Has the SCIE fallen in?

    Relations between the Social Care Institute for Excellence and the
    government, some say, are not what they used to be. And there are
    concerns that any lack of a warm relationship could prove to be not
    only detrimental to Scie’s future as an organisation but for social
    care as a whole.

    Last October news emerged that the government had wanted to give
    Scie responsibility for the seven key health and social care
    programmes that make up the Care Services Improvement Partnership
    (CSIP). The move would have seen Scie incorporate 150 staff
    currently working on the programmes as well as

    £30m of government funding – Scie’s budget at present is just
    £6m. And taking on responsibility for high-profile initiatives
    such as the National Institute for Mental Health in England and the
    Health and Social Care Change Agent Team would have boosted Scie’s
    status.
    Community care minister Stephen Ladyman fully backed the proposal.
    In early November he said that the Scie partnership would “help to
    ensure that social care has a prominent place in all of our service
    improvement work”. It was expected that Scie would become the CSIP
    host on 1 April. Little did Ladyman realise just how much would
    change in the space of a few months.

    In February, following a three-month consultation, it was formally
    announced that the CSIP would not be hosted by Scie after all. The
    official line was that the Department of Health’s need to influence
    the CSIP could unfavourably affect Scie’s independent charitable
    status, and that both Scie and the DoH felt that this should be
    preserved.

    But Ladyman publicly accused Scie of having “blown” its chance to
    raise its standing. From its corner Scie fought back making it
    clear that it was willing to proceed with the proposal and that the
    DoH had “changed its view”.

    As far as Scie is concerned, it all came down to dates. The
    sticking point appears to be around the DoH’s desire to employ CSIP
    resources and expertise – including staff – to help failing
    organisations, as a kind of “hit squad” improvement agency.
    According to Jane Campbell, chair of Scie, time was needed to look
    at the legal ramifications of this in terms of Scie’s charitable
    status. She believes that the situation could have been resolved,
    so why was the plan cancelled and not simply postponed?

    “Because the government had timescales that it needed to keep,” she
    says.

    Given that the DoH is not renowned for keeping to timescales, many
    observers have sought other reasons for the sudden halt.

    Right from the outset conspiracy theories have abounded as to why
    the CSIP plans fell apart. The fact that so few are prepared to go
    on the record with their opinions backs up suspicions that there is
    another agenda.

    Some people suggest that the initial stumbling block was the
    inability to appoint a national director. They say that the
    government had a candidate in mind to head up the partnership, but
    that this person proved unacceptable to Scie. These people say that
    once the DoH’s choice was out of the question, the government
    feared that it would not have enough power over the CSIP and so
    lost interest.
    Others suspect a personality clash or a loss of faith in the
    individuals who were involved. Or was it just government
    mishandling? As one social care commentator says: “There’s been a
    lack of competence. You don’t make an announcement in the House of
    Commons and then go back on it five minutes later. There’s been a
    lack of official competence and respect.”

    One consistent feeling is that the whole affair is indicative of
    just how the government views social care. This feeling is set to
    escalate, as it is rumoured – but as yet unconfirmed by the
    government – that the CSIP is now to be transferred to the
    Prescription Pricing Authority. The PPA’s main duties are to
    calculate and make payments to pharmacists and doctors and to
    provide prescribing information to GPs, nurses, and primary care
    trusts. Locating the CSIP within such an NHS-dominated environment
    is likely to send out, as another commentator puts it, yet another
    “unfortunate message” about the relationship of social care to
    health:

    “The CSIP partners are heavily embroiled in a social care agenda
    but they will be lodged in something typically NHS. This sends out
    a bad message as it comes across that this is an NHS takeover
    again. It’s one more nail in the coffin and the lid is going down
    pretty quickly. A tie up with Scie would have sent a more positive
    message to the field.”

    The partnership with Scie looked to provide a win-win all round. In
    addition to the benefits of more money and clout, Scie was
    attracted by the ready-made regional structure that the CSIP would
    have offered. Run through Nimhe’s established eight regional
    centres, the infrastructure would already have been in place to
    help spread knowledge and good practice out to front-line workers
    at the grass roots of social care. Meanwhile, for the other CSIP
    programmes, integration with Scie would have enabled them to be
    closely linked with a body dedicated to shaping social care policy
    via evidence-based practice.

    It is difficult to predict what advantages will accrue from
    offloading the CSIP onto the PPA, and to a certain extent this
    gives legs to the view that it has been a struggle to find a
    suitable home for the programme. Given the uncertainty with how the
    PPA fits in with the CSIP programmes, aside from providing an
    administrative hub, the anticipated move has also led to
    assumptions that the government has had to act quickly after the
    Scie disagreement, in a desperate attempt to offload the CSIP as
    part of its efficiency savings.

    Yet for all the speculation around the government’s handling of the
    affair, Scie has not escaped without blemish. Not only has it been
    accused of cutting off its proverbial own nose and missing a once
    in a lifetime opportunity to expand, but some go as far as to
    suggest that its leaders were a bit short-sighted in failing to
    spot the catch.

    “The government was handing over large sums of money. It was bound
    to want control over how that money was to be used. It’s naive to
    think otherwise,” says a source.

    “What wasn’t possible was for Scie to receive the money and then
    say that it wasn’t going to do what the government wanted. It’s
    surprising that anyone thought that was a solution or even an
    option.”

    To a certain extent, Scie could have saved itself a lot of hassle
    if it had rejected the government’s proposal at the first offering
    on the basis of wanting to maintain its independence.

    But Jane Campbell insists that Scie was always aware that the
    government would have some involvement – as it already does. “They
    are our major funders and through service level agreements the
    government needs to know and agree to our work programme. We were
    never naive.”

    It took courage to stop the process, she says, disagreeing with the
    view that projects, once started, should be seen through to the
    bitter end no matter what. Despite feeling “disappointed, a bit
    mystified and a bit bewildered”, she is adamant that the decision
    not to proceed was the right one in order to prevent government
    interference.

    “We have to retain that independent status. We were not sure that
    it would have been sustained if we went down the route at this
    point with the CSIP and we certainly couldn’t decide by 1 April,”
    she says.

    Falling out with your major funder is seldom a good idea –
    particularly when they are known to be looking for ways to make
    cutbacks. Four years ago, when Scie was just starting up, whispers
    could be heard suggesting that its days were numbered and that a
    merger with the National Institute for Clinical Excellence was on
    the cards. So just how vulnerable could Scie be now? Are relations
    with the DoH beyond repair?

    Campbell does not think so. “We’re all going to kiss and make up.
    This is going to strengthen our partnership and relationship rather
    than tear it apart. We can’t let this get in the way. It’s
    something we have both learned from and which will mature our
    relationship,” she says.

    As for any embarrassment caused to Ladyman, with the general
    election looming, there is at least a realistic chance of a
    reshuffle within the DoH and a potential opportunity to wipe the
    slate clean with someone new. But this can only extend to the
    relationships between individuals. As Scie is one of the four most
    influential social care organisations, could these shenanigans have
    a more lasting impact on the relationship between the government
    and the social care sector?

    One source certainly thinks so: “It won’t have helped the
    government to be confident that social care is coherent and able to
    speak consistently for itself.”

    But it’s not just Scie’s ability to represent social care that the
    whole affair has brought under the spotlight. A key reason for
    transferring the CSIP to Scie was to give Scie more clout, which
    many deem it to be lacking. Few consider it to have lived up to the
    expectation that it would be the social care equivalent of Nice as
    questions remain as to how far it can influence the government on
    issues of policy and practice. Campbell, however, disagrees saying
    that properly engaging with service users and practitioners takes
    time: “When you look at what Nice achieved in three years, with
    fewer resources, I don’t think we’re doing badly,” she says.

    As for profile, she thinks that progress has been made – progress
    that isn’t always noticed by people at the top of organisations who
    are no longer practitioners.

    “My litmus test tends to be more in terms of those who are making
    use of Scie’s products and activities,” she says.

    In terms of what Scie has, and will, achieve, Campbell remains
    focused and positive. As far as she is concerned the recent debacle
    with the DoH has been a learning experience, if nothing else.
    “Learn and move on” is her current mantra and she seems reluctant
    to dwell on what has happened.

    For those working in the swanky Scie offices on the banks of the
    Thames, it is business as usual – at least for the time being.

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