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A culture of diversity: at the heart of good social care

Debbie Sorkin National Director of Systems Leadership

Debbie Sorkin shows how good social care practitioners put diversity at the heart of their leadership role

This month’s Care Talk focuses on diversity and overcoming inequalities.  There is a temptation to see this as a matter of having the right policies in place: for example, as CQC noted in their 2016 State of Adult Social Care report[1], 99.6% of services had policies covering equality and diversity.  Services will also sometimes point to having ‘Diversity Champions’ amongst staff or Board members.

To my mind, both of these are examples of hitting the target but missing the point.  If we’re serious about good leadership in social care, we don’t pay lip service to equality and diversity, or treat it as if it’s some sort of separate ‘thing’ that we can tick off by having a policy on it.  We get it right because it’s intrinsic to good social care and the values that underpin it.

The Social Care Manager’s Handbook, in its very first chapter, talks about social care values.  These value recognise that the best practice is grounded in high standards of personal and professional integrity, and the commitment to delivery of services that centre on, and respond to, the people who use them.

This means that, in the words of the Handbook, “Treating people with dignity and respect will run through your service like a golden thread.”  Dignity and respect are one of the fundamental standards below which care should never fall: providers “must make sure that they provide care and treatment in a way that ensured people’s dignity and treats them with respect at all times”.

So working with people in a way that reflects their individuality, and accords them dignity and respect as human beings – in other words, respecting equality and diversity and living up to this principle in practice – is at the core of good social care leadership.

The same ideas inform CQC’s view of what good practice in equality and diversity looks like.  This was set out in their Equally outstanding: Equality and human rights – good practice resource,[2] published in November.  They note that many outstanding providers are using equality and human rights approaches to drive improvement, and explicitly make the connection between providers looking to improve their own ratings and learning from what the ‘Outstandings’ are doing in this field.

They also emphasise the link with behaviours.  What the best providers did wasn’t down to money or other resources.  Their success was based on changing behaviours and thinking about issues, in particular:

o   Leadership committed to equality and human rights

o   Putting equality and human rights principles into action

o   Developing a culture of staff equality

o   Applying equalities thinking to improvement issues

o   Putting people who use services – and their diversity – at the centre

o   Using external help

o   Demonstrating courage and curiosity.

And this wasn’t just a provider issue.  CQC emphasised that providers can’t do this work alone: it needs a system-wide approach, with support from commissioners, regulators and policy makers so that the sector can work together to tackle inequality and respect diversity.

So what does this look like in practice?  It means making it a reality in different care settings.  In Shadon House, for example, a Dementia Resource Centre in the north east of England that was rated as outstanding for being responsive, it started with the vision to “improve people’s health, wellbeing and quality of life; give people choice and control…maintain personal dignity and respect; and keep them free from discrimination and harassment”.  This then translated into all staff being trained in equality and diversity issues, and able to access detailed information about a wide range of religious and cultural beliefs and traditions.  Shadon now bases its work on the Human Rights ‘FREDA principles’ – fairness, respect, equality, dignity and autonomy, with procedures and training for staff to make FREDA ‘live’ every day through their work.

Similarly, Mersey Care, an NHS provider of mental health services, has been committed to equality across all protected characteristics under the 2010 Equality Act – age, disability, gender, gender reassignment, pregnancy and maternity, race, religion and sexual orientation.  The trust has won awards and charter marks in recognition of its approach to LGBT people, and works with a learning disability advisory group to promote the involvement of people using the service, based on human rights principles.

And you don’t need to be a large-scale provider to do this. Castlebar Care Centre is a private sector nursing home for 59 people, based in Lewisham in London.  Residents in the home originally come from 12 countries, and staff come from 27 countries.  It was singled out by CQC not just for its outstanding care, but for its work to promote individual rights and recognise diversity.

This has included activities such as Sweet readers, an intergenerational, arts-based programme between Castlebar and a local school, recognised in the school curriculum; Namaste, a multi-sensory programme for people with advanced dementia, which includes individualised activities, and support for individuals to follow specific interests.

Terry O’Connor, the Registered Manager at Castlebar, says: ‘Investment and culture change took patience and trust over time – but has led to big improvements in care and many areas of outstanding practice.’

There has been a growing appreciation within social care about what diversity means in practice: not just working with it, but celebrating it.  Manchester City Council has moved towards creating the UK’s first retirement community for LGBT people, and Anchor Care Homes’ LGBT Group has a clear remit to embrace and celebrate diversity through inclusion and respect.

Some commissioners have also got the message.  Central Manchester Clinical Commissioning Group has been recognised for its good practice in relation to end of life care, embedding equality analysis into its decision-making processes, monitoring performance on a regular basis, delivering training to staff in care homes and working with support organisations to respond to feedback from patients and advocates.  And it had significant impact, with admissions to hospitals falling by 68% as a result of these ways of working.

In all of these cases, the dignity, respect and individuality afforded to people makes a real difference, bearing out Dame Denise Platt’s view, set out a decade ago now, that “social care, when delivered well, has the power to transform people’s lives.” [3]

So how do you inculcate ideas around equality and diversity, and what they mean in practice, in your teams?

You ground it in leadership behaviours.  You make it part of everyone’s leadership responsibilities, and the everyday experience of all your staff.  CQC draws a direct link between equality for staff working in services and the quality of care provided, so begin with your staff, reducing differences in experiences and outcomes for them and learning from best practice.  The NHS Workforce Race Equality Standard[4] is a good place to start.

Another good guide is The Leadership Qualities Framework (LQF) for Adult Social Care[5].  It sets out what good leadership looks like, including in relation to equality and diversity, for people at all levels in the sector.  To start with, it’s central to the Dimension on Demonstrating Personal Qualities, especially the section on Acting with Integrity.  Whether you’re on the front line, an operational leader or someone working at strategic level, good leadership includes treating everyone with dignity, sensitivity and respect, as part of behaving in an open, honest and ethical manner and taking into account a person’s culture, beliefs and abilities.  So even if you are new to social care, you can value, respect and promote equality and diversity, by being sensitive to people’s culture, age, gender, religion, race, sexual orientation and disability.  At more senior levels, you have a responsibility to personally promote equality and diversity within and across your service, and to work to embed a sensitive and responsive culture across your service.

It’s also at the heart of the Dimension on Working with Others, for example through the section on Encouraging Contribution, ensuring that people who use services can express their views and participate in joint decision-making, and play an active role in community life.

It’s there in Managing Services, including in the section on Managing Resources, using resources effectively and minimising waste.  At a time when resources are often under pressure, why would you want to use them in a way that was inappropriate for people when you didn’t need to?

And it’s central to the Dimension on Improving Services, especially in the section on Encouraging Improvement and Innovation: leaders have a responsibility – played out at all levels in an organisation – to encourage improvement and innovation to create a climate of continuous service improvement.  This means always being on the look-out for better ways to enhance people’s dignity and to ensure they’re treated with respect.

By extension, this is about working beyond your organisational boundaries, and in partnership with other people – something social care staff are often very good at.  In other words, it’s about leading in a system, not just in a service.

You can support equality and diversity whatever your role.  If you’re an apprentice, or you’ve just started in social care, you can always treat people with dignity and as individuals, communicate effectively and work with them to improve their care and support.  If you’re a team leader, you can develop a convincing and authentic leadership style that promotes dignity and human rights.  And if you’re operating at more senior levels, taking up your leadership role includes actively building that culture in your organisation.

So equality and diversity aren’t something you pay attention to after you’ve looked at everything else: they’re at the centre of what you do.  Let’s make some noise about what social care providers and commissioners are doing to put equality and diversity at the heart of social care.

 

If you have examples of great leadership in your service, please send them in to www.caretalk.co.uk or contact Debbie.sorkin@leadershipcentre.org.uk.

Debbie Sorkin is National Director of Systems Leadership at The Leadership Centre.  Debbie.sorkin@leadershipcentre.org.uk @DebbieSorkin2

 

[1] CQC: The state of health care and adult social care in England 2015/16.  Published October 2016.  See pp 123-136: http://www.cqc.org.uk/sites/default/files/20161019_stateofcare1516_web.pdf

[2] Equally outstanding: Equality and human rights – good practice resource.  CQC, November 2018.  See: https://www.cqc.org.uk/sites/default/files/20181010_equally_outstanding_ehr_resource_nov18.pdf

[3] The Status of Adult Social Care: Dame Denise Platt, 2007: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_074218.pdf

[4] See: https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/

[5] The Leadership Qualities Framework for Adult Social Care: The National Skills Academy for Social Care, 2012: see http://tiny.cc/4vpt1x

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