As charities provide more health and social care services, their leadership and governance will come under increasing scrutiny from regulators.
According to the CQC's 2017/18 State of Care report, more than three-quarters
of NHS and independent community health service providers,
including charities, are providing good care. However, 26% were
rated as requiring improvement around safety, while 2% were rated
inadequate in this category. Just under a fifth (18%)
required improvement for being well-led.
Lesley Dixon, Chair of the health and social care special interest group at the Association of Chief Executives of Voluntary Organisations (ACEVO), is also Chief Executive at Person Shaped Support (PSS), a charity which works in adult social care, the criminal justice system and with troubled families.
Dixon feels that getting leadership, safety and governance right is all about having leaders at every level of the organisation. "It's about setting the right tone at the top of the organisation, working on the basis that there are leaders at every level, and clear policies and frameworks for people to work within but with the idea that in those frameworks there is freedom for people to work in their own ways," she says.
LEADING THE WAY TO SAFER CARE
Mark Ospedale is Director of Corporate Services at United Response, a charity which supports more than 2,000 people with learning disabilities and autism. He feels that charities should be doing more to ensure they are well-led, particularly as the CQC starts to ask whether the overall organisation is well-led rather than just the service it provides.
Skills for Care, the strategic body for workforce development in
adult social care in England, provides training for
registered managers. But Ospedale says leadership at all levels would benefit from formal development programmes involving interaction with colleagues from other organisations.
"It improves networking, the ability to learn from others and makes it a far richer environment than only ever learning from colleagues you work with," he says.
He adds good organisations should also offer a range of options for whistle-blowing, such as using well-signposted internal procedures, contacting the charity Protect (formerly Public Concern at Work) or going to the CQC directly.
"I think most organisations have robust whistle-blowing procedures, but I think the question that arises is whether culturally the people on the ground feel confident that nothing is going to happen to them [if they whistle-blow] and there is an open culture of speaking out."
Zoe Campbell, Operations Director, Transformation, Commercial and Outreach at Alzheimer's Society, says her organisation has invested in internal training modules called Cutting Edge to improve leadership.
"All of our management teams across the organisation take part in these modules so we have a consistent approach. We have a leadership group within the organisation, but we also talk to layers [of people] beneath that group about the fact that they are also leaders."
"Management is one thing but that is very different to leadership, and that is something we do emphasise across the organisation," she says.
Tony Hunter, Chief Executive at the Social Care Institute for Excellence (SCIE), a charity that identifies and shares good practice across all aspects of social care, feels that any perception that charities are poor relations of public services "is a deep insult".
Hunter says a recent SCIE roundtable breakfast meeting on safeguarding for charity trustees concluded that good leadership and safeguarding is about getting the foundations right.
However, he adds the charity trustees attending also spoke of concerns that boards may not see safeguarding as a priority, and work under the assumption that it "takes care of itself".
"Often a high turnover of workers and short-term volunteers mean safeguarding training can be seen as a wasted investment," he says.
Plus, he adds there can be challenges around determining
charities' responsibilities: "Some speakers felt
abuse and safeguarding is such a broad topic that it's hard to understand what falls under the remit for charities to deal with."
Hunter says other concerns include lack of time to review or implement good safeguarding practices, and a lack of money to purchase safeguarding training and invest in reporting systems. In addition, a lack of diversity on boards "encourages 'groupthink' complacency and an inability to see issues from different perspectives".
The final conundrum facing charities is that many simultaneously provide paid-for public services and have a campaigning remit. "That is a difficult mix to get right," says Hunter. "Councils will say 'we are not paying for campaigning, we are paying for services', while charity clients and relatives might be saying they are delighted by the campaigning as they can have a louder voice than a health or local government organisation."
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