Opinion: Let’s learn from failures, rather than waiting for reforms

Rob Finney, chief operating officer at Tristone Healthcare, discusses the relationship between learning from failure and the impact this has on operational effectiveness within a social care business.

The window of opportunity to feedback on phase one of a ‘Case for Change’ has now officially closed. There’s little doubt that the initial recommendations have divided opinion across the social care sector.

Have the proposed reforms gone far enough? Is it too early to tell what impact they will have on the industry? And does the report demonstrate a deep enough understanding of the difficulties the sector is facing?

It’s probably a case of no, yes, and maybe. The industry was clearly sceptical about what the report would include and, while there’s not a huge amount that’s new, many of the recommendations should be welcomed. For me, the key takeaways are:

  • Levelling up – it’s encouraging to see recognition around the need for increased investment and rebalancing of care provision across the UK, as the report said deprivation was a key factor among families needing help. Many of those who asked for support found assessments and investigations added to their stress.
  • Focus on early help – acknowledgement that the sector needs to redress the balance of focus on crisis support and a move towards providing early help is a real positive. What’s more, allowing social workers, who are the industry’s greatest asset, to spend more time with families – avoiding a situation where they’re being overwhelmed with paperwork – is an excellent move, as long as any changes are still safe and robust. 
  • Deregulation – there is some suggestion in the report that the review may push for more deregulation in how the community supports families, particularly in kinship care. This would be a worry for the sector if it did materialise and is one potential move that you can only hope gets lost in all the rhetoric. 

We’ve learned from past reviews, such as the Social Care Reform in January 2016, which looked at governance and accountability, practice and systems, and people and leadership, that well-meaning change can take time to trickle down to the grass roots.

It’s a slow-turning wheel. We’re only in phase one of the latest review, with further findings not expected until the spring 2022. As such, the onus is on the industry to create its own change, for organisations to identify ways of improving how social care functions, and for the sector to independently explore the relationship between learning from failure and the impact this has on operational effectiveness within a social care business.

Learning from failure

The biggest concerns for social care businesses are often linked to failures resulting in harm to an individual service user, striking at the very heart of what they’re aiming to achieve. If an individual experiences harm through ineffective practice or poor operational oversight, not only does this have serious implications for the individual concerned, but can also result in reputational damage, suspension of services, deregistration and ultimately a loss of trust.

It’s essential to put in place effective and robust operational measures to reduce the potential for harm and counter avoidable failings being repeated. Businesses need to quickly develop an approach to risk mitigation, to strengthen corporate governance and, crucially, disseminate key areas of learning that aim to reduce potential risk to service users.

Social care services are complex, and a primary function should be to manage risk. This risk can be from the service user to others, or to themselves. There are also risks posed by others wanting to exploit the vulnerabilities of individuals. To mitigate risks, social care businesses need to implement a variety of proactive measures that sit alongside the right culture and performance framework so that everyone can learn from failure in operational and commercial areas, including:

  • Safeguarding
  • Project management
  • Financial management
  • People strategy.

According to the latest CQC ‘State of Care’ report, 275 social care providers are classed as inadequate, with nearly 3,500 requiring improvement. Leading experts believe this often down to inconsistent leadership, poor safeguarding strategies, ineffective resource management and an inability to adopt the right values and behaviours. Creating an open, blame-free culture is seen as key to protecting against the risk of future failure, but this should also include individual accountability.

One of the professional standards for social work is to, ‘reflect on my learning activities and evidence what impact continuing professional development has on the quality of my practice.’ (Social Work England 2021). If we’re to succeed in achieving this, while creating operational effectiveness and quality-of-service provisions, every person within a social care organisation needs to take a step back and learn from crises, and smaller-scale failures, rather than waiting for reforms to show us the way. The case for change has already been made.

Rob Finney is chief operating officer at Tristone Healthcare. He has 25 years’ social work experience, including managing unregulated 16 plus provision, managing children’s homes and fostering services and commissioning children’s placements for local authorities.

Photo Credit – Petal


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