Following the publication of the recent Serious Case Review report into the death of Khyra Ishaq there were, as expected, calls for Tony Howell, the Head of Children’s Services, to resign, to which he responded that, although he intended to retire before long, he had no intention of resigning unless Birmingham City Council, to whom he is accountable, asked him to do so.
He was, in our view, absolutely right. Mistakes were made and opportunities were lost which could have protected Khyra, but the proper role of the Head of Children’s Services is to create the right setting (policy, finance, morale, communications systems and so on) for his colleagues to work in, not to be responsible personally for every single client and worker. If the chief officer had to resign every time something went wrong, there would be a rapidly revolving door in every authority in the country. In a big authority with massive social problems such as Birmingham there are bound to be misjudgements, mistakes and bad practice from time to time, some of which will have serious consequences.
The fundamental question, we suggest, is whether there is trust that people are motivated to do their best in the first place and to try to put things right if there go wrong. This is not only the trust of elected Councillors in the chief officer, but the staff trust in their managers, and vice versa, and – most important of all – service users’ trust in the professionals who serve them.
Trust is in one sense very simple; it is based on one person’s assessment of another. People often make their minds up quickly about such things – whether to trust a politician’s promise on television, whether to trust a doctor’s diagnosis, whether to believe a story from a child. The judgement is based on a number of factors – the person’s reputation and track record for reliability in the past, whether what is being said sounds convincing and fits the known facts, the person’s body language, the context and a judgement about the possible influences on the person.
At one time the word of professionals was given more weight and there was greater trust in their judgements. There was an assumption that they had their clients’ best interests at heart. Now, there is greater questioning and mistrust.
In part, it may be no bad thing if unquestioning acceptance of professionals’ opinions has been eroded. In medicine, for example, patients can learn much more about their conditions on the internet than previously and doctors need to assume that patients may be knowledgeable. In social services there are many more specialist advocacy groups that can help service users and brief them about their rights, and there are more complex legal processes to protect their interests and rights. All these things limit the power of professionals to act without being questioned.
In part, though, something has been lost. The emphasis on rights seems to have led to an atmosphere in which people make demands as if taking part in an adversarial process, rather than one in which the professionals are motivated to help. The setting of targets does not help, as it encourages workers to judge themselves and be judged by the criteria set, rather than by the satisfaction of the service user and the strength of the relationship between the professional and the service user – in short, their mutual trust.
If the relationship is based on rights, contracts, targets and criteria rather than trust, people respond accordingly. There is the risk that service users demand what is laid down, and professionals provide what is required but no more. We may lose the humanity and warmth in the process. When that happens, the service users may feel uncared for and the workers may get no job satisfaction. Trust is vital if service users are to feel secure in relying on professionals; this sense of security may be their lifeline, helping them out of problems to safety and then self-reliance.
The problem is that the centralising bureaucratic system of government, as applied for the last two or three decades, believes that if things are specified in accordance with good practice, they will be done and there will be good services. That may work in programming computers, but human beings don’t function like that.
Overload on instructions and they will be ignored. Be too specific and there will be human needs which do not fit the guidance. Be overdirective and people may rebel in subtle ways. Individual human beings need to respond to other individual human beings; they may like to experiment, to assert their individuality, to be themselves, to ignore guidelines, to put two fingers up to authority, to be non-conformist, to rebel perhaps.
What matters fundamentally is whether the relationship between worker and service user enables the service user’s needs to be met, not whether the regulations or guidance have been followed. We are not arguing for anarchy, and usually service users’ needs will be met best by following the guidance. We are just recognising the priorities.
The relationship between service user and worker will be one of trust when there is mutual respect, when the worker listens, when talking is straight (and kind), when the worker does what they promise to do, when the service user appreciates that the worker knows what they are doing or what they are talking about, when there is continuity of care to build up the relationship. Note that, while workers need to be skilled, most of the things that matter relate to their values and attitudes, their personal qualities.
Of course, there are many workers with the right values and attitudes, and many managers whose values are right and who are trusted by their staff. What we are suggesting is that the system built up over recent decades tends to some extent to undermine trust by undervaluing the quality of human relations and giving priority to bureaucratic processes. We are not arguing for a total change but a shift of emphases, but it is a shift which is important to both staff and workers.