Professor Martin Green, Chief Executive at Care England, urges care leaders to put people before process—and warns what’s lost when they don’t.
If you look at large organisations and institutions, they all pretend to be focused on the needs of the people they serve. In the vast majority of cases, this is very far from the truth. What we see in most bureaucracies is the organisation’s needs and processes taking precedence over the support of the people they serve.
This is a symptom of all organisations, including the public, charitable, and private sectors. In each sector, you can see examples of the subversion of the primary purpose and the sidelining of people’s needs.
One of the best recent examples of this has been the Care Quality Commission (CQC), which had completely lost touch with its primary purpose of good regulation and became so focused on the process of developing a new IT system that it completely lost sight of what it was there to do. The decision to develop a new single assessment framework was handled badly. It is so disconnected from the primary purpose of CQC that I doubt anybody in their senior management team or board asked the question: How is this going to improve our ability to assess the quality of a service reliably?
What we saw happening was that the process of delivering a new approach to regulation had become the priority. Another symptom of this approach is that when people realise it is going wrong, it takes them so long to admit their mistakes and row back from the disaster. That was certainly the case with CQC, which was in complete denial until the Government sent in Dr Penny, who exposed the true depths of the crisis. Despite being told by a range of important stakeholders that everything was going wrong, the CQC held fast to its misguided view that the new system was in everybody’s best interest.
I am also concerned that the recent decision to abolish NHS England will turn from a decision based on improving patient outcomes to one that descends into discussions about organisations, processes and jobs. Whilst I recognise these things are important, they must never be allowed to take precedence over the objective of delivering better patient care. It is very sad to realise that these subversions of purpose are not only regularly seen, but are well documented and theoretically, that should mean they are avoidable. However, what becomes apparent over time is that those who make decisions are often focused on operational issues rather than the primary purpose of the organisation.
I said this affected all sectors, and sadly, that is true. I have lost count of the number of commercial organisations I have tried to engage with over the years, who constantly put in place barriers and processes to stop me from getting what I should be entitled to as their customer. These businesses have lost sight of the premise of the business, customer service, and they do not understand that satisfied customers lead to robust and sustainable businesses. Any organisation that loses touch with its customers and its primary purpose is an organisation that will not only fail but also deserve to fail.
Organisations going through change and development must hold fast to their primary purpose. Without this clear objective, it is very easy to get sidetracked and for other issues to take precedence. If an organisation is clear about its aims and goals, and is underpinned by core values, it will be much easier to know whether your change agenda will deliver what is needed, and this will reconnect you to your primary purpose. Without this framework in place, and without a judgment as to what good looks like, many businesses and organisations will get sidetracked by the logistical issues and forget why they embarked on a change process in the first place.
The issue of holding fast to your values and being clear about your primary purpose is important in any sector, but I would argue it is far more important in health and social care, where our primary purpose is about supporting people and we must make sure that nothing gets in the way of delivering this commendable objective. This should be seen in every part of the system, including the NHS, CQC, local authorities, and care providers. Being clear about your purpose and delivering for your users is how to deliver a successful and sustainable organisation.
