Debbie Sorkin shows why speaking up for people makes you a leader in social care
Advocacy is the theme of this month’s Care Talk. It’s a term that sometimes gets used in specific ways in social care, to refer to services that help people, particularly if they’re not in a position to speak directly for themselves, to access information and services; be involved in decisions about their lives; explore choices and options; and speak out about issues that matter to them. In other words, it’s part of people having meaningful choice and control over their lives.
But I want to argue for a broader definition of advocacy. Fundamentally, it’s about how we express our values, through our behaviours – what we tolerate; how we address poor practice when we see it; and how we speak up for the sector as a whole.
And it’s about how we treat people with the dignity and respect we would want for ourselves or for members of our own families.
The very first chapter of the Social Care Manager’s Handbook talks about social care values. These value recognise that the very best practice is grounded in high standards of personal and professional integrity, and the commitment to delivery 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.” So advocating for people in a way that maintains and enhances their dignity, is intrinsic to good social care leadership.
So how do you do this in practice?
To begin with, you can’t advocate effectively for people if you don’t build and maintain relationships; if you don’t communicate in an open, accurate and straightforward way; if you don’t have good collaborative networks; or if you don’t encourage contribution.
So advocacy is built into The Leadership Qualities Framework (LQF) for Adult Social Care[1]. To start with, it’s central to the section on Working with Others. Good leaders, at all levels, build and maintain successful relationships, through being willing to listen, supporting others, gaining trust and showing understanding. This means recognising different perspectives and being able to empathise, taking others’ needs and feelings into account. Advocacy isn’t just about stating demands: you’ll get a lot further when advocating for someone if you can see other people’s point of view. As a corollary, it means being able to adapt your approach according to different situations and contexts. And if you’re working at a more senior level, it includes building and promoting a relationship-based culture in your organisation, so that there is an effective environment in which advocacy can take place.
And advocacy isn’t a one-way street: it’s based on encouraging contribution so that people feel they have the opportunity to engage in decision-making and challenge where they feel it’s the right thing to do. Even if you’re a front-line worker, the Framework makes clear that it’s part of your leadership role to support people who use services to express their views and needs, enabling them to participate in joint decision-making and play as active a role in they wish. In turn, this can entail your acting as an advocate for them. At strategic level, this means creating a culture of co-production as a basis for effective advocacy.
One area where you’re increasingly likely to come across this is in relation to Deprivation of Liberty Safeguards (DoLS). Last year, figures collated by NHS Digital showed that record numbers of care home residents were being deprived of their liberty, in some cases through being given particular drugs, in others through physical constraints[2]. In 2015, care homes in England asked local councils to approve over 195,000 DoLS applications, a significant increase on the figure of 137,000 for 2008. Around 25% of these were rejected, meaning that people were effectively being denied their freedom. So your ability and willingness to speak for people in these circumstances – which could involve needing to make the case in your own organisation – is where advocacy and leadership will come together.
This leads on to advocacy’s wider role. It’s not just about supporting individuals that you know and work with directly. It’s about speaking up for groups of people where you feel that something isn’t right. One – admittedly extreme – example: a residential care provider in Yorkshire, Maria Mallaband Care, were fined £1.6 million in 2016 for allowing a 91-year-old woman with dementia to die of severe hypothermia in one of their care homes[3]. The woman’s temperature was nearly 10 degrees below the hypothermia threshold of 35C, and the court described ‘systematic, systemic failures’ at the home.
But the court also noted that many people, including staff and relatives, had noticed the heating not working properly, and reported this to management. My guess would be that there would have been many others coming in and out of the home – District Nurses, OTs – who would have noticed the same thing. But no-one spoke up or advocated effectively. This is why leadership, as expressed through advocacy, isn’t just about our own practice: it’s about addressing poor practice wherever we see it. If you’re a social care leader, you don’t pass by on the other side.
And at the same time, you bang the drum for the positive side of social care. Advocacy isn’t only needed for individuals. I think the whole sector could do with some better advocacy – for the high quality care it delivers every day; to the difference it makes to people’s lives; for its role at the heart of communities; and as a significant local employer and driver of local economies. So I’d encourage everyone to act as advocates, and ambassadors, for social care. Of course we know the problems – we come up against them every day. But social care has fantastic experience of confounding the problems and still delivering excellent care and support. So let’s be leaders and advocates for ourselves: whether it’s in local or national media, or with councillors or MPs or government in general: let’s make the case for 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] The Leadership Qualities Framework for Adult Social Care: National Skills Academy for Social Care. See: http://tiny.cc/4vpt1x
[2] See: https://www.theguardian.com/society/2016/sep/28/care-home-residents-deprived-of-liberty-in-record-numbers?CMP=share_btn_link
[3] See: https://www.theguardian.com/uk-news/2016/sep/28/care-home-maria-mallaband-care-fined-allowing-woman-freeze-death?CMP=share_btn_link
