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10th August 2015 3

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Sir Robert Naylor

One of the longest serving leaders in the NHS, running one of the biggest Trusts.

What's life like at the top? Find out; in conversation with Roy Lilley; King's Fund 16th September

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Real managers are realists

News and Comment from Roy Lilley

I can't think of another business, were it faced with 150 allegations a day of abuse of its customers, it would wring its hands and make fatuous remarks to the press.

I'd expect an inquiry, the police to turn up, ministers to be on the telly and the prime minister to demand, urgently, what's what.

According to the Guardian there are 30,000 allegations of physical, emotional and sexual abuse and financial fraud around the care system. Our most vulnerable citizens are being abused on an industrial scale.

Andrea Sutcliffe chief inspector of care homes blames everyone and everything but herself. On her watch complaints about care are double what they were in 2011. Increase in demand, increasing in complexity and diminution of funding is pushing safe care out the reach of the CQC and the public. Sutcliffe is a spectator.

Once in a while, in the career of all managers, there is a moment when the voice whispers... are you sure? Do you really want to be doing this? Are you doing the right thing? Insecurity becomes your new partner. You know you are marking time, achieving nothing and probably doing more harm than good.

You arrive at the six realities of management.

#1 Your problems are your own.

In Sutcliffe's world that means an overwhelming 150 allegations of abuse a day. It will get worse. There is nothing inspection can do about it. It has gone from a tide to a tsunami. Sutcliffe is powerless. There is not enough money in the system to pay enough, well trained people, to provide enough decent care.

Managers arrive at a point where they know they applied for the job, made the decision, said to themselves; you can do it and now you are on you own. Your problems are yours and yours alone. People around you will look to you for answers, leadership and direction. There comes a creeping realisation... you can't do it. Care homes are getting worse, not better.

#2 No one owes you anything.

Where you once inspired people into believing they were on mission, part of a wider truth, could make things better, they realise it is futile. The tide overwhelms them and people leave, move on; avoiding being tarnished by failure. Usually it is the best people who jump ship, they can work anywhere. New people who join often can't.

As the Dilnot report reminds us:

"More and more people are becoming disengaged from a care system that is increasingly dysfunctional, driven by crisis..."

#3 It is someone else's fault.

Sutcliffe is highlighting the cuts in social care budgets. She is right; it is an impossible task to improve care homes where budgets are reduced and demand is exploding. Sutcliffe will inspect herself to a standstill. When she closes the last care home... what happens next? The decline is out of her control.

#4 There are no shortcuts.

Sutcliffe will be looking for an angle, a formula, a resource, a toolkit, a workshop, a conference, anything to put it right. She will frantically highlight instances of good practice and claim they can be replicated... if they could be, they would be. Care home proprietors would be doing it for themselves. This is a sector in decline. The sector itself says so.

#5 Everything will be ok.

It won't. Government will not provide more money. Interest rates will go up; the living wage will be increased, impacting on operating cost. Local authorities will cut their tariffs. Things will get worse, as will the quality. Inspection cannot improve it, merely highlight it. Sutcliffe first warned us that care homes were 'unacceptable' in 2013. What has changed?

#6 Dreams don't come true.

The reality is a nightmare; things will get worse. No one in government is interested in increasing taxes or expenditure. The care home cost cap has been shelved.

There is no point the CQC hammering a fragile sector that has neither the money, the resource, the training nor the wherewithal to make it work.

Inspection adds costs, highlights the problems and makes it less and less attractive as an investment option or a career. Banks won't fund it and people won't work in it.

The six fundamental truths of management. Tough but real managers are realists.

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