, “You are in a hot air balloon hovering approximately 30 feet above the ground. You are between 40 and 41 degrees north latitude and between 59 and 60 degrees west longitude.” “You must be an engineer,” said the balloonist.  “I am,” replied the women. “How did you know?” “Well,” answered the balloonist, “everything you told me is technically correct, but I have no idea what to make of your information, and the fact is I am still lost. Frankly, you’ve not been much help so far.”

3. Management The woman below responded, “You must be in management.” “I am,” replied the balloonist, “but how did you know?” “Well,” said the women, “you don’t know where you are or where you are going. You have risen to where you are, due to a large quantity of hot air. You made a promise which you have no idea how to keep, and you expect people beneath you to solve your problems. The fact is you are in exactly the same position you were in before we met, but now, somehow, it’s my fault.”

4. Winterbourne Viewhttp://www.youtube.com/watch?v=ioWkb5eig1c&noredirect=1 Was this abuse or torture?

6. What did we learn? • Staff are often afraid – feel bullied • Do we have sufficient staff both quantity and quality? • Meeting inappropriate targets with bureaucracy • Compassion fatigue • Authority - Finland

7. Lessons from Baby P and the subsequent Social Work Reform Board • Call for leadership development strategy for front line social work managers as this was seen as critical for ‘client’ safety.

8. Our response • Working with Learn to Care (National Association for Workforce Development Managers in Social Work/Care) we started in 2009 to develop a leadership and management pathway for social work managers Q • A number of pilot sites (local authorities) working with adult and children’s services and IVP sector

9. Guiding Principles in Developing Leadership and Management Programmes 12 principles which can be summarised into 4 areas: 1. Programmes should focus on leadership in the health and social care sector and not be generic leadership programmes. 2. Establish senior management ‘buy-in’ from the start. 3. Why Self-Leadership? 4. The importance of assessment. (adapted from Holroyd and Brown 2011)

10. 1. Programmes should focus on leadership in the health and care sector It might be obvious now, but leadership development really does need to occur in the context of health and social care. We are not making or selling ‘widgets’ but caring for some of the most vulnerable members of our society.

11. 2. Establish local management ‘buy-in’ from the start Too many leadership programmes appear to be ‘purchased’ by ‘commissioners’ who have not ensured management ‘buy-in’ from the start. Effective leadership development really occurs when the whole organisation is behind the endeavour and senior managers are supportive and engaged with the process.

12. 3. Why Self-Leadership? Self-leadership is about tapping into an innate wisdom, an internal resilience of human potential of knowing; creating perspective when it counts, reducing the impact of being overwhelmed. Professionals with the ability to react with flexibility at those crunch moments, able to judge with wisdom, rooted in real-world evidence-based practice. It allows staff to ‘tap into’ being their best (the person they joined the profession to be) and reduces the destructive risk and impact of poor quality thinking which can manifest as; collusion, victimhood, negative catastrophising, moaning, martyrdom and all manner of limited beliefs. However assessment is crucial to prevent cycles of expensive leadership training (often borrowed from elsewhere), resulting in little impact at the ‘front end’ (and therefore further disillusionment) and further expenditure.

13. 4. The importance of assessment There is too much training based on simply turning up. No evidence of the level of understanding attained and therefore no opportunity to even speculate on a return on investment or expectation. Assessment provides that crucial progression of learning, practising and demonstrating understanding and application. It serves as an important quality assessment on whether what has been taught actually makes a difference in practice.

14. Impact evaluation of IPOP – Self-leadership and resilience • Over 200 managers covering 12 local authorities plus 6 other organisations including NHS trusts. • Significant organisational shift and organisational change. • Of note this change continued and was still apparent well after the ‘learning’ occurred. • The principles and pathway works and changes culture without significant additional new resources – simply by using existing resources more effectively.

15. Leadership Pathway – further development • Developed a whole new leadership & management series of texts (Sage/Learning Matters) to support the sector. • Delivery and further evaluation being undertaken throughout England • Hampshire Children’s Services – Pilot site for further research developments

16. Safeguarding – Patient safety SAFE – Online Assessment Tool

17. Summary Although this work was initially developed for social work/care it has been demonstrated to work and be of value in healthcare to: • Change culture and improve organisational performance • Self-leadership and resiliance is the key to enabling staff to feel confident and able to exercise appropriate professional judgement.

18. So in summary a heart-felt plea! There have clearly been well-reported cases of unacceptable care in the recent past, but the majority of professionals have a deep desire to make a difference and to care. What they need is support and development to help them cope more effectively with the ever-increasing pressures on them, and self-leadership that is assessed has been shown to be a real and valuable way to support these staff. .

19. What is not needed is the creation of new leadership strategies and structures. Let’s use that energy to apply what we know works – self-leadership – and please can we stop this culture of blaming individuals. We owe it to all our professional colleagues to support and develop them to deliver the best possible health and social care.

20. Questions and discussion In pairs discuss how the NHS can “change the culture” to ensure the lessons of the Francis Inquiry can be put into practice What will you do differently or what action will you undertake to respond to Francis?