Professional Leadership and Judgment in Caring for Vulnerable Citizens

1. Caring for Vulnerable Citizens: The role of professional leadership and judgement in nursing Phi Mu Chapter Sigma Theta Tau International 4 December 2012 Professor Keith Brown Director of the National Centre for Post Qualifying Social Work

2. A young police officer was taking his final exam at Hendon Police College in North London. Here is one of the questions…. “You are on patrol in outer London when an explosion occurs in a gas main in a nearby street.  On investigation you find that a large hole has been blown in the footpath and there is an overturned van nearby.  Inside the van there is a strong smell of alcohol.  Both occupants - a man and a woman - are injured.  You recognise the woman as the wife of your Divisional Inspector, who is at present away in the USA.  A passing motorist stops to offer you assistance and you realize that he is a man who is wanted for armed robbery.  Suddenly a man runs out of a nearby house, shouting that his wife is expecting a baby and that the shock of the explosion has made the birth imminent.  Another man is crying for help, having been blown into an adjacent canal by the explosion, and he cannot swim. Bearing in mind the provisions of the Mental Health Act, describe in a few words what action you would take.” The officer thought for a moment, picked up his pen and wrote: "I would take off my uniform and mingle with the crowd."

3. Reflections • The demographics • The economics • Personalisation • A very personal reflection • The key – professional leadership • Issues for professional education

4. The demographics • From 1984 to 2009 – over 65 age group from increased from 15% to 16%. An increase of 1.7m. • Over the same period – under 16 age group decreased from 21% to 19%. • By 2034 – 23% of population projected to be aged over 65, compared to 18% being under 16.

5. The Barnet Graph of Doom

6. Demographics – Myth or Reality? The pension ‘time bomb’ assumes more of us will be living well into our 80s and 90s. Will this happen? What about the impact of raising the state pension age to 68? Will this cause a reduction in life expectancy? Also consider impact of obesity and diet.

7. The economics - Public Spending

9. Recent Newshttp://www.youtube.com/watch?v=ioWkb5eig1c NHS!

10. Elderly NHS patients' harrowing plight is revealed in reportSome elderly patients were given no help to eat or left in urine-soaked clothes, according to the health service ombudsman Denis Campbell, health correspondent. The Guardian 15/02/2011 The NHS is inflicting pain and suffering on elderly patients and ignoring their most basic needs, according to a report by the health service ombudsman which highlights cases where vulnerable patients were failed. Some patients were not offered help with eating or bathing, and one was left in urine-soaked clothes held together with paper clips. Older people too often did not receive the care, compassion and respect they deserved, according to the ombudsman, Ann Abraham. Her report cites 10 cases inadequately investigated by the NHS, in which elderly men and women were treated appallingly, often towards the end of their lives. It details serious failings in how NHS staff managed the patients' pain, nutritional needs and discharge from hospital, often with disastrous consequences. Her disclosures led to calls for the NHS to urgently overhaul its care of the elderly.

11. "These often harrowing accounts should cause every member of NHS staff who reads this report to pause and ask themselves if any of their patients could suffer in the same way. I know from my caseload that in many cases the answer must be 'yes'," said Abraham. The 10 anonymous cases outlined in the report include: • Alzheimer's sufferer Mrs J, 82, whose husband was denied the chance to be with her when she died at Ealing hospital in west London because he had been "forgotten" in a waiting room. • Mrs R, a dementia patient, who was not given a bath or shower during 13 weeks at Southampton University Hospitals NHS trust. She was not helped to eat, despite being unable to feed herself, and suffered nine falls, only one of which was recorded in her notes. • "Feisty and independent" Mrs H, who had lived alone until she was 88, was taken from Heartlands hospital in Birmingham to a care home in Tyneside but, when she arrived, was bruised, soaked in urine, dishevelled, and wearing someone else's clothes, which were held up with large paper clips. • Mr C suffered a heart attack soon after undergoing quadruple coronary artery bypass surgery at Oxford Radcliffe Hospitals NHS trust. Trust staff turned off his life support machine even though his family had asked for them to wait for a short while longer.

12. Winterbourne View Was this abuse or torture? Rochdale – child prostitution Essex - £285,000 per year for one child in care Haringey – Child protection / but what about neglect

13. Personalisation Clearly personalisation and direct budgets have been of great value to the adult disability community, allowing for much greater freedom and self control. But what about the most vulnerable citizens: • the very elderly • those with dementia • the learning disability community Can, and indeed does, the personalisation agenda raise serious safeguarding issues for these citizens? Are we allowing abuse to occur, or potentially occur, due to our lack of consideration of safeguarding as we blindly follow a social policy initiative?

14. A few personal reflections How many of us who lead or develop strategies for vulnerable citizens actually interface with them on a regular basis? • The ‘hidden’ vulnerable: the homeless • Basics Bank – a story and a personal challenge • Bolingbroke Hospital

15. Professional Leadership One of the key recommendations of the Social Work Reform Board was for the development of a leadership and management pathway for front line social work managers. This surely must be the key to driving up standards and quality and in particular ensuring that abuse of whatever kind does not occur. Inspection and regulation simply cannot achieve this. Staff did not go to Winterbourne View to abuse residents but the culture allowed this to occur and nobody stood up to report this behaviour.

16. Recent Press and Public Concerns about the Care of Vulnerable Citizens • Jeremy Hunt MP: Managers have been too focused on targets and finances and have ‘lost sight’ of the quality of patient care. 7 November 2012 • Professional Standards Authority new Voluntary Standards are based on Seven Core Values • Responsibility • Honesty • Openness • Respect • Professionalism • Leadership • Integrity

17. Our Response • Leadership • Assessment and Impact Evaluation • Safeguarding Training

18. We have continued to deliver, evaluate and refine our ideas Leadership Following the launch last year of the Leadership and Management Pathway for Social Work and Social Care

19. Leadership • We believe that the ‘Seven Core Values’ cannot be achieved without offering leadership development based on our new principle of ‘Self Leadership’ • Staff require and deserve the opportunity to develop the skills and capabilities of Self Leadership as this is fundamental to being able to achieve these Seven Core Values • Without clear leadership development for all staff, as all professionals exercise some form of leadership responsibility, we have little or no chance of preventing abuse in care • Why did the staff at Winterbourne View who were not involved in the abuse, not report it?!!

20. This training needs to be assessed: • So that we know the learning has occurred • Good assessment strategies also help the learning process by reinforcement, extending the experience and allowing for reflection • …and also evaluated for impact: • Does it make any difference ?

22. Professional Education • How do/will education of health and social care keep up to date with current and developing practice? • Research – but most of this appears to be about educational process and has little impact on practice. • The REF Driver – does this develop practice?

23. Professional Education 2 • We need to engage with current practice and practitioners especially via CPD programmes. • We need a clear focus on what we are about as professionals ie promoting and enhancing quality of life and at times ‘saving’ lives. • Self Leadership can be a vehicle to ensure we keep this focus: “Good to Great” – Jim Collins and the hedgehog.

24. Why bother at all? When the head teacher Philip Lawrence was killed just before Christmas 1996, his only son Lucien wrote the following message to Father Christmas. Dear Father Christmas I hope you are well and not too cold. I hope you won’t think that I am being a nuisance, but I have changed my mind what I want for christmas. I wanted to have a telescope but now I want to have my daddy back because without my daddy I will not be able to see the stars anyway. I am the only boy in the family now but I am not very big and I need my daddy to stop my mummy and sisters from crying. love from lucien lawrence Age 8