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A trap to catch us all

November 26, 2018

By guest blogger Dr David Zigmond

John Burton’s blog of January 2st again takes to task the CQC’s senior executives. He finds more examples of clumsy mismanagement and their avoidance of discussing the consequences.

This is a familiar pattern throughout our welfare services. As a veteran NHS doctor, I have seen this increasingly in the NHS. In particular, large organisations know how to game the system; smaller ones tend to be more vocational and nakedly honest, so are more likely to be found ‘inadequate’, taken into ‘special measures’, or even closed – all these despite clear objections from those who know and use the service most.

John Burton has long been doubtful that our culture of ever-more regulations, management and inspections is helpful or even sustainable. Most experienced practitioners strongly agree. Notably, the system’s few defenders are its administrators.

Yet, when I have managed to talk to these senior officers, they too are stressed, entangled and compromised by this system: they are caught in a publicly accountable, but doomed, mission. That mission is to provide machine-like efficiency to our welfare services. Why is this doomed? Because humans are not machines, and to get the best from one another in complex care we cannot simply command-and-control by increasing our use of sticks and carrots.

A good system is one that is likely to bring out the best in us, while a bad system does the reverse. This is true whatever the claimed intent of the system: the road to hell is paved with good intentions.

Our lives are now largely dependent on brilliant machines that we do not understand but which we command-and-control, usually by finger-tapping, to immediately grant our wishes. Magic!

Adopting the same mindset with humans in complex relationships and activities is leading us into a swamp of foolish misunderstandings. John Burton’s catalogue of CQC follies provides excellent examples of this cultural trap – to manage our fellows like machines.

This trap can catch us all alike: practitioners, clients and managers…

If you want to read more try Playing the ball not the player, on my Home Page, http://www.marco-learningsystems.com/pages/david-zigmond/david-zigmond.html Letter 95.

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.

4 Replies to “A trap to catch us all”

  1. Excellent blog. Recently I wrote an article on inconsistencies in CQC regulation caused by humans not machines (posted on LinkedIn) and got the following response from a medical doctor with a specialism in data science: “The regulator has more than enough granular data to develop a QA framework for consistency that is based on prior variables. With all the talk about machine learning I would be surprised if that’s not something they’re thinking about or actively working on.” A complete obsession with the power and infallibility of machines! Pleased I am not alone in my skepticism on this issue.

  2. The report on research assessing CQC’s impact on provider performance (conducted by the King’s Fund and Alliance Manchester Business School) suggested a more collaborative model for regulation. “Our work has highlighted the social dimension of regulation and the importance of relationships between CQC staff and those working in health and social care provision, and suggests that a more transactional approach to regulatory interventions risks undervaluing the soft, informal, influencing power of regulation. It suggests that, however well conceptualised, designed and planned the regulatory model may be, its impact is fundamentally shaped by how it is experienced, how it is implemented, and the skills and values of those who are involved in regulation.” Not too much about machines replacing humans in that!

    So far, however, that particular seed appears to have been allowed to fall on fallow ground; the sum total of column inches devoted to a wide-ranging discussion of that interesting suggestion has been zero.

  3. Sadly Bob I think you are right. I read with despair the paper before the recent CQC Board meeting on their change programme. It was focused on digital transformation, as well as being written in complete gobbledygook. I am reminded of the excellent book by Francis Wheen. How Mumbo-Jumbo Conquered the World. I should send the new Chief Executive a copy to read over Xmas…

  4. How refreshing it is to read David Zigmond’s take on regulation in health and social care. (And there’s plenty more Zigmond wit and wisdom, and wide ranging ideas in his brilliant book “If you want good personalised healthcare – see a vet.”) The point is that social care – even more than healthcare – is about human relationships and they are very difficult to measure. While there are some important measurable technical functions of a care home the core of care is a matter of feeling and judgement. The best judges of care and how good a place is are the residents and their relatives and friends. They need an inspector and regulator whom they know and who can, when necessary, call in to require improvement. Someone who is close and responsive, and knows how things work. We don’t need to change the basic standards and legislation; we just need to use them properly with human beings.

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