The news is full of the crisis in health and social care. We all know that something has got to change. We all know that the NHS is unsustainable without an effective social care system. We all know that things are not going to get any better. The things we should be celebrating; like living longer and having more effective treatments for medical ills are, instead, portrayed as the reason for our failing system. Or, just as commonly, it’s claimed that the bosses are useless, nurses are callous, care assistants are careless and money has nothing to do with quality.
I’ve argued for a long time that we need a radical rethink of how we view, and how we support, social care to be the essential part of our society and economy that it needs to be. It should be as fundamental to our society as the infrastructures of rail, roads and power. If what we want is kindness, compassion and warm human care, why do we surround it in a system that’s impersonal, adversarial and super-critical? What we want is good relationship-centred care that is human, kind and empathetic. Why can’t we do it?
Many of you will recall the terrible disaster, 30 years ago, on the 28th January 1986 when the space shuttle Challenger broke up shortly after lift off. All seven of the crew were killed along with the loss of billions of dollars worth of space shuttle and the reputation of NASA. Why did the Challenger break up? Technically it was all down to a rubber ‘O’ ring about half an inch thick. This ‘O’ ring was part of a seal that prevented the hot exhaust gasses on the shuttle’s solid rocket booster from escaping and threatening the integrity of the fuel tanks. On 28th January, the seal failed and hot gasses damaged the fuel tank. It broke away and the destabilised shuttle broke up at 48000ft, travelling at twice the speed of sound. Why did the ‘O’ ring fail? NASA has an enormous system of checks, protocols, launch procedures, safety checks and yet this thin ‘O’ ring didn’t work on the day. Why? Well there was nothing wrong with the ‘O’ ring, nothing wrong with the seal. After all, it had worked well in the previous 26 shuttle flights. All previous flights had lifted off in an ambient temperature above 12 degrees.
On the 28th January it was cold, below freezing. When cold, the thin rubber ‘O’ ring became rigid and hard, not soft and pliant. It didn’t make the seal and failed. The company that designed and made the seal had concerns about the ‘O’ rings’ integrity, in below freezing temperatures. However, the launch went ahead. The outcome was tragedy. Interestingly, the decision to launch was made between the managers and engineers. Those with the most to lose, the astronauts, weren’t included in the process. The cause of the disaster was not the ‘O’ ring. It was not because there wasn’t enough paperwork, check boxes or audits. It was because the people in the ‘system’ collectively denied the laws of physics.
Now, getting back to social care (and health), I think we ignore the obvious facts. The ‘O’ ring represents every person working in health and social care. Each one a tiny player in a huge complex system. If one fails, tragedy can result.
Underpaid, overworked, undervalued care workers, without the warmth around them to be ‘soft and pliable’, can become ‘rigid and hard’. Tired and anxious doctors can’t be ‘soft and pliable’; can’t be good ‘O’ rings. Fearful, overburdened care home managers, constantly criticised, struggle to concentrate on what matters most – the relationships they nurture. The ‘O’ rings are failing to make the seal. Care providers can’t recruit enough of the right kind of ‘O’ ring, hospitals can’t recruit CE ‘O’ rings.
Social care is under too much pressure. Current Care Quality Commission ratings highlight, on a daily basis, the poor performances of providers. It’s not because the people working in them are useless. It’s because we’ve made their task too hard, too complex and too vulnerable.
What are we doing about it? We are making it even colder. Denying resources, ramping up the blame and shame. Everyone standing back, demanding quality without putting any of their own ‘skin in the game’. We are just telling the ‘O’ rings to be kinder, safer and cheaper, and they can’t do it. We are just like those engineers, convincing ourselves that things will be fine, even though they knew the ring would fail. We can’t afford to ignore the laws of our humanity.
The system needs to turn up the thermostat and make everyone warmer. Care needs more money, more status, less bureaucracy and more thought. Then we can all be good, safe ‘O’ rings and our shuttle will fly.
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