Debbie Sorkin on how good leadership helps you strike the right balance
In February, the Daily Telegraph reported that Somerset Safeguarding Adults Board had accused the National Autistic Society of allowing horrific abuse at Mendip House, a care home for people with learning disabilities. The article makes grim reading. Amongst the allegations, residents had cake thrown at them; were forced to eat chillies; were repeatedly thrown into a swimming pool; and were made to crawl around on all fours.
So when we talk about dignity, and safeguarding people whom we support, we know what we want to avoid. At the same time, if we want people to have as full and as ‘normal’ a life as possible, we have to accept some risk-taking, on our part and on the part of people using services. So where to draw the line? As this issue of Care Talk focuses on dignity versus safeguarding, I thought it would be useful to look at the relationship between both of these issues and leadership, as it seems to me that leadership is key to getting the balance right.
Leadership is intrinsic both to treating people with dignity and to safeguarding. This stems from leadership being based on everyday behaviours, and rooted in social care values. The very first chapter of the Social Care Manager’s Handbook focuses on values, recognising that best practice will be grounded in high standards of personal and professional integrity, alongside commitment to delivering 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.” Moreover, “Part of according the people you support the respect and dignity they are due, is active promotion of their independence.” It follows that working with people in a way that maintains and enhances their dignity, and managing the risks and safeguarding issues that come with independence, are intrinsic to good social care leadership.
In balancing dignity with safeguarding, I think there are two things to keep hold of. Firstly, leadership is for everyone, no matter what their job title is or what they do; and secondly, everyone needs to take responsibility for what they do and address poor practice wherever they see it.
So if you feel that something is going beyond people being accorded dignity to live the life they choose, and starting to shade into safeguarding, then doing something about it – whether that’s telling someone about it or intervening directly to put things right – and not turning a blind eye – is the right thing to do. It’s what makes you a true leader.
And there is guidance on dignity and safeguarding in The Leadership Qualities Framework (LQF) for Adult Social Care. Ensuring the safety of people who use services is built into the LQF, being one of four components of the section on Improving Services. To ensure the safety of people who use services, leaders need to assess and manage the risks associated with service developments, and balance the need for user safety with other considerations. So good leaders always:
o Identify and quantify the risk to people who use services, using information from a range of sources
o Use evidence, both positive and negative (i.e. what is and isn’t working) to identify options
o Use systematic ways of assessing and minimising risk
o Monitor the effects and outcomes of change.
And you can be a leader whatever your role. If you’re an apprentice, or you’ve just started in your first care role, you can still act to ensure the safety of people you support. In fact, safeguarding is especially important at front-line level, as this is where issues are likely to come to light. So good leadership includes front-line staff feeling confident to challenge appropriately and being prepared to raise concerns about quality, safety and performance, even if – especially if – this means reporting on the actions of a work colleague, which people often find difficult to do.
If you’re a team leader, you can show you’re prepared to raise concerns and take action if a member of your team comes to you with an issue, and you can instil a ‘safe to challenge’ culture whilst encouraging people to gain independence. And if you’re operating at more senior levels, taking up your leadership role includes actively building that culture.
Balancing this, Improving Services also means Encouraging improvement and innovation. Leaders at all levels have a responsibility to create a climate of continuous improvement, always being on the look-out for better ways to enhance people’s dignity and independence. Dignity is also part of the section on Working with Others, for example through the chapter 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. And it’s there in Managing Services, including in the section on Managing Resources, using resources effectively and minimising waste. Why would you want to have someone you support fall ill or lose some of their independence when they don’t need to?
If you’re in a very senior role, balancing dignity and safeguarding is closely tied in to vision and strategy. It means creating a vision for an organisation that reflects the needs and aspirations of service users – including for dignity and independence; communicating that vision in a way that engages and inspires others; and implementing a strategy to put the vision into practice on the ground.
This means embedding safeguarding, both in itself and as the flip side of independence, right from the start. Getting staff teams to think about safeguarding as the standard way of working is key to developing a safe organisation. One way to do this is by embedding personalisation. People who are empowered by having choice and control over their lives, and who feel they are being accorded dignity and are entitled to it, are much less likely to be victims of abuse. And working in a personalised way means that staff see real people whom they treat with dignity and respect – not people they can throw cake at or force to eat chillies.
Aside from being a fundamental building block of care and support, you’ll find that having well-developed safeguarding pays dividends when demonstrating how ‘safe’ your organisation or service is for regulatory purposes. Many of the CQC key lines of enquiry for the ‘safe’ criterion focus on safeguarding and on the confidence that staff feel that they can report on issues and that, if they do, appropriate action will be taken, and fast.
Balancing safeguarding with dignity can also surface in how a service or organisation works in partnership with others, both within and outside social care. So taking both seriously marks you out not just as a leader, but as a Systems Leader – being prepared to lead across boundaries; where no one person is in charge; where you’re dealing with complex issues with no easy solutions; and where you make progress by being able to work with, and influence, other people. As the LQF also notes: ‘Collaboration within and across systems plays a vital role in the delivery of services. Effective leaders work in partnership…to deliver and improve services.’
So balancing safeguarding with dignity is at the heart of your leadership. If you’re starting out in your social care career, it’s one of the ways you demonstrate good leadership. If you’re a Registered Manager, or acting in other senior roles, it’s how you embed it and build a leadership culture. But wherever you are in social care, showing that you balance dignity with safeguarding is one sure-fire way to make good leadership an everyday reality, and to instil quality – even outstanding quality – as standard.
If you have examples of great leadership in your service, please send them in to www.caretalk.co.uk or contact firstname.lastname@example.org
Debbie Sorkin is National Director of Systems Leadership at The Leadership Centre. Debbie.email@example.com @DebbieSorkin2
 Daily Telegraph, 8th February 2018: ‘Autism charity accused of hiding horrific abuse at care home’: report by Victoria Ward