I interpret the ‘view from the top’ as being more about an overview analysis than pronouncements from someone who feels they occupy a royally-elevated position, so, with that Corbyn-esque democratisation of leadership, I’ll begin.
Reflections on the last decade
At LCA, we have been trying to work effectively with local authority and health colleagues at a strategic level since about 2005. That’s about a decade, isn’t it? What comes most to mind as I reflect on that period from the threshold where we stand now, at the eve of the ‘integration’ era? Er…Jackanory.
While fees and funding dominate the sector discourse, and shock-horror headlines the sector’s image, it is really about the story. The NHS has one and it is revered. Talking of the NHS can bring a tremulous note to the speaker’s voice and the expression you see in those Russian posters that showed the conquering proletariat staring steely-eyed to a new dawn. The immense positive regard is also a much-needed sustaining force.
However, when we refer to the independent care sector, in many ways indistinguishable from the NHS, it causes no such swelling breast. The template precedes and frames the reality. The worst of the NHS, when it comes to light, has no impact on its overall positive narrative; while the best of the independent sector doesn’t make a mark on its critical template.
These templates are not the reality, which is fantastically more complex – nor is the debate framed in the same way across the third and private sectors – but the filters shape thought, perspective and attitude amongst even the most sophisticated of professionals and policy-makers. It is, oddly enough, these intangibles – barriers arising from the ways people think – that feature largest in my reflection on the last decade.
I didn’t know I was going to say that here. Perhaps I’ll rephrase it. A decade of under-funding and a longstanding workforce crisis leaves the independent sector fragile. It is struggling to meet the overwhelming demand, increased expectations and needs, and over-regulation that characterises the sector. It has been a decade where we have seen ever-greater resources going to an army of regulators and overseers, who have questionable impact on ultimate care outcomes and are not regulated properly, while frontline care struggles for air.
Projections for the next decade
Integration and workforce are the watchwords. Integration is the next big thing. It means different things to different people. One thing I hold true: independent care providers need to have an effective voice in shaping integrated care.
Also, without addressing the workforce crisis, it’s just putting new wine in old bottles. The absence of a sustaining narrative and affective attachment for the independent sector weakens that voice. The challenge for us is to develop that narrative and workforce self-esteem. In Lancashire, we are having some ‘blue-sky’ thinking about a care academy – working with schools, further education and higher education – to help make care the source of pride we want it to be.
I’m a chief executive in the not-for-profit sector, facing the big-small challenges anyone in a similar position faces. How do you do the big things well, the aspirational aims, and also make sure you’re on top of all the detail, not least your finances?
My biggest musical influence is Jeff Lynne. But I don’t think that’s relevant. My wife is my biggest influence. Honestly! She is organised, pragmatic, has clear standards and has drive. She helped me find direction and focus. She’s an occupational therapist! She won’t read this, so I’m not just saying it for effect.
One thing I’ve learned – oh, no, I said that phrase – is there’s always a danger in being influenced by people or ideas you like or who make you feel comfortable. The challenge is to learn from people you don’t like and learn from situations you wouldn’t choose to be in. I’ve also learned, it’s much easier to say than do.