Business ideology has no place in care services and social work

The exodus of staff from caring professions may be driven by a realisation that the profits of private firms are triumphing over person-centred care, writes Diarmaid Twomey

Abuses of the type revealed in ‘RTÉ Investigates: Inside Ireland’s Nursing Homes’ are fostered and perpetuated by a focus on box-ticking corporate compliance, rather than tangible outcomes of good person-centred care. Picture: RTÉ

A recent Hiqa report highlighted concerns around timely interventions for children at risk of abuse in an area of Dublin.

One of the primary issues highlighted as contributing to these concerns was the negative impact of staffing levels on the particular service’s ability to deal with the demands placed upon it.

This report forms part of an ongoing trend of media headlines lamenting the lack of suitably qualified staff in various professions involved in the delivery of care services in Ireland.

In my own profession of social work, this problem is not new, so why have we not got to grips with it? Among the myriad reasons highlighted as problematic, one of the most prominent is the high degree of turnover of social workers, with some sectors particularly hard hit.

In recent times I have been reflecting on my own career path, and how close I am to being part of those statistics.

It is important to acknowledge from the outset that all professions have their own challenges, none more so than when the cornerstone of your work involves dealing with highly complex and emotive problems. Yet, of late I have been particularly struggling with one aspect of the way in which the various caring professions have to operate for our most vulnerable; the hegemony of business processes and concepts that seem to now characterise every facet of care.

Person-centred care

While I am deeply passionate about my profession, I have begun to question how far removed it has become from what initially attracted me to it well over 10 years ago, and how much this realisation jars with my own value system.

One of the cornerstones of social work has always been to practice in a person-centred manner, where the needs of the person should predominate any and all decisions. I feel that translates to all caring professions — from social carers to nurses to health care assistants, to name but a few. 

Yet, adopting a business ideology and mindset, where care is appraised on spreadsheets and the institution or service demands the leading role, is incongruous with the very idea of keeping the person at the heart of their own care. 

Ergo, I have begun to wonder if the idea of person-centred practice across the caring professions is merely tokenism at this point, as systems, and one’s ability to operate as a corporately lubricated cog within them, rely more on corporate compliance, rather than tangible outcomes of good care.

Viewers shocked by the abuses shown in ‘RTÉ Investigates: Inside Ireland’s Nursing Homes’ understandably focus on the individual staff members but a more nuanced approach is to understand how a care system focused on spreadsheets rather than on the person is not only complicit in such inhumanity, it fosters and perpetuates it.

Salt to the wound, in recent times, private enterprise has firmly embedded itself in the space of the caring professions, confident in its ability to yield vast profits from the most vulnerable in our society, in a system that values corporate compliance and its associated byproducts.

Simultaneously, the not-for-profit care system, which accounts for the vast majority of care services, has appeared to let the tail wag the dog. Data-driven systems which were originally seen as a complement to the work of care, now appear to have devoured it.

Metrics, efficiency, and process-driven systems define the success of care interventions. Suddenly, care could be defined as robotic, remote, and ultimately tick-box.

Cast your mind back to the exceptional, if not heartbreaking RTÉ Investigates programme on nursing home care in June of this year. Viewers bore witness to elderly residents feeling the brutal brunt of a lack of humanity and care, in two private nursing homes run by the multibillion-euro international conglomerate Emeis Ireland.

Employers create the conditions 

The kneejerk and understandable response to the horrifying images of elderly people being manhandled and left in soiled beds for hours on end would be to blame the individual workers tasked with their care. Yet, while there is merit in that, the more nuanced approach is to understand how a system that measures care on spreadsheets is not only complicit in such inhumanity, it fosters and perpetuates it.

The delivery of care in these homes seemed to be entirely task-based, with workers rushing to fulfil duties, while grossly under-resourced, the residents appearing to be distractions to the work. In such an instance, should culpability lie solely with the worker, with the organisation, or with the system of care that in this instance appeared to measure care in a boardroom and not a bedroom?

A part of me accepts that the train has already left the station; being semi astute in business appears to gift you the right to do almost anything these days, from running a country to affording your voice credibility on any contemporary issue. This now appears to have extended to running care institutions and dictating how care systems should operate.

However, what I struggle to understand is what a business model brings to care that doesn’t morph it into something entirely different, something tangibly worse for the person that should be at the centre of it.

And so, as I grapple with this I am left wondering if the ever-increasing number leaving the caring professions have realised this, and if this shared observation has been the catalyst to their departure.

Have we simply replaced one form of institutionalised care with another form of hierarchical care, a collective stain which will only become apparent with the benefit of a protracted hindsight?

Care is being transformed right now

Whatever the truth, I worry that the transformation of care services is happening before our eyes, with little to no objection, systems and people having being wooed by the allure of data, ‘work ons’, and business models. Losing our humanity, both as deliverers and recipients of care can only end one way, in the normalisation of a system that works for itself and not for the person it exists to serve.

Speaking from my own perspective, that is the antithesis to my passion for the work, and the further normalisation of this system would be the cleared path to my departure. I yearn for an urgent return to the fundamentals of person-centred care; yet this can only happen with a demotion of business ideology and everything it permeates.

To achieve this requires a deep level of introspection across education providers, regulatory bodies, and all systems of care, both private and public.

A mammoth task but, without it, I can’t bear to think about the future of care, for you, for me, for us all.

• Diarmaid Twomey is a social worker and undergraduate tutor at the school of applied social studies in UCC, with interests in the area of children and young people. The views expressed in this article are his and not those of his employer.