One of the flagship policies of this new coalition government and one mentioned in the Spending Review is about outsourcing services from directly provided in-house type provision to a tendering out type market led style of outsourcing services.
This is not new in adult social care. It was an attempt of the 1990 NHS and Community Care Act. We (social workers) were going to be buying in services from many different sources. We were to be care managers rather than care providers. It was a seismic shift in social care provision driven by the ideology of Thatcherism which equated private sector as good versus the clunky inefficiency of the public sector.
Indeed, a part of the ‘Big Society’ ethos is ‘shifting power away from central government to the local level, – to citizens, communities and INDEPENDENT PROVIDERS’.
All sounds nice and fluffy but – we have local authorities in London at least (possibly throughout the country but honestly, London is what I know best) merging services to create a potential democratic deficit – for the record, I don’t in general have an issue with joint service provision across boroughs but it doesn’t seem to fit 100% into the localism agenda. It is the ethos behind a move towards independent providers that I fear.
I have seen the future and it is shaky and dangerous without exceptional and firm regulation and honestly if one thing is going in the cuts, it is exactly that.
Let me explain further taking the lessons learnt from the contracting out of services in social care.
Firstly, I have come across some exceptional private care providers but they are a rarity rather than the normality that they should be. That breaks my heart as I move from social worker to care manager. How much confidence can we have in recommending care packages when we know there will be issues in the quality of service provided by profit-making agencies.
We can see with the story that was in the news recently regarding Jamie Merrett, a 37 year old man who is tetraplegic following a road accident and who was reliant on care being provided by nursing staff. A nurse was supplied via an agency who was not able to manage his care and she switched off his life support machine which lead to permanent brain damage.
Jamie had installed cameras into his home as he was concerned about the quality of care provision and it was this camera that allowed this error to be highlighted.
It isn’t the nurse at fault so much as the agency that sent her. The nurse Violetta Aylward was not trained in ventilator care. She was probably cheaper for Ambition 24 (the agency) to supply as a result.
The agencies must be held to account as much as the individual nurses especially if the nurses have been sent into situations that they are not trained to manage by the agencies.
This agency, Ambition 24, received ‘three stars’ from the CQC in their last inspection round. It will retain those three stars as the star system doesn’t exist any more so no new inspections will be made and those star ratings will not be changed.
Anyone seeking to use them (and I include procurement teams in local authorities and the NHS) might be swayed by those now, redundant three stars which are resplendently displayed on their site.
They are a large multinational firm that provide nursing care through a number of agencies internationally – no doubt making massive amounts of money and the question has to be asked about the corner cutting that leads to incidents such as this. Where is the morality in the private sector? I know it exists but it also seems to cost. That is the price that not all commissioners are willing to pay.
Yes, this is one case. One incident. But I could tell a few stories about multi-national care agencies providing poor care at high cost and cutting corners on the day to day care to maximise profit – unfortunately, they are not my stories to tell but rather the stories of those who are most affected.
This is what happens when private companies serve public authorities for profit-making purposes. Sure, they can lower some costs, but what what cost?
How many people whose family have been actively affected would say that they get a better quality service from agencies than from the directly provided services that have now been decimated through the ideology of the previous Conservative government?
Some would, I’m sure. I think there would be a majority who would despair at the fall in the quality of care provided.
Direct payments and personal budgets will help some people recruit directly, possibly bypassing agencies but not everyone has the same level of choice. A part of my difficulty with personal budgets is that everyone should be equal but some (those who are able to manage their budgets themselves or have active family members to assist) are more equal than others and more likely to get the better services.
Remember for every case we hear about, for every Jamie Merrett who saw to put in a video camera into his home, there are probably thousands who don’t complain, who can’t complain and who we never know about because they either lack the capacity to have an understanding of the quality of care that is being provided or because they don’t want to ‘make a fuss’ because they fear their own carers or they just can’t speak out because the damage has been done.
Most of the safeguarding investigations I undertake involve formal carers. Those are just the ones we know about.
This is what happens when independent providers are left to patch up the gaps in public services and make profit from the care that they provide.
As I say, I know it isn’t all carers or nurses that work for private agencies but it is the agencies that I blame rather than the carers. They push people to work in areas that they are not trained to. They don’t pay for travel between service users’ homes and turn a blind eye or actively encourage shortened visits and less attention to care.
Equally, the local authorities bear a responsibility for caring more about getting services at the absolute lowest cost rather than judging by quality. Contracts are tendered and granted on the basis of cost.
It is a similar story with residential and nursing homes. Local authorities are pushing the payments down, providers are more concerned about the figures than the quality of care. If you pay someone minimum wage for doing such a vitally important job, you don’t provide them with the training and support they need, you don’t keep staffing levels up to staff levels then you will have increasingly poor quality care provided.
This should be a lesson to have been learnt from pushing the privatisation agenda.
Combined with a paring back of all regulatory bodies, this is dangerous. It will be those with the quieter voices who suffer the most.
My plea to the government would be ‘look at the history before you destroy the future’.
I know it is in vain but that won’t stop me shouting as long and hard as I can.
This is why I fear for the NHS in the future. We have seen the future. It doesn’t work.