CHAPTER 7
Leadership and direction
We evaluated the leadership and direction of health and care services to be unsatisfactory, with major weaknesses.
Senior managers had a vision of community-based, person-centred services to improve the outcomes for people using services. Health and care services were going through a major transition in order to deliver services at a community level. The transformation strategies were aimed at addressing a range of long-standing service and financial challenges. However, at the time of our inspection, it was too early to evidence their impact.
This vision was not clear to many of the staff we spoke to, and even where it was, staff did not feel included in its implementation.
Elected members we spoke to although active in, and committed to, developing health and care services were not always well informed about the challenges services faced. Nor were they in a position to be able to effectively scrutinise activities.
We found significant difficulties in relationships between and within staff groups at all levels. There was a lack of trust and communication was often distorted. Morale amongst staff was low and had been for a long time. Leadership across the service was weak.
There was a lack of clarity about the role of the chief social work officer and issues of accountability and decision making in some areas of social work practice.
The follow-up inspection of criminal justice social work services also identified weaknesses in the leadership and management of the service. Despite a clear improvement plan being in place, the service had failed to deliver on many of the required improvements.
Vision, values and aims
Promotion of vision and values
The council had a vision to be one of the leading councils in northern Europe by 2010, a vision set out in the community plan in 2005-06. A key objective had been to promote a more positive corporate approach with services delivered jointly at a neighbourhood, community level. As described in Chapter 4 this had led to the development of 37 neighbourhoods each with their own plan.
The transformation strategies approved in October 2007, set the vision for health and care services:
' At the heart of this strategy is the delivery of high-performing, integrated, citizen-focused services.'
In addition, health and care services aimed to develop more personalised, self-directed care packages through the implementation of 'In Control'.
The chief executive was clear in his vision for health and care services and about his commitment to see change to improve the outcomes for the citizens of Aberdeen. He wanted to improve corporate working and stated that any departmental barriers within the council or with partners had to be overcome. He told us that he had consciously adopted a more hands-on approach within social work. It was his view that a less directive approach had not succeeded previously. He also made it clear that this was aimed at supporting the service and its staff.
We found that the senior management team were also clear about the vision, values and aims they wanted to achieve for health and care services for adult and children's services.
In the SEQ, senior staff stated that the majority of staff within health and care had a good awareness of the vision, values and aims of the council. We found the opposite to be the case. The staff and managers we spoke to did not think this vision had been communicated effectively throughout the service. Few staff felt part of this direction or clear about their role in achieving it. Only some staff who responded to our survey agreed that there was a clear vision for social work. This was at the lower end of responses to date from other inspections. Managers and fieldworkers recorded negative responses to this statement.
The new approach to self-directed care was a bold step in the planning for change against a traditional centre-based service. There had been a number of briefings of elected members, staff, stakeholders and senior managers. However, many staff and some managers still had doubts about how significantly services would be changed.
Staff and some managers also told us of a range of anxieties they had about the move to a more localised method of service delivery. They stated that they were not against the general direction rather that they did not think the implications for all service users had been thought out.
Role of elected members
The new administration had been elected in May 2007. The senior politicians that we met acknowledged that many of the current challenges were long-standing and reflected key problems in forward planning, strategic management of services and the achievement of balanced budgets.
These serious issues had not been dealt with by the elected members in the previous administration. They had failed to address the urgent need to modernise the services and to ensure budget efficiencies were achieved either well enough or quickly enough.
However, we remained concerned that the current elected members we spoke to still did not fully understand the range of issues facing health and care services in Aberdeen, or some of the limitations of the proposed plans to address the problems. We were not confident about their ability to appropriately challenge and hold officers to account. As outlined earlier we were also concerned that there was not enough information provided in budget reports to enable proper scrutiny by elected members.
When interviewed, elected members had not been able to comment on matters or issues outwith their precise responsibilities. There appeared no overlap across the lead member arrangements for education and health and care. This was an important gap in the council's commitment to developing cross-cutting approaches. The considerable overspend on placing children out of the city appeared to have little or no political scrutiny nor questioning about developing alternative provision within the city.
Only some staff (22%) who responded to our survey agreed that social work was highly valued by elected members.
Recommendation 19
Health and care services should ensure further work is undertaken with elected members to enable them to effectively exercise their responsibilities towards health and care services.
Cross-cutting approach within the council
The council's commitment to a cross-cutting approach to service delivery was demonstrated through the changes in the council structure. The three area corporate directors were charged with making sure that services came together around the needs of communities and citizens. They held responsibility for all services in their area.
Aberdeen City Council had chosen a very different structural approach to the delivery of services. In order for any structure to be successful there must be effective communication, clear lines of responsibility and good working relationships. We found all of these areas to have significant weaknesses.
We found real tensions between those with strategic and operational responsibility. A significant number of managers told us of that they did not think that those with responsibility for strategic leadership had sufficient knowledge of social work services. They did not think some of the proposals in the transformation strategies were achievable. Those with operational responsibility for learning disability services were not clear about the strategic direction of the service, despite a clear business plan being in place. Stakeholders and partners also told us of their concerns that strategic and operational teams were not working well together.
Despite arrangements being in place for formal and informal joint working across the three areas, it appeared to us from our interviews that there were tensions between those operating at heads of service level. We were also told of a competitive culture between the neighbourhood areas that was not supporting collaborative working.
There appeared to be overlapping lines of responsibility between the strategists within the office of the CSWO and those within the other sections of strategic leadership. There was potential for confusion about these responsibilities which was acknowledged by the acting corporate director for the service, who had already identified this as an area for improvement.
The chief social work officer post was situated at the third tier of management, at the same level as the heads of service. A number of managers at different levels suggested that this position created a tension in decision making and leadership on social work issues. The CSWO told us that initially her authority had been uncertain within the structure. Professional responsibilities had been unclear in the relationship between their role and the role of the heads of service. We were told that this was now resolved and responsibilities and accountabilities were now clear.
Some staff and managers we spoke to were not clear about the role of the CSWO within the service and in particular how the role related to the heads of service. From two of our interviews with elected members, one clearly did not support the role and another was unclear about the position and its status within the organisation. The criminal justice inspection that is reported in detail in Chapter 9, noted that the head of service and the CSWO did not appear to be working effectively together to address the problems in the service, first reported in 2006.
The chief executive told us that any disagreement between the heads of service and the CSWO would be resolved by the corporate director for strategic leadership. We were told by the CSWO and the corporate director for strategic leadership that a direct relationship existed between the CSWO and the chief executive. This had been positively encouraged.
The CSWO stated that her role had become more apparent within the structure. However, it appeared to us that this was very much dependent on personal influence rather than clearly stated and agreed authority and responsibilities.
Recommendation 20
In accordance with the principles outlined in Changing Lives, the council should clarify the role and responsibilities of the chief social work officer and communicate these throughout the service.
We discuss the communication difficulties later in this chapter.
We read a corporate parenting policy which had the right aspirations but did not state how it would be implemented. It outlined the value of such an approach but had no outcome measures, targets, or clear action plans. The corporate parenting responsibilities of the council were not always well understood by the elected members we spoke to.
Leadership of people
Positive leadership culture
The senior management team were enthusiastic about and committed to tackling the significant change agenda that was required within the city. Health and care services were seen as a priority service area, as illustrated by the first transformation strategies aimed at their improvement. Senior managers were aiming to ensure that this improvement was integrated throughout all processes, including supervision and appraisal systems, the development of stronger planning processes and initial steps towards greater user, staff and stakeholder involvement.
However, we did not find a positive leadership culture within health and care services. We were told during fieldwork and through the surveys of a top-down approach by management. Some of the comments in the staff survey suggested that the leadership culture was one that was 'macho', 'punitive', 'autocratic' and 'hectoring'. This appeared to be affecting all tiers of staff. Some staff in some service areas told us during fieldwork that their direct line managers were protecting them from some of the impact of this. We did not find any direct evidence of such an approach in our inspection, but as stated earlier, some staff and some managers clearly perceived this as a dominant culture.
We were told by different managers that in the past staff and managers had not been held to sufficient account for services or for budgets. This had led to a culture whereby decisions had sometimes been taken without sufficient rigour in assessment or reference to resource availability. As the change process had begun to take effect, and a more consistent approach to accountability was put in place, there had been significant resistance to this level of scrutiny.
We found that this was part of an unhelpful dynamic of relationships between staff within the council that is elaborated further in the next pages.
As outlined in Chapter 4 the employee morale and motivation group had concluded that the main factor influencing an employee's motivation was their relationship with their line manager. As a result the council was delivering training on leadership to all its managers and leadership competencies are part of the corporate appraisal process. This was in addition to a range of other positive activity described earlier. A simple but pragmatic approach included ensuring that all interviews for management positions required applicants to be questioned on how they would approach morale and motivation issues with their staff group. A range of training and coaching processes are also in place to support managers in their role in developing leadership skills.
We were concerned that a small minority of front line staff seemed to operate outwith operational systems in a number of basic areas. These included not answering calls, blocking the smooth transfer of cases and not inputting data onto CareFirst in a timely or accurate way. Staff must act in a professional and accountable manner within a clear set of responsibilities. This must be addressed by both line managers and staff.
Senior managers told us that there was a culture of non-compliance across the council, including in health and care services. We found some evidence of this. For instance in the transfer of cases between teams and in implementing the disaggregation plans. As managers had begun to introduce a more robust approach to performance management, this was meeting with some not unexpected resistance.
Recommendation 21
Health and care services should ensure that all staff are aware of, and are held to account for their responsibilities as employees of the local authority within health and care services.
Involvement of staff
Only some staff who responded to our survey agreed that senior managers communicated well with them. Fieldworkers and managers responded most negatively.
Staff and managers told us in the surveys and during fieldwork that, despite significant levels of experience in the city, they felt that their views were not seriously listened to:
' I feel impotent of being able to influence or even feed into the decision making process.' (staff survey)
' There are major issues that are not being listened to or addressed properly.' (staff survey)
' Decision making often does not take into consideration the view of staff with the most relevant experience.' (staff survey)
Staff and managers told us that when they did express worries they were viewed as being obstructive or failing to embrace change. We saw written evidence of such a response.
One manager in a partner service stated that corporate directors were not interested in debating or listening to evidence and the strategists were neither confident nor experienced enough to allow a debate. This was further acknowledged by one of the elected members we spoke to during fieldwork. Given the significant number of staff and managers reflecting this view to us we thought this could present a potential risk to people using services where services were being developed without due attention to professional concerns.
The heads of service in the neighbourhoods should have a pivotal role in managing the tensions between operational concerns and strategic direction. It did not appear to us that this was always as effective as needed.
The development of the transformation strategies took place within a clearly defined timeframe to ensure that the evidence on which they were based remained valid and meaningful. Although we were shown material about the briefings that had taken place for staff of all grades to tell them about the strategies, it was clear that some managers and staff did not feel the timeline allowed this process to be as inclusive as it could have been.
Low staff morale and poor relationships between teams presented Aberdeen City Council with further potential risks in implementing new ways of working. For instance, in discussing the implementation of the new eligibility criteria, we were told by some staff that due to worries about possible risks to some users of services, some would be assessed at a higher level of need than was required. There was a risk that staff could subvert the implementation process if they did not understand why the change was being introduced. Staff had been briefed and training sessions provided. As already discussed a risk register was in place, identifying and addressing this issue. Again, however, it was striking that staff still did not feel engaged.
The SEQ submitted by the council acknowledged that they 'still have some way to go to win the hearts and minds of all staff' and we would concur with this view. It is of concern that in the next sentence they believed that 'we have good communication at all levels of the organisation'. We found the opposite to be the case.
We saw evidence that senior managers, including the chief executive were routinely visiting teams and services and that there were open staff briefing sessions. The senior management team were providing opportunities for staff to hear about changes and for staff to tell them about their experience. This appeared to be having very little effect. We found a very serious breakdown of communication between staff at all tiers of the service. Communication was taking place however, staff and managers appeared not to be listening to each other.
Recommendation 22
Health and care services should take urgent action to improve relationships and rebuild trust between staff and managers.
Leadership of change and improvement
Political leadership and capacity
As already stated above we had some concerns about the extent of the understanding of elected members about their responsibilities to health and care services and the implications of the change agenda.
An elected member was part of the CitiStat meetings and was engaged in the process of performance management. Elected members played a role in an annual programme of visits to different establishments and teams.
Well-managed leadership of change
Only some (19%) staff who responded to our survey felt that there was effective leadership of change in health and care services. Leadership in these services had undergone radical changes to both personnel and structure over a period of less than two years. Change of this order presented challenges to service stability to ensure that people continued to receive services under the new arrangements. Senior management in the council were aware of this potential risk.
The chief executive was clear that change was necessary within health and care services and the transformation strategies highlighted that 'whilst we have some high performing services, overall the services … are not consistently performing amongst the best in Scotland … services are not consistently citizen focused ... we are currently consuming far more resources than are justified or available in the current climate'.
The chief executive saw improving health and care services as a key priority and had taken on more direct oversight of service performance. Staff told us that he had always been visible to them through briefings and at their inductions. On occasion we were told that this was in contrast to the lack of visibility of the corporate directors. He was actively supporting the CitiStat process and was about to take on the chair of the JADAT. This was part of an intention on his part to be more 'hands on' in his management of the service to ensure service improvement. It was notable that some senior managers stated that they had come to recognise the importance of this approach to drive up standards in the shorter term. They also acknowledged that this approach could be experienced negatively. This was contributing to the difficult dynamics in communication within the service.
The council had a commitment to developing a culture of continuous improvement. In order to meet the aspirations set out in the transformation strategies this would need to be embedded at all levels of the organisation. Given the difficulties outlined above in terms of the perceived lack of staff involvement, the low morale and difficulties in trust this will be a significant challenge for the service to achieve.
However, many of the issues that health and care were facing were long-standing. These included poor budgetary control, an excessive use of external placements for children and adults with learning disabilities, low morale and poor outcomes.
For instance, low staff morale had been identified as a problem in 2005 through the employee opinion survey, as was poor communication and management of change. A committee report written in October 2005 20 contains a response from Unison which stated that 'there has been a serious issue with morale over the past few years'. Although this covers the whole council, it was apparent the worries staff had were not new.
The transformation strategies were radical changes in direction for the service and it was too early to see their impact on some of these issues at the time of our inspection.