http://www.communitycare.co.uk/Articles/10/11/2011/117741/judge-orders-council-to-rethink-care-provider-fee-freeze.htm
I've been reading a bit about this and what I'd like to know it to what extent the profits of these private providers were impacted on by the freeze. We are in a recession and many of us have not had a pay increase - in fact given inflation we have had a pay reduction. Were these owners really unable to provide the level of care required or were they unwilling to reduce their profit margin? Which is, in effect, something many people have had to do who have suffered pay cuts or even unemployment.
Local authority fees do not really cover the cost of care and never have, they are regularly subsidised by private payers, the levels of fees are about 50% more if you go private. I couldn't declaim on profits margins without looking at the individual companies, but there is a basic safe and dignified level of staffing that must be provided and that does cost money. Utility bills continue to rise above inflation.
I do not think (and I am unhappy with the very idea of profit-making in social care) that it's a simple matter of "oh, they can just cut profits". For some companies, yes, but don't forget many have to service and get loans in the commercial marketplace and if they don't make enough profit they won't get/keep them.
Yes, you are right if they don't make enough profit they will close down shop but what would be interesting to know is what is 'enough profit'? I guess it's whatever the owner decides is enough profit.
It all make a bit of a mockery of neo liberal ideas about the free market. If I go into Marks and decide the jumper I wanted is too expensive I am not forced by a judge to pay more for it. Alhough having said that I think the judge in this case did not say they shouldn't have frozen the fees but that they should have consulted on doing so. There again if I decided not to buy the jumper no one would force me to discuss that with M&S share holders!
The most important thing to realise about the private sector is that there is a huge variance between the 'profits' that these providers make. Three different types (and these are not exhaustive) are:
1. Small family owned businesses...run by individuals who have taken huge risks, re-mortgaged their own family homes, have run at a loss, make hardly any profit (which is not good as it puts the whole operation in jeopardy and puts service users at risk of having to leave their homes). These individuals earn very little and often do it as they have been disillusioned by LA provision and want to take it upon themselves to do things differently
2. Medium sized privately owned businesses who make a healthy, yet not exhorbitant profit. These organisation are run by Directors / Managers that get an annual income similar to LA employees. Company accounts are fully available through a public finance report and due to the size of the organisation, its quite easy to see the profit/loss status. These organisations can be well placed to deliver services as the 'profit' they make is often kept in reserves to tide the provider over in tough times (ie when there are vacancies) or they are used to open up new services. Some of these providers provide services of an excellent quality.
3. Large privately owned companies which maximise profit to pay out their shareholders. These larger organisations can make significant profit and this can sometimes be at the risk of reduced quality. Due to the size of the organisation, there needs to be someone at the helm who places service users needs first. Unfortunately the priority for some shareholders is often profit and so it can be a tough challenge to satisfy everyone.
The PROBLEM that we have in the public sector is that we foolishly stereotype all private providers and think they are all earning huge profits and don't put needs first. And if there's something that social workers really shouldn't do..it's to stereotype!! If we are going to get the best for service users we all have a duty to be a bit more open minded and find out more about the variety of different services in the private sector.
Looks like more and more are shutting up shop:
http://www.guardian.co.uk/business/2011/nov/14/care-home-administrations-double?CMP=twt_fd
It's a ridiculous way to carry on - leaving care of our most vulnerable members of society to the vagaries of the free market.
Reality is... whilst we are living in a free society, we are never going see health and care services located exclusively in the public sector. People will always have the freedom to set up their own services. The fact we have a 'care market' really isn't a problem.
Our problem is that LA's are not managing the market well. There is no real competition, no level playing field, and a lack of individuals with both care and commissioning experience in the driving seats. And overall we don't have a healthy culture of impartiality and objectivity.
For years we have seen blame for failure placed at the private providers door...but finally we are starting to see a shift and a focus on the consequences of LA commissioning practice. One example being the annual OFSTED report in 2010 which concluded that it was poor commissioning practice in LA's that was contributing significantly to poor outcomes and placement breakdowns.
We NEED a market. Markets mean we can create competition.. competition is what creates quality and value for money. But the issue is that LA's generally refuse to acknowledge this.
I've yet to go into a home, in twenty years of doing so, that I would happily live in. I have not seen any evidence to support your statement that competition creates qualtiy and value for money. I am unclear as to how the LAs commissioning pracitces are to blame, could you possibly expand a little? Thank you
Well.. first of all you have to accept that Social Care is a business. However uncomfortable that may feel... the simple fact is that one party buys a service and one party provides it. It's governed by legislation, contract law. regulations and has to be sustainable through healthy financial management.
Just like any other business... whether retail or service based, quality and value for money can only be achieved by opening up the market. Just think about anything else... clothes, hotels, cars, plumbers, hairdressers, houses.. You would want to look at the options that you had before confirming your choice.
If you knew you needed a blue jumper and had time to shop around, you wouldn't go into the first shop, see a very expensive and poor quality jumper and decide to buy it without looking at other shops. No, you'd likely have a look in a few shops and maybe online too before making your choice to get the best quality for the lowest price.
The problem we have in social care is that there is rarely any real choice when it comes to securing services for individuals. Look at the LAC system where we are instructed to place children 'in-house' and are not allowed to even look at what other options there may be..many of which could meet particular needs much better. Or when we have to use a particular dom care agency for an eldery person...even if they don't have staff that can speak the necessary language.
Thats where commissioners get it wrong... they set up systems and strategic frameworks which are far too restrictive on the ideology that it will save money, and they wrongly think that a generic specification is 'enough' to meet a variety of needs ...but it ends up costing more in the long run if we don't have choice when commissioning for individuals.
If we opened up choice more, that would mean that providers (including in-house) wouldn't have such a guaranteed income. By knowing that they were being compared alongside other providers for services, providers would reduce costs (we'd see a reduced profit margin for some) and they'd improve quality. Where we have seen LA's opening up competition, we've seen the benefits of this... but most LA's simply aren't brave enough to take the leap of faith. It takes a good strong brave leader.
Competition increases quality and reduces cost. Its simply economics.
Seems to me that competition can drive up standards or it can drive down costs but not necessarily at the same time - have you never flown Ryan Air? When deciding to buy a jumper I tend to chose between cheap and bugger the quality or expensive and better quality. Similarly with domicillary care agencies - you can pay less which means the carer may not be able to speak mandarin chinese when communicating with your service user who can only speak mandarin chinese or you have to pay more - that is not to do with the local authority.
We as a community have decided to make a low investment in social care. This is is not due to the ideology of commissioners but rather due to political and economic decisions.
But you are coming from the point at which you, as the consumer, have decided what you want. In your example... you placed cost as the priority. What if you decided a minimum level of quality, and only then put cost as a secondary factor with the aim to choose the cheapest out of the options that met your minimum standard.
As an example.... you want a flight from Birmingham to Edingburgh, you set a minimum quality standard in terms of leg room, service, qualty of food etc. After looking at options, you may decide to discount Ryan air ... as it doesn't meet your pre-set quality standard, but you still have the option of Easyjet or Bmibaby. Assuming they both met your quality standard, you would only then go for the cheapest.
Unfortunately the systems and frameworks commissioners are setting up for health & social care don't always work this way. Cost gets the priority and so the cheapest often has to be used regardless of quality.
Of course its about the ideology of commissioners... they have the choice to weight quality and price. It's NOT coming from central government as a small number of LA's have the conviction to place a higher weighting on quality. But sadly they are few and far between.
Competition implies that the less competitive companies fail and that's their version of being accountable.
Really with social care, having the company fail should not exempt directors of services which fail basic health and safety checks from facing serious prison sentences. ie. imagine the fallout if a LA service failed in safeguarding the way that Castlebeck did.
There's a good blog here about why the purchaser/ provider split is failing.
My fault but the example of the flight or the jumper does not really work as I have the option not to buy either - neither are crucial services. To paraphrase our national treasure Jeremy Hardy privitisation is all very well if you want a nice cup of coffee but not, in this case, if you want someone to keep you safe and help you go to the toilet. I could afford a cheap jumper and, every now and then, a cheap flight but I can't afford to pay either £350.00 or £450.00 a week to be looked after - that is why we subsidise these costs - like we do with housing. There are certain costs that can't be met by the average wage or pension so the state funds them from our taxes.
Do you really think that commissioners make the decision about how much the state is going to pay to subsidise care costs? Is it not the owners of the business who set their price, decide how much profit they want to make and then advertise their wares in the market place? And is it not the electorate who decide how much tax they are willing to pay for such care? Seems like the commissioners are trying to get the best price they can on behalf of the tax payer - a broker you might say?
I've yet to read your link copperbird, will do as it is beginning to seem pretty relevant.
A few comments..
Copperbird, About the blog...
1. The provider / purchaser split is not failing. The article fails to make any reference to models where LA's have retained their own provider services but have placed them on a level playing field with external providers. This model works extremely well if done properly. However, there are so few examples as LA's are reluctant to do this. Why? Because it puts a real magnifying glass on in-house services who may not be as effective and efficient as has been portrayed 2. Because if in-house services can't compete on quality and cost it puts jobs at risk and 3. the model means LA officers having to start to scrutinise the services managed by colleagues. (which can be very uncomfortable..and so yes, a brokerage model is certainly the way forward)
But... as we will always have private services and there will always be support for public services, it is the only model which transparently compares the two alongside each other and provides users or their advocates with real choice.
The blog also fails to come up with any constructive way forward...which is a disappointment and does discredit it to some extent.
Chirpy Cockney, just because a service is essential does not mean there should not be choice and that we shouldn't have the best methods possible of identifying services.
I didn't say that commissioners set the price. They can't and that would be dangerous. It has to be the market that dictates price...and that's all about demand and supply. Its natural economics and LA's need to learn how to manage it, rather than try and impose prices. The bottom line is .. if a service user NEEDS a service and there is only one provider in the whole country that can provide that specialist service at that particular time (it does happen), then the LA HAS to pay what the provider asks for as there is no alternative. You may disagree ... in which case, let me know what the alternative is. Yes, there may be an option to develop / commission new services at a lower cost, but if the need is immediate the price has to be paid albeit for a temporary period.
But if a provider does whack on a huge profit margin, they may be foolish as their services are unlikely to be used again. In my experience its pretty rare to find providers that operate in such a way as they fast go out of business (and there are much easier ways of making a fast buck!)
Now profit... A completely misused word. Some food for thought...
1. One LA paid out £569,000 to a councillor when he left. It came from 'reserves'. Looking at comparable accounting terms, this would be labelled as 'profit' in the private sector. Make you think doesn't it???
2. Many tenders ask for a minimum profit to be made by private providers, so that there is assurance that, in the event of vacancies, services can be maintained. Every year hundreds of providers do not qualify as LA procurement teams deem that they are not making 'enough' profit. (So mixed messages are being given!)
3. Significant levels of 'profit' are re-invested into developing new services that are requested by LA's. LA's do not have this capital and so if the money was not in the privaye sector, where would it come from?
4. We are seeing an unprecedented amount of resdential providers leaving the sector due to financial difficulties. Some going into administration. Some of these charging £3k to £4k per week. If they were making such huge profits they could have sold the business. They simply are running at a loss.
It makes me wonder... do we need the SW course to cover economics and the commissioning cycle so that there is better awareness of these issues based on actual evidence (rather than stereotype and assumption?)
Having been in the sector as provider and purchaser for around 20 years now, I am convinced that there are models that work (like the one explained in my first point). And that we really need more genuine and facilitated partnership working.
The BBC news today has an article about how the National Audit office concludes that short term cuts can cost more in the long run. Unfortunately, unless we have dynamic leaders that put in the right models now, we'll see social care fast going the same way. The private sector is sometimes favoured because of its culture...the openness to change, the ability to take risks, its ability to create efficiencies by pushing decisions to the lowest level possible. All factors that make for effective and efficient provision.
The problem with the public sector..is that many LA's are too risk averse and are heading in the other direction. Its a huge shame.. there is a wealth of skills and knowledge in the public sector. There are many dynamic and forward thinking individuals that are held back by old fashioned systems and culture. And they are moving to the private sector.
But I've come to the conclusion that that really doesn't matter... they are staying in the social care sector and at these times when we need good people around who can (a) put people first and (b) know how to operate effective, efficient, safe and viable services... I really don't care which side of the fence they sit on.
I'm just happy to work with anyone who has those qualities.
What is it about choice that it has become at one and the same time deifyed and yet so elusive? So I get the chance to choose between one naff care home and another, whoop de doo. I'd rather have no choice and one good quality home that ploughs any profits made back into the proiding affordable provision rather than into individuals or share holders pockets.
To reply to your points:
Yes councils waste money as in your example of money paid to a councillor but that doesn't make people profitering out of tax payers money ok.
Given we have privitised care the least tenders can do is ask that they are viable, once again this does not make it right that people make profits from tax payers money.
Funding for new services would come from the savings made in local authorities not using tax payers money to fund profits.
How long does a business run at a loss? Surely that is not viable and as you say, many are closing down, that is what happens in the private sector and then what happens to the residents? Such crucial services should not be left to the vagaries of the free market. It's natural ecomomics you might say, I say it's people's lives. A failing market involved in a race to the bottom in terms of care standards is not in resident's favour.
Seems to me that just because someone decided social care should be a business didn't make it a good idea.
Still not read the link, will do later
I am sorry.. but I find your answer so naivie. Can you give me one example of a service or product that does not have any competition at all...yet manages to remain of an excellent quality and is provided for exceptional value for money?
Eton College, the Bar Association, Farmers Union, Cambridge University, MIT Boston, Rolls Royce and Bentley cars, Medical research, the Royal FAmily for the patriotic and it goes on. Rainbowarch, you seem to equate excellence with consumerism and from that extrapolate that if you get to choose between 14 pairs of shoes and 18 winter coats that by definition means we have good choice. Question is why do you need to have more than one of something if you could have just one excellent thing. Your definition if choice and competition is resource wasteful and in reality a false abundance because though you beleive it to be true, there is no real free trade given that Tesco and aAinsbury fix praices and most products, including social care provision, is priced by barely disguised cartels. ,
I think this is a good and important debate.
I agree with Rainbowarch that commissioning has been badly wanting (and probably made worse in recent times by the completely mis-judged belief that all service users wil be turned into consumers via personal budgets and so reduce Councils' commissioning role). However, I dont agree that choice can drive up quality. The economics of choice requires a surplus, so that providers whose goods are not chosen can still survive to fight another day. Of course, customers pay for the surplus in the prices paid. There is no way that public funding will stretch to funding surpluses.
But I believe that money and profit are by no means the only - or even the best - motivation for public services. They are riven with people who are intensely driven by the public good. It includes people working in the independent sector, who are happy to get their living from profit, but who are passionate about their work.
I dont agree with price competition in social care. We have surely seen how deeply damaging that can be, attracting all the worst of operators who will make their money at the lowest prices. I believe we need a concept of fair price and of fair profit - and we need commissioners with the wit and skill to idenitfy they best people to work with, to work in partnership with them to help them achieve the very best they can.
Colin Slasberg
Off the top of my head there is the amublance service, the fire service, police and armed forces. As I'm sure you know cheapest is not always best and I am sure that if other services such as the nhs and social services were funded adequately they too could provide excellent quality services that were good value for money. But as it is they are trying to provide adequate services cheaply.
re Lovecats point on barely disguised cartels. Yes, it is the nature of the market to create monopolies and personally I would rather have a state monoploy whcih is in someway accountable to the electorate as opposed to a private monopoly which is only accountable to it's shareholders.
Most of the examples given don't work as they can be compared to other services / products (ie cars). Either that, or they sub-contract and use the private sector for products and services (the armed forces being a good example)
I'm really pleased CS has made 2 important comments. 1. A reference to 'fair profit'. The recognition that its okay, and even a positive thing for there to be profits (or 'reserves as LA's will call it) is a good thing. 2. A reference to partnership working. It is the one single thing that is going to result in better services for users. But whilst we have social workers who maintain the 'stop privatisation!' mantra without putting forward any constructive practical solutions, I fail to see how we will make progress
Rainbowarch: I am sorry.. but I find your answer so naivie. Can you give me one example of a service or product that does not have any competition at all...yet manages to remain of an excellent quality and is provided for exceptional value for money?
BBC
Of course the BBC has competition!
Sorry but I'm not sure how (or why) you are comparing our emergency services to cars?
I have no problem with reserves that are used to enrich the services the tax payer has paid for and not, and sorry to repeat myself here, to enrich the pockets of shareholders.
Given the complete mess we are in due to rappant free marketeering and neo liberalist policies I do find your exhaultation of choice, no matter how false a notion that may be, and profits well, erm, naive I guess you might say.
My constructive proposal is for crucial services that most people can't afford to pay for individually to be paid for by all of us and not set up for the benefit of a few to make a profit. As said, social care has been turned into a business - an opportunity to make a profit - but that has not make it a good thing.
Well.. firstly, I didn't compare cares to emergency services, so maybe you need to re-read that post.
I think we're in agreement about shareholders... I am not a fan of large venture capatalists taking over care services either. I also think that when you have shareholders of these organisations...the individuals at the top become disassociated with whats going on at the front line, that most neither care or have the time to do anything about poor service delivery. In many of these set ups - profit is the priority and that's obviously wrong
But.. as I keep saying on this forum (and a point that some people find hard to grasp).. a huge number of privately run care services do not have boards of Directors and a hidden group of faceless shareholders. Many are family run businesses, or small private organisations and many have individuals at the top who know every member of staff and the service users they support. These small to medium organisations make modest and not exhorbitant profits, they often deliver services of an excellent quality and many are run by individuals who started off their career in social work. They simply left the public sector because they wanted the freedom to develop services of a higher standard and did not feel this would happen in the controlling, bureaucratic & risk averse public sector.
They make enough profit to earn a fair living, have reserves in the bank in the event of either reduced contracts (so they can maintain services for existing client for a period of time) or they use these reserves to open up new services.
It is these organisations that I feel need to be championed. They place users at the forefront ...but sadly too many people in the public sector have a distorted view of the private sector and think that all privately owned services put profit first. Its simply stereotyping and ignorant.
Social Care is a business... we are never going to go back to the days when its provided exclusively by the public sector. No matter how deep the passion...it'll never happen. So.. we must turn our focus to how we can best manage the market to get the best for vulnerable individuals.
Most of the examples given don't work as they can be compared to other services / products (ie cars).
In my experience the smaller homes I have been to are indeed an improvement of the larger warehousing operations that bupa and the like run but I have never been to a home that I would want to live in.
Whilst the intentions of the smaller home owners may be more honorable I'm not sure that good quality care can be provided at the price we, the tax payers, are prepared to subsidise it at and, as said earlier, those of us on average wages or pensions cannot afford to pay for good quality etc care on an individual basis. So the council pays private providers to provide a naff service and for someone to make a profit. Some people may actally want to provide a private service for nothing, out of the kindness of their heart , but they will go out of business as they have to eat, pay the mortgage etc. So we have meagre amounts of money being spent on some of our most vulnerable members of society. I don't think leaving the care of these people to an increasingly unregulated private sector is a reponsible approach.
You are right Social Care is a business and as I have said making it a business did not make it a good idea - just look at Southern Cross, and as you have said, the many other providers that fail. It may be it will never go back to be provided by the public sector but surely must be able to consider alternatives.
As the authour of the blog I thought I'd chip in here and reply to a couple of points you raise..
comparing in-house care with external providers is difficult on a cost basis, as in my old LA we were told no-one really knows how much the in-house provider is costing on a per-hour basis. Of course it was possible to tell what the costs of the provider were, but converting this into an comparable hourly rate is actualy a tricky business (or so I was told by the senior people) and in the case of my LA the figure we used was actually a guess!
It's a seperate, but related point as to why I say that the purchaser/ provider split isn't working and it is down to some pretty elementary economic theory. The issue is that the quality of care provided cannot exceed the cost paid for it. In a market situation (where the LA is the funder but not provider) this means that if an LA pays £300 per week for a place in res. care, then if the provider provides care to a greater value, they will ultimately be forced to leave the market as the LA will pay no more.
On the other hand an LA provider isn't so rigidly bound by the rules of the market. It simply provides the service and meets the cost, so if the same person was in a LA res. care home and all the costs of providing that care brought it to a total of £350 per week then that is what the LA pays as it is in effect paying itself.
You may well argue that in reality LAs face financial constraints, which they do, but the essential element is this. In the private res. care home there is a cap on quality.
There were 2 big issues in my LA when I was there. First, as I mention in my blog commissioning, or their polices, were driving the cost of care down. In ordinary home-care charges fell to a level where lots of small local providers were forced out of the market in favour of big national providers with economies of scale who carved up the area between them leaving SUs with no choice as to their care provider
In res. care at my LA we were increasing our MFLs by about 1% per year. Great for the LAs budget, but speaking to someone who worked as head-of-care in a res. home it seems that margins became so tight that things were happening like electrical sockets breaking and not getting fixed, a little thing but maybe symptomatic of the system. My reading of Southern Cross is also that tightening of margins changed the picture quite dramatically.
I'm not one to say public good/ private bad, basically I blame LAs for the situation. As bulk purchasers of care their actions do shape markets. It seems to me that starving them of cash has led to a system which isn't benefitting anyone.
Most problematic though, as I mentioned in my blog post is the lack of direct accountability. LAs are effectively turning a blind eye to how savings are being made, often by squeezing the pay and conditions of it's workforce.
In terms of not providing a way forward you have a valid point. I beleive the situation is so complex that it can only be fixed by going back to the drawingboard with legislation which fixes the whole funding issue. Personally I have little faith in LAs in their current form which seem like my old employers to be simply shedding functions until all they are is 'commissioning bodies' (beleive it or not my LAs stated aim!)
What I would like to see though is more pressure put on politicians to create change.
Exactly. Which is why I am proposing PROPER commissioning. Not just the current lipservice that councils pay to it. But methodologies that truly embrace the principles of transparency, fairness and equity. And where ALL services, where public, private, independent or voluntary are treated the same.
THATs the difference we need.
Yes, starving LAs of cash has led to LAs starving providers of cash which as you say benefits no one.
In terms of quality LAs are also able to provide better pay and condions which means staff stay around for longer. The high turnover of staff in agencies and private res homes is very noticeable. But as LAs have shed most of their provision this positive impact on quality has been lost.
I'm with you on putting more pressure on politicans to create change. What is clear is that privitisation has not delivered what was promised but quite what politicans can do about ensuring we do have good quality excellent value care in a society where any suggested increase in taxation means politicans are voted out, or more likely not voted in in the first place, I do not know.
Chirpy cockney gets to the real nub - money doesnt guarantee quality, but absence of it guarantees failure. One of the most pernicious effects of the current focus on "personalisation" is that it carries the message that money somehow doesnt really matter - so long as people have choice and control and they are empowered, what else do you need to worry about? The message lets politicians off the hook completely, and lets Directors have an easy ride with their members. This is the dynamic that has to change - I would like the new White Paper to place a duty on Directors to know the extent of unmet need in their community and to let their members the true cost of achieving their declared vision for social care. Its called putting your money where your mouth is. And of course as a country we can afford to do better - we just choose not to.
I think that's the major sticking point. Ultimately politicians are accountable to the electorate and if the median voter refuses to pay any more tax, or to prioritise social care then as you say politicians who go against this will find themselves out of office.
As much as we can blame politicians - (though in my opinion they are to blame for ducking out of the debate when the going gets tough) ultimately the responsibility lies with the electorate, and society as a whole... just where you begin with sorting that one I don't know!
Also the point about personalisation - that is why I was so sceptical about personalisation. Not because I was anti-choice, or a naysayer in general, but it seemed to me that after the initial cash boost for total transformation areas and all the hype about football season tickets instead of day care went away then what would be left is SU's either topping-up if they had the resources, or if they didn't being forced (and note I say forced, not choose) to rely on family and friends. For those who were employing someone direct it may be different, but how many people had someone reliable and willing to provide a few hours care here and there with a great degree of flexibility? For many people the reality would be the only option they had would be to buy-in services from one of the major national providers and at extra hassle to themselves.
As I say in my neck of the woods, which was a Total Transformation area, commissioning policies were driving small local operators (who may be more expensive, but are also more likely to be responsive to the needs of an individual SU in a way a massive care provider isn't) out of the area, so what choice did that leave SUs who wanted to employ a care agancy of their choice with? Certainly the LA would be unwilling to fund IB users at a higher rate so they could afford greater choice.
Neil, as you say ...commissioning policies are driving away small local operators who are more likely to be responsive to the needs of an individual SU.
Exactly my point - we need proper commissioning. ! I get so annoyed that many SW's don't realise that their LA's actually aren't commissioning!! Despite the titles such as 'Commissioning Manager' and the 'Commissioning Strategies' .. most of this is just lipservice to try and fool people into thinking they are commissioning. They aren't.
When you really look at what commissioning means, you see that most LA's just take the 'bits' they like to suit their own needs.
I have yet to find one LA that truly embraces the principles of commissioning.
'The man who pays the piper calls the tune' - or does (s)he?
well...they should. But the problem lies in how and why they choose a particular tune.
Rainbowarch- I fully agree with your view that commissioning can and should be the route to fit for purpose provision, and that it is too rarely (if ever!) found in LA's. But the link below takes you to an article about a strategy adopted in a Unitary Council a few years. I would be really interested to know (if you have the time and inclimation to read it) if you think this is the style of commissioning that you are trying to identify. Its all about commissioning for outcomes and doing so through partnership between Council and providers.
www.dhcarenetworks.org.uk/_library/.../Paley__Slasberg_article.pdf
Unfortunately it said that the page could not be found
Found it by googling!
Some great points which I agree with;
1. The challenge of getting care management practitioners to understand exactly what an outcome is
2. The need for LA's to lose their culture of control & for care managers to be less prescriptive
3. The need for partnership
4. The need for trust
It clearly delivered better results for users. Although the handover period seemed to be very poorly managed :-(
I'd be interested to know a bit more about how the finance team coped with it. How were budget forecasts managed without a set 'weekly price' ?
The most challenging financing issue to resolve was in relation to charging service for only actual hours received, while allowing providers to invoice for commissioined hours. In terms of budget management, paying providers by commissioned hours is, in fact, more stable. However, custom and practice has been that providers invoice for actual hours, which is usually substantially less than commissioned hours. So moving to commissioned hours - which we thought was right to allow providers to move their business on to a more secure footing which, in turm, they could pass on to their front line staff - required a renegotiation of costs and risks. Before I moved on, we had set out the terms of that change on a no-winners- and-losers basis, but I dont believe it was implemented. There are powerful incentives within both Councils and (to my surprise) amongst providers to retain a very short term view in managing costs and profits.
http://falseeconomy.org.uk/blog/barnet-care-privatisation
^The unrecorded costs of privitisation. This demonstrates for me why the argument that competition drives up standards whilst offereing value for money is a complete fallacy.