Private doesn’t always mean best

Social care has more contracts 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 1998-9 was provided by the
private and voluntary sectors, 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 sectors 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 dependence 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 services 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 suggests 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 services 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

Conditions for improved services

– Adequate funding for public services.

– A consistent rationale for using public private
partnerships.

– A strong public sector partner.

– Responsible private and voluntary sector providers willing to
embrace high standards of transparency and accountability.

– Legitimacy, both in the eyes of the public and the
workforce.

– An evidence-based approach to policy. A commitment to pilot,
monitor and systematically evaluate different partnership
arrangements and to roll out or roll back arrangements according to
the evidence of success or otherwise.

A partner that works better

– Enhance the status and career structures of procurement
officers.

– Allow public agencies to bid to become accredited
commissioning experts.

– Contracts should be flexible in a way which promotes
continuous improvement, and value for money over time.

– Contractual payments should be outcome-based – linked to
tangible benefits for service users, and user satisfaction should
be used to determine a part of the payment to providers.

– Where groups of local authorities commission jointly, there
should be pump-priming money to reward them.

– Public authorities should know they are under no duty to
select least-cost bidders – “indeed this may fail to achieve best
value”.

– Purchasers should be allowed to include issues such as health
and safety, equality and training in contracts.

– More evidence is needed on the impact of public private
partnerships on the workforce. If this shows they worsen pay and
conditions of new staff, there should be stronger regulation.

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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.

Centrepoint 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
white paper. Mental health charities were unhappy with the original
white paper’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 difficulty charity Mencap.
However, Richard Kramer, head of campaigns, stressed that the
measures fell short of the overhaul of the law on sex offences that
is required.

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.

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Doing it for the kids?

A recent Social Services Inspectorate report found there were
striking variations in local authorities’ delivery of Quality
Protects initiatives. Claire Laurent reports.

Almost three years since the launch of the government’s
much-hailed initiative for “transforming the management and
delivery of social services for children”, questions still hang
over the benefits of Quality Protects for those delivering and
receiving the services.

In October 2000, the scheme was extended from three to five
years by health secretary Alan Milburn, alongside an increase in
funding from the original £375 million package to a total of
£885 million.

But the findings of a Social Services Inspectorate inspection
(News, page 3, 21-27 June) suggest a degree of over-optimism on the
part of both the government and most social workers working with
children and families. When Community Care surveyed these
social workers earlier this year, they described Quality Protects
as “very” or “fairly effective”.

The SSI inspectors found a striking variation in the quality of
services across all councils, with particular concern about staff
shortages, low levels of training and services being hard to
access.

The inspection programme was carried out between August 1999 and
July 2000 in 31 councils across England – one fifth of the total.
The inspection team found some evidence that the Quality Protects
programme was “diverting experienced staff away from frontline,
mainstream services”.

Barry Barnes, director of children’s services for NCH in London,
was not surprised by the findings. “Recruitment is a huge problem
for us, and it is exacerbated by the raft of government
initiatives. Often experienced staff will be attracted by
specifically-funded initiatives and that leaves you with staff who
are not necessarily as experienced and well trained.”

The effect of that for children and families services is a high
turnover of staff, with the problems a lack of continuity brings.
One of these problems was raised by the inspection report: a
failure to review earlier work with families which can lead to a
delay in intervening to safeguard children.

In 6 per cent of the cases examined by the inspection team,
children were judged to have not been adequately safeguarded and
the team found instances of delays in intervening decisively to
safeguard children in what it describes as “very dysfunctional
families”.

Low levels of training among social workers were highlighted by
the inspection team, particularly in relation to communication with
children, which was reflected in low levels of recording of
children’s views in case notes.

The inspectors found “considerable variation in the importance
attached to recording a child’s ethnicity, first language and
particularly their religion”, with this information being poorly
monitored and not used to shape services.

Billie Ibidun, national co-ordinator of the care leavers’
organisation National Voice, says: “Those things play a huge role
in a child’s sense of their own identity. Being in care can mean
being wrenched away from what you know and what’s familiar to you,
so it’s important to hang on to the things that make you feel like
you.”

Ibidun is particularly concerned at the failure to use
children’s views to shape services. “Because of initiatives like
Quality Protects, many local authorities have fixed on the need to
appear to be listening. But if that listening doesn’t result in
feeding back to young people, it’s just an orgy of listening
without hearing. Young people become cynical, and rightly so, when
all this listening doesn’t result in a better quality of care.”

No one type of council was better or worse, although there were
familiar patterns: London councils had the worst staffing
difficulties, while unitary authorities had limited capacity for
planning and development. Metropolitan councils had the most stable
and experienced staff, and shire counties were least likely to
experience serious staffing difficulties.

In the London Borough of Lewisham, one of the councils
inspected, a new initiative has just got off the ground, aimed at
improving the recruitment and retention of staff. Jackie Stirling
is group manager for employee services for social care and health.
She says vacancy rates in Lewisham are running at 18 per cent lower
than at the time of the inspection. She says the low training
levels highlighted by the inspection do not reflect Lewisham’s
experience. “We have an extensive children and families training
programme, which covers things like capacity building, which is our
non-qualified training, plus our qualified structure.”

Rob Hutchinson, chairperson of the children and families
committee of the Association of Directors of Social Services, links
staff shortages with low training levels. “Social worker training
courses need to have covered these practical and theoretical issues
in detail to give social workers the tools they need to work
effectively,” he says. “However, this also needs continually
updating when social workers are practising, and this sometimes
represents a real challenge when there are significant shortages of
staff in allowing social workers the proper time available for this
training.”

He wants incentives to recruit and retain child and family
social workers to be on a par with those proposed for teachers,
nurses and other public sector workers. “We need to emphasise the
fulfilment, the challenge, the importance of the task and high
levels of achievement which can provide such an exciting and
worthwhile career.”

Department of Health, Developing Quality to Protect
Children: SSI Inspection of Children’s Services – August 1999 –
July 2000 from www.doh.gov.uk/scg/developingquality.htm