In Focus news analysis on privatisation

In Focus news analysis from Community Care
magazine.

(see below for analysis of the Queen’s speech and the
implications for social care).

(It may be advisable to print this document as it is
long).

Private doesn’t always mean best

Social care has more contacts with the private sector than any
other public service. But the report of the Commission on Public
Private Partnerships makes clear that such contracts must not be
associated with cost-cutting and that commissioning must be more
stringent. Frances Rickford reports.

Social care may not be the most popular, well funded or high
status public welfare service, but it comes top in one league –
privatisation.

As the Commission on Public Private Partnerships reports, 40 per
cent of publicly funded social care in 1998-99 was provided by the
private and voluntary sector, including more than two-thirds of all
social care provision for older people. This compares to just 10
per cent of public spending on education, and 16 per cent of health
spending.

But is social care’s close partnership with the private
sector a good thing for service users and the public in general?
The commission’s report Building Better Partnerships pays
little attention to the outcomes of privatisation in social care,
but the general points it makes about the principles that should
underline public private partnerships make uncomfortable reading
for those concerned about service quality.1

Gavin Kelly, research director at the Institute for Public
Policy Research (IPPR), was at great pains to scotch suggestions
that the commission was gung-ho about more privatisation, or that
it believed the private sector could necessarily improve services.
The commission for example dismisses as “spurious” the
government’s argument that private sector investment enables
it to take on more capital projects.

What was important, he claimed, was that people felt at the end
of this government’s term of office that public services
should be delivering what they elected the government to deliver.
Making the best use of the “skills, creativity and areas of
expertise” within the private and voluntary sector could help
achieve that – but only if the conditions are right.

In social care, two problems are now emerging for the
government, arising directly from the growth of private and
voluntary sector provision. One is the challenge facing the quality
strategy for the personal social services – including the General
Social Care Council and the Social Care Institute for
Excellence.

As Amanda Edwards, who heads the quality strategy at the
department of health noted at a recent research conference, when
services are being provided by hundreds, if not thousands, of small
private and voluntary sector enterprises, the job of making the
strategy stick is going to be very different than if it had to
address only large public sector organisations.

Another problem thrown up by the growth in dependency on the
private sector is ensuring enough provision, let alone continuity
in services for vulnerable people. Changes in the economy,
especially the property and employment markets, can have a rapid
and devastating impact on the pattern of provision which local
authorities, users and their relatives are powerless to
prevent.

The commission argues that in general the strength and expertise
of the commissioning public sector partner is crucial to the
success of contracts. Kelly suggests these problems might be less
acute if local authorities had negotiated better contracts with
private sector partners, and placed more emphasis on quality than
cost. The report claims: “At the moment (the public sector) suffers
from a severe shortage of skills (in commissioning services) and
those it has are often under-utilised. It finds it hard to learn
from past mistakes (and) it is poor at picking quality
partners.”

The commission notes that improvements in public services are as
likely to be achieved from within the public sector as by
contracting with private companies, and recommends that public
sector bodies be allowed to trade their expertise with each other.
In particular, expertise within the public sector at negotiating
with other providers should be spread around more widely. It says
that social service managers should now have as much experience and
expertise in contracting with service providers from outside the
public sector as anyone, so may find their skills are in demand if
this idea takes hold.

But it is in the content of contracts themselves that the IPPR
report has perhaps most to say to the social care sector. The
report starts from the principle that partnerships with the private
and voluntary sector should not themselves be a matter of principle
– either for or against.

Instead they should be considered where there is evidence that
they can help to improve the quality of services. Social equity,
value for money and clear forms of accountability should be the
criteria for assessing whether this is the case, it says.

The commission makes a radical proposal that contractors should
have their payment linked to both user satisfaction, and the
achievement of tangible benefits to service users. Contracts need
to build in an expectation that services will continuously improve.
Gavin Kelly also suggested that a long term commitment between
commissioners and providers, with less spot purchasing, would be a
way of preventing the vicissitudes which have led to so much
instability in home and residential care services for older
people.

But the report’s key challenge to social service
departments is the proposition that public private partnerships
should no longer be associated with cost-cutting. When the
inspectors applaud an authority for awarding a contract to the most
accountable provider, or the provider with the most stable and well
trained work force – even if the bid was the most expensive –
we’ll know the tide has turned.

1 Building better partnerships: the final report of the
Commission on Public Private Partnerships. Institute for Public
Policy Research, tel. 020 7470 6100

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Selected runners put under starter’s orders

From a restricted field of social care bills the government has
made adoption services a clear favourite.

Mark Hunter reports on the likely
winners and losers in the legislative race.

With Her Majesty apparently eager to get to the racing at Ascot
and a number of notable omissions from the 20 Bills announced, the
Queen’s speech was perhaps more notable for its brevity than its
content.

The central theme, of course, was the government’s renewed
commitment to the public services, with schools, hospitals and the
police force high on the agenda for the next parliamentary session.
But before social care workers could become too excited, a warning
was immediately sounded by the leader of the public sector union
Unison.

General Secretary Dave Prentis, addressing his union conference
in Brighton, promised a “nationally co-ordinated campaign” against
the creeping advance of the private sector in the management of
public services.

Within the social care sector, the measure most widely welcomed
was the reappearence of the much-heralded adoption and children
bill.

The bill appears identical to the one that received all-party
support in the last parliament, but was scuppered by the general
election.

It aims to increase the number of children adopted by at least
40 per cent and outlines new safeguards for overseas adoption, and
legal controls to cover so-called internet adoption,

The bill promises a national register to speed up the adoption
process by helping to match children and would-be parents. Courts
will be required to draw up timetables for adoption cases and there
will be an independent review mechanism for would-be adopters who
think they have been unfairly turned down. Local authorities will
be required to provide a support service for adoptive parents to
help them cope with often troubled and challenging children.

The adoption bill apart, however, many within the social care
sector found themselves scouring the Queen’s speech for traces of
bills that surfaced in the last parliament but now seem to have
become forgotten.

Homeless charity Centrepoint had been hoping for the
reappearance of the homes bill, with its expansion of the
definition of priority need to include 16 and 17-year-olds.
Following initial concern that it had not been mentioned in the
Queen’s speech, the charity was delighted with the unexpected
publication of the homelessness bill last week. It includes the
provisions contained within Part II of the homes bill, which will
improve protection for homeless young people and force local
authorities to take a more preventive approach.

Chief executive Victor Adebowale said: “Through encouraging
housing, social services and the voluntary sector to work together,
we have seen the difference an effective strategy can make to the
lives of homeless young people.” He welcomed measures announced
within the welfare bill to help young people into work, but added:
“It’s crucial that the safety net of priority need is extended to
16 and 17-year-olds and care leavers as soon as possible.”

One no-show in the speech was the controversial Mental Health
Act. Mental health charities were unhappy with the original Act’s
emphasis on compulsory treatment and lack of commitment to
patient’s rights. The Mental Health Alliance has therefore
expressed the hope that the delay will be used to “take a second
look at the proposals to ensure that they will meet the needs of
all those who experience mental health problems”.

Measures within the criminal justice bill to strengthen the
supervision of sex offenders by tightening up registration
requirements were welcomed by learning disability charity Mencap.
However, Richard Kramer, head of campaigns, stressed that the
measures “fall well short of the fundamental overhaul of the law on
sex offences that is so urgently needed”.

He said: “Legislation is needed to uphold the human rights of
vulnerable adults to ensure they are protected from abuse.”

Mencap would like to see it made an offence to have sex with a
person with a learning difficulty who cannot consent, for a care
worker to have sex with a person with a learning difficulty in
their care, and to obtain sex with a person with learning
difficulty by threats or deception.