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.