Best of the frontline bloggers (week ending 2nd November 2012)

We love public and voluntary service bloggers. At their best, they capture the day-to-day reality of public services in a way that Westminster-commentators can’t – and they have the real expertise and insights we need to improve social policy. Here’s our selection of the best frontline blogs we’ve read this week. Do send us your suggestions for great posts we’ve missed – and those frontline bloggers we should follow in the future.

Social care

Is there any way to improve?

From How Not to Do Social Work

Posted on 31st October 2012

“So today when I was asked the question is there any way to improve? the answer was Yes, talk to Social Workers, understand what the difficulties are in social work and where the learning is needed to develop practise including investing in social work and acknowledging that specialist knowledge is learned over a long period of time not over a fancy title.”

How Not to Do Social Work, an experienced social worker, reflects on many years of discussions about how to improve social work for children’s services, and especially the difficulty of dealing with what is still the biggest issue: defining what a vulnerable child is and at what point intervention is needed.

Education

Sorry you got a C… No Sixth Form for you!

From The 99% Blog

Posted on 1st November 2012

“I suppose all we can do is wait and hope for errors to be put right as they should be. If this works then yippee, if however it doesn’t, then we as a collective; the generation of a new age, need to establish a way for us to voice our opinion and succeed in omitting errors in society that affect us and others.”

Aaron challenges the unfairness of the GCSE exam re-grading fiasco and how it has damaged the aspirations of thousands of young people, but notes the possibility of “one last shot at justice…”

Why all teachers agree with David Laws

From Pedagoggles

Posted on 26th October 2012

“Teachers refuse to work longer than the 9-3, and as we know, those six hours are dedicated to the systematic beheading of every child’s hopes for the future.”

Good news for the Government (or possibly not), as one teacher agrees with David Laws’ recent comments about the profession fostering ‘depressingly low expectations.’

Health

More wisdom from those who think that NHS IT has landed on the moon

From Northern Doc

Posted on 1st November 2012

“…when someone who works for an organization called the NCB tells you that they are “pushing for the end of 2015 to eradicate paper from the NHS” you can bet the smart money will be buying shares in paper manufacturers.”

Northern Doc shares his doubts about the ‘next big thing in NHS IT’ – or “hugely expensive white elephant”, depending on where you stand.

Time for an update

From Life in the NHS

Posted on 28th October 2012

“I predict that once the dust has settled and the ‘bureaucracy’ has been removed, some people will be very shocked by what is left. They will be surprised that the NHS isn’t actually being run by GPs (though they have a wonderful nominal role) but by rehashed senior managers some of whom work in Leeds and many more work out in the local areas.”

A welcome return to the blogosphere to a ‘nurse, manager, wife and mum’ – and a warning about the coming chaos in a changing NHS.

Policing

Backwards to the future – A scientific(ish) experiment

From PC Bobby McPeel

Posted on 30th October 2012

“Ok, this is probably the least scientific experiment in the history of science, and I’m sure someone much more intelligent than me would tear it apart. However, I wasn’t really trying to be scientific. I am trying to make a serious point that these piecemeal police reforms that fail to recognise the unique nature of policing…”

PC McPeel (“proud to be a pleb”) does some rough maths on the Winsor reforms to see the effect on police numbers – and finds they don’t add up.

Justice

To hurt or to heal

From Ben’s Prison Blog – Lifer On The Loose

Posted on 30th October 2012

“Criminals grow up in communities, they live in them and they then harm them. It is in communities that our best chance of reclaiming people lays. To shrug off our difficult members and hide them behind high walls is short sighted, expensive, and ultimately futile.”

Previously known as “one of Britain’s best known prisoners”, PrisonerBen challenges the policy focus on prison and instead proposes a community-based alternative.

Can the Tories – or any government – be trusted with human rights?

From Jailhouselawyer’s Blog

Posted on 29th October 2012

“See, if you’re David Cameron, prisoner votes are as close to a perfect policy as you’re likely to find. Opposing them makes him look like he’s finally getting tough on the ‘faceless Belgian bureaucrats’ and ‘unelected judges’ who think they can boss us about, which looks great in front of the wing of his party mostly comprised of the elderly and mildly xenophobic. …While this might make for a calming influence in the party, and an easy news cycle for Grayling, what it amounts to is a defence of widespread disenfranchisement.”

John Hirst argues that withholding the right to vote from prisoners is really a matter of fundamental human rights, not about Europe.

If you’re a frontline blogger, do send us your latest blogs on policy issues or posts from the past that you’re particularly proud of, and they could be included in next week’s round-up. Get in touch with us at: info@guerillapolicy.org or via Twitter @guerillapolicy and @guerrillapolicy


Best of the frontline bloggers (week ending 5th October 2012)

We love public and voluntary service bloggers. At their best, they capture the day-to-day reality of public services in a way that Westminster-commentators can’t – and they have the real expertise and insights we need to improve social policy. Here’s our selection of the best frontline blogs we’ve read this week. Do send us your suggestions for great posts we’ve missed – and those frontline bloggers we should follow in the future.

Local government

Graph of doom – fact or fantasy – an alternative perspective

From Mr Reasonable

Posted 1st October 2012

“Barnet Council have been pushing a chart …which has gained the rather unpleasant title “The Graph of Doom” to show how the Council will run out of money for any services other than Adult Social Care and Children’s Services by 2030. This chart has been used in Cabinet documents to justify the need for the One Barnet Outsourcing programme. It has also gained traction in the national press where it is seen as a revelatory document which we should all be accepting as the gospel according to St. Barnet.”

A ‘reasonable and respectable resident standing up for common sense’ in the London Borough of Barnet dissects the infamous (in policy circles, at least) ‘Graph of Doom’ – and shows that the reality is more of a ‘Graph of Choices’ instead.

Disability

Disability issues finally break through at Labour conference

From Diary of a Benefit Scrounger

Posted on 3rd October 2012

“No matter what we did, we had to break the consensus. We had to make sure that the opposition opposed. Just two years ago we had nothing and no-one. Today, we have a very different board to play on. Many will say it is not enough, and of course, they are right. But as a friend once said to me, “Don’t judge on where someone is, judge on how far they traveled.”

Sue Marsh provides a perspective on this year’s Labour Party conference where disability issues finally made it into the mainstream – after a massive effort by campaigners and activists.

Probation

Train crash

From On Probation Blog

Posted on 3rd October 2012

“As I’m writing this, there are civil servants down in London at the Ministry of Justice drawing up contracts for the benefit of private companies such as G4S. How is anyone to feel comfortable or reassured that they are any better than their colleagues over at the Department of Transport in being able to fairly assess the relative merits of different bids, and especially those that have to be measured against public sector bidders?”

Jim Brown speculates on what the West Coast mainline franchising fiasco means for the outsourcing of prisons and probation services by the Ministry of Justice.

Carers

Children shouldn’t be responsible for filling gaps in care

From Carers Blog

Posted on 1st October 2012

“One of the problems we face is that where local authority care budgets are cut, then if someone has care needs, that care still has to be provided by someone – and it inevitably falls to friends and family to provide it. This is hard enough for adults, and we know many are struggling to cope with cuts in services and family finances. We need to make the point crystal clear that it is never acceptable to expect a child to fill the gap in care which is left when services are cut.”

Moira Fraser of the Carers Trust reports back from the Labour Party conference and shares her concern that those organisations working to support young carers are not communicating their messages clearly enough.

Policing

National Police Air Service launches today – lies and spin

From Police Aircrew

Posted on 1st October 2012

“There are some basic facts that need to be cleared up. You wouldn’t think “facts” needed clearing up would you because they are facts; the truth and therefore should be clear to all. Unfortunately Mr Green the Policing Minister has either been misinformed or is not telling the truth.”

Welcome to a new frontline blogger, Police Aircrew. In their first post they debunk the facts that have been presented to rationalise the police helicopter service into the new National Police Air Service. The new service is designed to save £15 million a year; in this post Police Aircrew speculates about further cuts that are coming down the line.

If Michael Portillo forgets you…

From Catemoore’s Blog

Posted on 29th September 2012

“When Michael Portillo looks at a person in a uniform, he sees just that. A person in a uniform. If that person is driving a fast car with blue lights flashing and siren blaring, or if that person is involved in an active arrest, shouting at suspects or perhaps cuffing a prisoner, Michael Portillo’s brain recognises a Police Officer. If that person is guarding a gate or standing on a fixed point or chatting to the public, he just sees a person in a uniform. That person might be an armed officer but could just as easily be a PCSO or G4S guard or security at an airport. His mind does not differentiate any more.”

A ‘woman, mother, wife, carer and retired Met officer’ reflects on how the quasi-official appearance of private security company employees may have affected how the public perceive the police as just another group of ‘jobsworths’.

Previous reads

Here’s another great post published in the last few weeks.

Clustering and Payment by Results: The end of service user centred mental health care?

From The Masked AMHP

Posted on 27th September 2012

“Most mental health service users will be completely unaware that when they are assessed by Community Mental Health Teams or in hospital their mental health problems and symptoms are now subjected to an arcane system known as Clustering.”

The Masked AMHP describes the impact of the use of clustering and payment by results in the commissioning of local mental health services – and argues that the real ‘customer’ under this approach is the new GP consortia rather than service users.

If you’re a frontline blogger, do send us your latest blogs on policy issues or posts from the past that you’re particularly proud of, and they could be included in next week’s round-up. Get in touch with us at: info@guerillapolicy.org or via Twitter @guerillapolicy


Best of the frontline bloggers (week ending 21st September 2012)

We love public and voluntary service bloggers. At their best, they capture the day-to-day reality of public services in a way that Westminster-commentators can’t  and they have the real expertise and insights we need to improve social policy. Here’s our selection of the best frontline blogs we’ve read this week. Do send us your suggestions for great posts we’ve missed – and those frontline bloggers we should follow in the future.

Health

A rare shaft of light

From The Jobbing Doctor

Posted on 15th September 2012

“Anna Soubry, the new junior minister at the Department [of Health], is reported to say that the Government screwed up by not engaging with the professions. She is right, although they never really intended to win hearts and minds: we are not idiots and could always see what was planned. This comment is a shaft of light in the murk of the plotting to break up the NHS.”

The Jobbing Doctor, a GP working in a large industrialised conurbation outside London, argues that the Government health reforms are not about empowering the professions but a detailed and planned assault on the service – supported by all the main political parties and a ‘tiny list of supporters’ to provide cover.

Education

A new summing-up

From Scenes from the Battleground

Posted on 16th September 2012

“The central contention of this blog is that our state school system is simply not good enough. It does not provide a decent quality of education for the vast majority, and most would avoid it if they could afford to. Too many people with power over education are content to provide a service that they would not think good enough for their own children.”

A dumbed-down curriculum and teaching methods, the ‘behaviour crisis’, and bureaucratic and incompetent management: the problems facing the education system as described by an ‘utterly dissatisfied’ secondary school teacher – and what the future holds.

Social care

Consulting on the CQC

From The Not So Big Society

Posted on 20th September 2012

“For a regulator to have public confidence, the public have to know what they do, what they are responsible for and what they are not responsible for. …Inspectors could have a greater visibility online and using broader social media to communicate with the public – not just through PR people. I want to know what inspectors do every day. I’d love to see a regular blog from an inspector (without needing to mention any specific services but just with broad themes – generally frontline blogs are more interesting than management blogs!)”

Ermintrude, a ‘social worker by trade but so much more’, reviews the new draft strategy for the health and adult social care services regulator the Care Quality Commission – and argues for a much more people-based approach.

Disability

Care is care. Let’s stand together for political and social change

From The Caregivers’ Living Room

Posted on 19th September 2012

“The thing is …we are all sitting around here talking about big ideas like nurturing leadership in our disabled youth population and whether we should lobby for more disability arts initiatives. What I think we should talk about is whether in ten years time, there will be anyone around to wipe our bums. I believe we are heading toward a time when giving care will be devalued and we will all end up being warehoused in institutions with lousy care and no one will notice.”

Donna Thomson, former actor, director and teacher, now parent to a disabled son and with a ‘second career’ as a disability activist, reflects on the challenge she once heard in a meeting of activists – and the need to think like a movement in order to achieve political and social change for the good of families and the future.

A perfect storm

From Welsh Wallace

Posted on 17th September 2012

“…according to the new test for the benefits I wasn’t disabled. I could pick up a pencil off the floor (regardless I had to feel around for it for a good five minutes first). I can walk (regardless I can only stand for about 5 minutes before my spine gives out) but enough in their words to walk from a taxi to an office. …So because I passed these “tests” I was refused on those grounds for disability benefit. Being blind was not an issue because I could still walk so with that logic walking a few steps enabled me to see where I was going, to read letters, to cross the roads without danger just as any sighted person could. It was a miracle! I was cured!”

A powerful post on what it’s like to ‘walk in the shoes’ of a blind man – and to undergo the disability test when you’re having a very bad week.

Welfare

Universal Credit – how is this simplification?

From DPAC (Disabled People Against Cuts)

Posted on 16th September 2012

“Overpayments under the new system will not be subject to the same rights of dispute which currently exist, so many claimants simply won’t be able to properly contest an unfair decision. When government is asked about the problems all of this creates they stick to script and tell us all how ‘work pays’. The emphasis on work is backed up by an assurance that simplifying the benefits system makes it more possible to transition from welfare to work; the new highway for making the transition is Universal Credit which we are all told is ‘on track’.”

Universal Credit is meant to merge all working age benefits into a ‘single streamlined payment.’ Not according to this detailed analysis it doesn’t, originally from the MyLegal forum.

Previous reads

Here are a few more great posts from the past few weeks.

Welfare

Problem?

From This is My Blog

Posted on 12th June 2012

“The big line being pushed by our beloved government this week is about “problem families” and the need to “crack down” on them. …So what makes a “problem family”? How do we define the country’s “worst scumbags”?

Mary, a 30-year-old knitter living with her husband, a robot vacuum cleaner – and ME – finds the Government’s definition of ‘problem families’ uncomfortably close to (her childhood) home.

Policing

The high price of cutting costs

From Minimum Cover

Posted on 5th July 2012

“…there is sometimes a huge chasm between the headline saving and the bottom line cost. Some officers, including me, have resorted to sorting these types of issue at their own cost on more than one occasion. It’s just what we do to keep things running smoothly.”

M.C.’s blog – a “mixture of personal experience, factual accounts, [and] a modicum of fiction here and there to ease the literary process and protect the innocent” – reflects on how ‘cost-savings’ have turned replacing a 29 pence light bulb into a kerfuffle costing £100.

Standing outside the fire

From Cate Moore’s Blog

Posted on 12th June 2012

“I am telling you to play clever. And safe. You do not need to shy away from your ideals and the things that you care passionately about. Indeed you are letting the public down if you do. Speak truth, speak it fairly and speak it pleasantly.”

A retired policewoman encourages other officers to use social media to comment on government policy – but to do it carefully.

If you’re a frontline blogger, do send us your latest blogs on policy issues or posts from the past that you’re particularly proud of, and they could be included in next week’s round-up. Get in touch with us at: info@guerillapolicy.org or via Twitter @guerillapolicy


Best of the frontline bloggers (week ending 14th September 2012)

We’ve written before about our love of public and voluntary service bloggers, and how we’d almost always rather read a dispatch from the frontline than largely warmed-over opinion from a Westminster-centric commentator. At their best, frontline bloggers capture the day-to-day reality of public services in a way that others can’t  including the dirty, difficult, and sometimes dangerous experiences that make for real expertise and the insights we need to improve social policy. So here’s our selection of the best frontline blogs we’ve read this week. Do send us your suggestions for great posts we’ve missed – and those frontline bloggers we should follow in the future.

Policing

Dishonor Among Ranks

From The Custody Record

Posted on September 10, 2012

“The actions of such officers tarnish us all and transcend through time to today. As an honest cop I am fed up of holding up my principles and morals for inspection only to have them cast to the ground and shattered by individuals intent on giving the police a bad name. There was no room for you then and there is no room for you now. Get out of the job.”

In the wake of the release of the Hillsborough report, one copper reflects on the divided loyalties that are sometimes provoked by working at the frontline of policing.

Suicide prevention

From Mental Health Cop

Posted on September 10, 2012

“The Government will today publish a new 10-year strategy for suicide prevention.  …what we can already say is that it will need to re-address gaps which we have existed for years and which we know are spoken of, time and again. I also fear that it will be unable to address the underlying political, social and economic issues which we know contribute to suicide levels, alongside medical and psychological factors.”

On World Suicide Prevention Day, Mental Health Cop explains why the police are often put in the position of responding when personal crisis becomes a public emergency.

Social care

In the shoes of Karen (2)… a daughter’s insights into life in a care home

From Whose Shoes

Posted on September 11, 2012

“In order to safeguard vulnerable adults, I have felt the need to share this with the management at [this care home], but this is addressed to you directly so you might develop some understanding of the impact of your words and your attitude on people’s lives. It seems only fair to tell you myself.”

Here’s a moving and challenging post from ‘Karen’ (who tweets as DazeinourLives). Karen’s mother has dementia. Here Karen shares a letter she wrote complaining about an incident she witnessed in the care home whilst visiting her late father.

Education

How is it possible that no-one in England knows what a C-grade answer looks like?

From LKM

Posted on September 11, 2012

“Somewhere Gove is sitting waiting to pounce on this to make a reform announcement and I am sure we will rake over his changes time and again. But among all that analysis I hope that someone asks him thisHow will the new reform help teachers know what C (or B, or A) grade quality is? Because if teachers don’t know then we are the blind leading the blind, and no matter how ‘rigorous’, or dull, or comparable-to-Singapore our new qualifications are, there is still the same risk of this happening all over again.”

After it was revealed that OFQUAL did in fact ask at least one exam board to reconsider their GCSE boundaries, many questions can be asked, including: How is it possible that no-one in England can agree what a C grade English GCSE answer looks like?

Probation

Smoke and mirrors

From On Probation

Posted on September 11, 2012

“Payment by Results is the coalition government’s new wonder answer to everything, in fact just like the Private Finance Initiative was to the last Labour administration. Of course the latter has proved to be an utter disaster… But so attractive is the idea proving to politicians as being the next ‘magic bullet’ that the idea is being rapidly promoted everywhere and before any research as to its effectiveness is concluded.”

Welcome to the personal thoughts of Jim Brown, an ‘ordinary probation officer’ struggling to come to terms with constant change, whilst trying to do a useful job for society. In this post, Jim explains why Payment by Results is just a new ‘smoke and mirrors’ way to run public services – yet another futile attempt to get more for less.


Selling public services – where’s the evidence for outsourcing?

In posts over the past few weeks, we’ve looked at the issues of accountability, transparency and reliability raised by the Government’s ‘open public services’ agenda, in particular its plans to outsource more public services. We’ve focused especially on how outsourcing threatens to undermine another recently announced Government initiative, that for ‘open policy making.’ If the Government wants policy to be based on real expertise and evidence, it’s important to ask where the evidence is that outsourcing produces better public services – and who continues to push outsourcing in the absence of this evidence. The answers suggest that we are a long way from genuinely open policy and the independent research that we need to inform better policy.

The outsourcing of public services has never been popular with the public. According to a recent YouGov survey for the Fabian Society, nearly two-thirds of people think that ‘services like health and education should not be run as businesses. They depend on the values and ethos of the public good.’ Two-thirds of people also believe that public services should be provided wholly or mainly by national or local government. A third of the public believes that when politicians talk about ‘choice’ in public services, they really mean privatisation. Most of the public like the idea of public services, publicly delivered – and publicly accountable as well.

Given this, why have governments of all stripes over the past 30 years continually sought to extend outsourcing to more public services ? Where is the evidence that outsourcing works? If outsourcing isn’t popular with the public or the people who provide public services, who is it popular with? The next few posts will examine the arguments and evidence in favour of outsourcing – and who’s being paid to promote outsourcing in more and more public services.

Typically there are three main benefits of outsourcing that are put forward as part of the ‘Whitehall consensus.’ As we’ve discussed in posts over the past few weeks, all of these benefits can be questioned – and need to be if we are going to avoid more public services turning into public policy disasters akin to rail privatisation.

The first claimed benefit is efficiency. The flag bearer for this is the 2008 review commissioned by the previous government and conducted by the DeAnne Julius. This found that the ‘public services industry‘ in the UK is the most developed in the world and is second in size only to that of the US (in 2007-08 it represented nearly 6 per cent of GDP with revenues of £79 billion and employing more than 1.2 million people). But although the Julius review is often cited as evidence in support of outsourcing, it was  never a study of its overall benefits (or disadvantages) – rather it was a review by a corporate insider on how government could support the growth of the public services industry.

The description ‘corporate insider’ is not hyperbole. Julius is a former senior economic advisor at the World Bank, founder member of the Bank of England’s Monetary Policy Committee, and non-executive director of BP. She is also on the board of partners of Deloitte UK, and since last year also an independent non-executive on Deloitte’s main board. Julius was, until December 2007 – that is, when she was appointed to conduct her review – a senior independent non-executive director, and member of the audit committee, remuneration committee, training and development committee, and nomination committee of Serco Group plc and Serco Solutions Ltd. In addition, the advisory panel for her review included representatives of the CBI, Partnerships UK, Cap Gemini, Working Links, Logica CMG, Spire Healthcare, Babcock, KPMG, and Serco itself – all of them with very significant interests in outsourcing.

Regarding the repeated claims for ‘greater efficiency’, of course it’s possible to reduce contract costs through open tendering – you pick the lowest bidder, despite the impact this might have on quality or effectiveness (which is the real measure of value for money). But for such a widely accepted policy (at least in certain circles) there’s little clear-cut or comprehensive evidence that outsourcing improves the real quality or efficiency of public services. As Nick Timmins of the Financial Times noted at the time of the review (in, of all places, Serco’s own journal): “What is still needed, …despite the release of the Julius Review, is a better analysis of where it works well and why. We also need to know why, when it fails, [if] it is due to structural and incentive problems rather than an individual company, or third sector provider, failure.”

The second benefit put forward for outsourcing is that it produces more responsive public services – services that engage more with users and respond to their needs. The Whitehall consensus says that outsourcing helps to break-up bureaucracies and creates far more responsive services – something both left and right can get behind (this is where even supposedly progressive think tanks fall for the notion of more ‘diversified provision’). But as we’ve noted in previous posts, outsourcing and the push for more marketised services generally have often undermined efforts to work with service users and the public – firstly because increasingly fragmented services makes sustained public engagement and real choice more difficult, and secondly because it has led to the growth of very large providers which are too big to care what individual service users – or even the public as a whole – might think.

The third supposed benefit of outsourcing is innovation. In particular the (often left-leaning) ‘innovation industry’ – of which I used to be a (small) part – that calls for ‘new solutions to old problems’ seems to hope that outsourcing will somehow magic innovation out of thin air. But as we’re now being reminded under austerity, innovation on the cheap leaves people without adequate services and support, as much-touted innovations from care in the community to personal budgets have shown. Some of these innovations – however positive the ideas on paper – have helped to prepare the ground for cuts and reduced access to services, for example the way that personal budgets have made it easier to reduce support than it would have been to decommission traditional services.

In reality, there can be little innovation or even improvement without both proper investment and sustained engagement with the people who use and provide services – but these are exactly the people who are marginalised by an outsourcing agenda that they didn’t vote for and don’t agree with (despite being exposed to more than 30 years’ worth of propaganda in its favour).

In many respects the current Government’s open public services agenda merely restates the recommendations from the Julius review, such as its call to open up public service markets and for ‘competitive neutrality’ between public, private and third sector bidders to deliver public services (there is, however, a notable lack of evidence in the open public services white paper – as if the benefits of outsourcing are now so obvious they hardly need to be mentioned). Looking back at the Julius review now, what’s most striking is its complete lack of any other perspectives. For example, there’s no evidence from service users about the quality of outsourced services, and no sense of how public services can be accountable to the public other than by being re-designed as individualised consumer-like services.

We’re still waiting for an independent, rigorous and reliable analysis of the effects of outsourcing – one that incorporates long-term value for money rather than short-term costs, but also evaluates the wider social, economic and political impact of the public services industry. What is especially absent is any analysis about what outsourced public services look like from the perspective of the people who use and provide public services – as opposed to the industry insiders who benefit directly from selling-off public services to the lowest bidder.


Winterbourne View shows that some policies are ‘out of sight, out of mind’

In a previous post we suggested that outsourcing can be a way to protect unpopular policies. In the case of vulnerable adults with learning disabilities, outsourcing has become a way to abandon them in poorly run institutions far away from their families – until scandals like Winterbourne View force us to confront the abuse that this isolation enables. Blaming poor providers is only part of the picture – we also need to look at the bad policy that enables such abuse to happen.

Winterbourne View Hospital was an admission and treatment unit for people with learning disabilities in Bristol, managed by social care provider Castlebeck. A Panorama programme, Undercover Care: The Abuse Exposed, first shown on BBC One in 2011, uncovered the endemic abuse and neglect taking place at the centre. The programme showed footage of one member of staff who trapped a female patient under a chair whilst he watched television; another female patient was dragged from her bed by two male members of staff. The appalling abuse that took place at Winterbourne was only uncovered because a whistleblower, Terry Bryan, was prepared to raise the alarm.

This is not just about one bad provider, however. Following the scandal, the Government asked the regulator, the Care Quality Commission (CQC), to make unannounced inspections of 150 similar learning disability services. CQC found that nearly half of hospitals and care homes are still failing to meet acceptable standards. The degree of abuse at Winterbourne View is sadly not unique either – it follows other recent scandals in NHS care homes for people with learning difficulties in Cornwall and in Merton and Sutton.

Multi-agency working clearly also failed in the case of Winterbourne View, and the Department of Health has called for more joined up working – the usual mantra after such scandals. Avon and Somerset police were called 29 times but failed to observe any pattern or draw any conclusions about the level of incidents at the home. The local Adult Safeguarding Board received 40 alerts over three years but took no action, whilst CQC decided not to follow up the notifications of abuse it received because it assumed that the local Safeguarding Board was doing so. CQC had also inspected Winterbourne View prior to the Panorama programme and concluded that the service met its standards. Vulnerable individuals have been at a centre of a web of public bodies who are all pointing the finger of blame at each other, from the CQC, the local Safeguarding Board, NHS commissioners, to the police and the local hospital.

But this is not (just) a failure of regulation either. Various reports relating to successive scandals have pointed not only to gaps in multi-agency working, but also to poor training, the pay and conditions of staff employed in adult social care, commissioning focused only on procurement rather than managing contracts, and poor representation of the views and aspirations of disabled people and their families. In other words, it’s time we focused on what’s wrong with the policy as well.

Many people assume that the NHS or local authorities provide services for people with a learning disability, but scandals like Winterbourne View highlight that much of the social care system is outsourced to providers who run these services to make a profit. Despite the perception of over-regulation of these services, something is not working if cases like Winterbourne View, Cornwall and in Sutton and Merton continue to emerge – and these are just the ones we know about.

Despite the rhetoric of ‘localism’,  ‘choice’ and ‘personalisation’ that underpins the Government’s open public services agenda, too many adults with a learning disability are still being placed in poorly-run institutions far away from their families and friends. This is the argument of 86 individuals and organisations that wrote a joint letter to Paul Burstow MP, the Minister for Care Services.

Admission to an assessment and treatment unit such as Winterbourne View is supposed to be time limited to complete a new assessment and treatment plan or change medication. However evidence points to the fact that people go in and stay in. The CQC Count Me in 2010 census looked at providers of in-patient learning disability services. It found that 67% of all patients in England and Wales had been in hospital for one year or more, 53% for two years or more and 31% for more than five years. This policy could be characterized as ‘out of sight, out of mind’, which was the theme of a recent report from Mencap in how to stop the neglect and abuse of people with a learning disability.

Many people with a learning disability want to live in the community that they come from, near their family and friends, with support available locally. Mencap and other providers have called for policy changes, in particular the closure of these residential assessment centres, to be replaced by a system of local care and support. One of the problems of Winterbourne View was that in some cases families were actually refused contact or had contact their family member restricted in some way. Abandoning people in long-term residential centres far from their families leaves people feeling very isolated, especially for older people with a learning disability where their parents may be frail or have passed on with family contact left to siblings or distance relatives.

To place one person in one of these assessment and treatment units can often cost in excess of £150,000 per year. Supporting people in their local community would cost significantly less. Large sums of public money are being spent on inappropriate treatment that many people with a learning disability and their families don’t want to access. A wider debate about the policy is urgently needed. If charities, families and people with a learning disability are telling us they would like a different approach to delivering care and support, why is this being ignored? The Government’s recently announced open policy agenda is all about ensuring that more expertise and evidence informs policy, wherever this input comes from. What price genuinely open policy if it might threaten the current lucrative market for outsourced delivery in which services users have little voice?


How outsourcing can reduce real choices for people using services

In recent posts we’ve been exploring the tensions between two competing Government agendas – for so-called ‘open public services’ and ‘open policy-making’. Choice is supposed to be a central part of the Government’s agenda to open up public services to greater competition in order to improve outcomes, quality and efficiency. In this post we explore three ways in which outsourcing can actually reduce real choices for people using public services.

You might have missed it, but in June the Cabinet Office announced an independent review led by David Boyle into the barriers to choice in public services. The review is looking to address the factors that prevent people from understanding and exercising the choices available to them in a range of public services. But the review does not address another pertinent question: how ‘open public services’, especially outsourcing, can reduce real choices for the public.

Firstly, there is no getting away from the impact of the cuts, which are creating poor choices for users of public services. For example, local councils are due to make cuts of about £2 billion to adult social care budgets between 2011-13, with £890 million coming out this year alone as part of the Government’s deficit reduction programme. Outsourcing services to non-public sector providers is seen as the main way to reduce costs.

Take this example: domiciliary care services (care in the home), much of which is outsourced, is one area that has borne the brunt of cuts. Hourly rates for dom care have dropped in some parts of the country to as low as £10-12 per hour. From a provider point of view, the only way to make these contracts work financially is to increase the volume of customers and reduce costs. Given that the majority of cost is staff time, this means becoming a minimum wage employer and reducing staff terms and conditions – a move that many charities and private sector providers are (being forced into) making. It also means cutting the time allocated for care visits to under 30 minutes and sometimes to less than 15 minutes.

Rationing of social care has also meant the things that people want to choose – for example social contact or help with domestic duties such as housework, shopping and gardening – are not available unless they can afford to pay from their savings. According to Age UK 33% of older people report feeling lonely, with this figure increasing to half for those aged over 80. It’s obvious that a 15 minute visit doesn’t leave time for a conversation.

Outsourcing based on price is bound to affect quality. A review into choice and competition in public services by the OFT found that competition based on price alone is likely to lead to a deterioration of quality. This is backed up by the results from a survey conducted by the National Care Forum of 40 social care providers this week, which showed that the social care workforce is rapidly ageing, and that there has been a hike in staff turnover rates. Given the unsociable hours and low pay, social care does not tend to be an attractive career option for young people. 46% of care staff are aged 46 or over, whilst turnover rates for domiciliary care for older people has climbed to almost 28%.

Secondly, information about services available is fragmented. It is well documented that advocacy, information and advice services are withering on the vine as a result of the cuts. Yet good quality information and advocacy support are integral to supporting choice. Information about providers is hard to find with services such as Find Me Good Care, Shop4Support and the Good Care Guide in their infancy. The Government has been reluctant to invest in services such as these – the Social Care Institute for Excellence has invested their reserves into Find Me Good Care instead. Providers have also been agnostic about these services as many of them find business through word of mouth or local authority referrals. Yet without adequate market information, real choice for service users will be undermined.

The views of service users are not always well understood or captured by services. Take another sector as an example: 11,000 pupils are placed in out of authority special schools at an annual cost of £572 million. A review of this market by the Audit Commission found that young people were rarely asked for their opinions or offered choices. Instead, choices are made by parents and professionals, not the young person themselves. Many young people want to be placed nearer to their family but the concerns of their parents tend to take precedence.

Thirdly, the ‘bigger is better’ approach to outsourcing is reducing real choices for people. The outsourced public services market is maturing around a group of large providers who are increasingly too big to fail. The Government is ever more reliant on providers such as Capita, Atos, A4e, Serco and G4S, who alone have the scale and funds to absorb the risks associated with this ‘bigger is better’ approach to outsourcing. A4e now delivers services across welfare to work, adult social care, information and advice and offender management. The dominance of these providers crowds out small charities and providers who cannot compete on a level playing field, which again reduces choice for service users but also commissioners of services.

Choice is nothing new of course; successive governments have embraced it as a way to improve performance across a range of public services, and in one sense the current Government under its open public services agenda is only continuing this trend. But after nearly 30 years of promises of increased choice – often to be achieved through increasing amounts of outsourcing – many of the actual choices available to the public seem less and less appealing. The one choice we don’t seem to be being offered is the political choice to challenge this agenda – for the users of services and the professionals who deliver these services not to be subject to imposed ‘choice’, but rather for them to be able to determine together how services can be improved and for policy wonks to get out of their way. Perhaps the Cabinet Office could add this type of choice to its review, if it is allowed to.