Pat rescue

Remember the scene in Superman where Lois Lane’s
helicopter crashes as it lifts off from a skyscraper? Lane dangles
from the open door and then falls, plunging down towards the street
50 storeys below. A blue blur in red underpants swoops up from
nowhere, catching her neatly before rescuing the helicopter and
saving the day.

Fictional heroes are all-powerful, bursting in on terrible crises
at the last possible second, rescuing the stricken, redirecting the
wrongdoer and ensuring happy endings all round. Is this the
scenario the Department of Health had in mind last September when
it announced plans to send in teams of private consultants to sort
out failing social services departments?

These performance action teams – quickly dubbed “hit squads” by
sceptical directors – were targeted at departments the Social
Services Inspectorate felt were failing to make enough progress or
simply “not considered capable of taking appropriate action”. The
DoH put the proposal out to tender, and three large private sector
consultancies won the contracts. Teams went in to four authorities
last August, followed by two more at the end of the year (see

So far, so good. A new round of star ratings came out last month,
revealing that four of the five authorities that received PATs in
2002 have now been upgraded to one star. The fifth, Birmingham,
remains on zero stars but is, according to the DoH “making
progress”. But in a comparable time frame, another zero-star
authority, East Sussex, gained two stars, without the aid of a PAT.
So are these superhero squads really worth their weight in

Lesley Heale, an assistant director for performance management at
Birmingham, says the team sent in initially was very helpful. It
stayed nearly a year, leaving this September. “They were very, very
good – quite experienced senior people who understood social
services,” she says. “They took a pragmatic project management
approach. Because our chief executive was on the performance
improvement board we got a lot of corporate buy-in for the work
that we were doing. Plus it was done in a very supportive,
involving way so it was a core part of our work, not just another
add on.”

But Heale says the first team was withdrawn after a few months and
replaced with a more junior team with less experience. She says:
“It was a real pity because I think we lost some of the momentum
then. The new group were helpful, but they were more private-sector
focused and didn’t seem to know much about social services. They
were still valuable for middle and senior management, but not so
much for front-line services and staff.

“We could have made better use of the last four or five months they
were here. Gradually they focused more on checking up on the
paperwork when we’d have preferred them to be out talking to
front-line staff and service users.”

However, Heale says that the team was useful in identifying the
problems early on. “We didn’t have that analytical self-awareness,”
she says. “Now, we’d be able to do a lot of it for ourselves.
Changing teams was a hiccup, but overall we’ve learned a great deal
from the exercise.”

Others’ experiences have been less satisfactory. There has been
criticism of teams whose members did not have the right mix of
skills to reflect what was going wrong, or who lacked understanding
of the core business of social services. Others found their PATs
too critical and overly interested in analysis, rather than in
offering practical support and guidance to help put right

Coventry was another authority that received a PAT when it was on
special measures. John Bolton, who became director of social
services after the PAT team started, says: “The team were brainy,
bright people – clever auditors, clever statisticians and one
experienced front-line manager. But it became clear that they were
providing a lot of analysis of what was wrong, but weren’t
providing the tools and the leadership necessary to change. Most of
the problems had already been identified, and I was concerned about
the team simply repeating old cycles, explaining to Coventry why it
was failing, rather than giving people practical support to

A positive SSI inspection after Bolton arrived took the department
off special measures. The SSI team praised the work of the PAT but
Bolton is not sure why. He believes most of the improvements – with
the exception of some excellent work on the council’s duty service
– would have happened regardless. He says: “If at the start they’d
offered me a team of competent, experienced social care managers
I’d have been delighted. But, as it happened, while the team were
here I was changing the management of the department, bringing in
people I knew and trusted. Most of the changes would have happened

To be fair, performance action teams were set up quickly and
parachuted into departments whose staff had just been told they
were bottom of the league table. Results were expected quickly,
even though in some cases the entire senior management team had
just departed. Everyone had to learn “on the hoof” and mistakes
were inevitable. The real question is whether they have been worth

It depends on the measure of success. It is impossible to compare
costs with outcomes, because the DoH has kept the figures secret.
It will say only that it has fully funded most of the teams from a
£4m pot top-sliced from the performance fund special grant to
“support poorly performing councils by paying for performance
action teams and other related work”. Councils such as Haringey,
Lambeth and Plymouth, which have requested a PAT – as opposed to
having had one sent in – may have had to contribute to the cost.
If, as some have suggested, the rate is about £1,000 a day,
the bill could be several hundred thousand pounds for each
authority, which seems a lot to spend on management

David Reason, director of government services for the largest PAT
provider, KPMG, says the cost of teams is justified. “It could be
seen as a high price, but look at it in terms of outcome – what
value do you put on an authority being supported to put in place
good quality, reliable services and systems that could prevent
another death like that of Victoria Climbie? Ultimately the DoH and
local authorities have to be the judges.”

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