“New philosophy of caring needed in the management of the health and homeless services or real reform will not happen”
Alice Leahy, Addressing TRUST Seminar, Royal College of Surgeons
“Wasting time with people” is the way the current management philosophy of the various health, social and homeless services regards anything above very minimal human contact by front line care workers with patients and those they are meant to serve, Alice Leahy, Director and Co-Founder of TRUST said today (Tuesday, October 12, 2004) at a seminar entitled: “IS THE MANAGEMENT PHILOSOPHY OF BENCHMARKS AND PERFORMANCE INDICATORS INCOMPATIBLE WITH A PHILOSOPHY OF CARING?”
“The most important aspect of the delivery care by a front line medical professional, nurse or a doctor is the time spent with the patient. There is something very dangerous about measuring the quality of that time in quantitative terms more suitable for the production of widgets. However, it is also a false economy because as people do not find help they become a bigger and more expensive burden on the State.
“This is most obvious in our work with people who find themselves homeless on the streets. Those who feel themselves outsiders in our society and cannot cope need understanding and more than a few minutes at a time before being moved on to the next service provider. This is one by product of the current management system – people being constantly moved on but never really helped so that they become like permanent refugees inside the system. This explains why the current model is not producing results except swallowing up more and more resources for temporary and unsuitable emergency B&B accommodation.
“One of the reasons this failure is not being addressed in a more forthright way is because many of the organisations that traditionally provided the prophetic voices in defence of the most vulnerable have allowed themselves (often with the best of motives) to be commissioned with larger and larger grants to carry out the role of the State in meeting the needs of the most vulnerable on the street.
“In short, through a process of soft privatisation the State is allowed off the hook. However, the voluntary bodies cannot solve the problem either because the flawed management philosophy employed in the state services is forced on them
as well in the way in which their grant applications are assessed. Human contact is undervalued and the quality of care is driven down as the culture of benchmarks and performance indicators award points for moving people on which inevitably means the most vulnerable continue to be excluded.
“This is of course fundamentally about human rights in the sense of respecting people as people and refusing to see them as mere statistics to be measured and researched like inanimate objects. We have been concerned for sometime about the way in which the people we meet everyday are forced to trade the most personal information for help – for example a hostel bed. Often the questioning is done by people with little or no training so that it can be damaging for people already reduced to sleeping on the streets precisely because they cannot cope with the rigours imposed by society, the form filling and other demands the rest of us take for granted. But the benchmarks and performance indicators cannot be seen to be achieved unless the information is harvested and so the damaging cycle repeats itself.
“For most people their only experience of how time and human contact is undervalued in the health service is the way many GPs are forced to meet very heavy demands with less and less time spent with each patient. However, that management philosophy imposed on people who are homeless on the street, many with serious addictive, mental and psychiatric problems means they are reduced to being constantly referred on and on in a painful and ironically very uneconomic cycle from the point of view of the state.”
“Undervaluing human contact and front line care must stop. It is intangible. It is not easily measured. However, the consequences of the failure of the current management philosophy especially as it has been applied in the homeless services has made life much tougher for the outsiders in our midst and the taxpayer has got a bad deal. A philosophy of caring is good for people but is also the most economic in the long-term. We would argue for it even if it was more expensive but the evidence available suggests the opposite is the case and an even greater irony is that the current management philosophy which is supposed to expose inefficiency has done a very good job covering up its own inadequacies as services are rewarded for moving people on,” ALICE LEAHY said.
