Podium: Aiming for adequacy

Podium — By TFNadmin on 13/05/2011 12:00 am

ANOTHER major third sector care provider consults its workforce on cuts to pay, terms and conditions. Its directors will have agonised about how to approach the dilemma now facing increasing numbers of providers: do we hold firm and risk losing business to more keenly-priced competitors; or do we make our own price more competitive by cutting workforce costs?

Earlier this month, the Coalition of Care and Support Providers in Scotland (CCPS) published a report documenting the hard decisions that many care providers have made in an effort to keep their heads above water. Sick pay, pensions, travel expenses, holiday entitlements, even basic rates of pay: nothing has been left untouched, and there is no longer any single element of public sector terms and conditions universally available to staff in voluntary organisations.

Meanwhile behind the scenes, a collective groan has gone up from the last few organisations that have so far managed to maintain (comparatively) good terms and conditions, because they can see that this new development is likely to hasten the day when the pressure to follow suit becomes too great to resist. Thus the vicious circle cranks a little further round on its rotation, and the sector continues – as a local government specialist put it to me many years ago – to “collude in its own exploitation”.

The dilemma faced by providers presupposes that there are only two options available: either lose business to a lower-cost provider or become one yourself. I’m sorry to say that almost everything we’ve learned about public procurement in the last three or four years has led us to this depressing conclusion.

Yet Best Value was always supposed to be about balancing cost with quality, not prioritising one and sacrificing the other. It was also meant to relate to the total public purse, not to individual public bodies in isolation from one another other.

Cool appraisal is therefore required as to why some services cost more than others, and commissioners need to be at least open to the possibility that it’s because some providers are in fact better than others at supporting people to realise their potential and live more independently. They are better at contributing to the achievement of long-desired outcomes, such as reduced hospital admissions, lower rates of re-offending, or higher levels of educational attainment; better at developing and nurturing family and community support; better at giving disadvantaged people their lives back.

Many such providers are third sector organisations, and a large part of the reason why they are capable of delivering these results is because they are able to attract and retain a skilled workforce. Maintaining this capability may not deliver short-term savings, but it’s highly likely to reduce future demand for high-cost, high-intensity services – although crucially, not necessarily those funded by the same pot of money.  The Scottish Parliament Finance Committee is well aware of this, and so is the Christie Commission. So why is there still such intense pressure on staff costs?

I wouldn’t argue for a second that just because something’s expensive, it’s got to be good: you only have to look at the track record of some of the more eye-wateringly expensive public sector services to understand that. I would argue strongly, though, that the ability to offer a decent service becomes very difficult indeed once the amount that commissioners are prepared to pay for it has dropped below a certain point.

We saw this demonstrated quite clearly on Panorama not so long ago: hard-pressed people trying to do the best they can on the minimum wage and a zero-hours contract, with little or no training or supervision, their time sliced up into 15-minute ‘care’ interventions, the day’s case notes doled out from a car boot and constant phone hassle from managers to move on to the next client.

If commissioning authorities are to avoid a starring role in a similar future production, they need to start thinking realistically about what they are likely to get for their money if the rate they pay won’t even cover a decent wage for support workers.

At least Panorama succeeded in raising wider awareness of these issues. The Local Government Committee of the Scottish Parliament was particularly incensed by it, and extremely supportive of efforts by CCPS and others to counter the worst effects of poor public procurement. Lengthy guidance for local authorities has now been produced; the online “auctioning” of care and support has been outlawed; and Audit Scotland is taking a keen interest in the way that social care is commissioned.

Yet none of this has been able to prevent the continuing downward slide of pay and conditions in the sector. Last year, CCPS secured an amendment to the new scrutiny legislation to the effect that local authorities must now take account of quality information held by the regulator when making commissioning and procurement decisions. We believed that this would encourage authorities (to borrow a term that has driven much care policy in the last decade) to “aim for excellence.”

This has proved naïve. At least one authority has responded by stating explicitly in its commissioning plan that whilst services assessed by the regulator as good, very good and excellent are of course desirable, at the end of the day it’s happy to do business with anyone who can manage an adequate.  Such are our modern aspirations for care: “aiming for adequacy” doesn’t have quite the same ring about it, does it?

Even more worrying is the fact that the roll-out of personalisation and self-directed support – which should be a major step forward, both for people with support needs and for those supporting them – is now becoming dangerously entangled with this cost-cutting agenda, and risks becoming discredited as a result.

During its first term in office, the SNP government expressed (and demonstrated) strong support for the third sector. Yet for most service providers, things have become progressively worse rather than better: we’re still a soft target for cuts, we’re still placed under enormous pressure from procurement exercises that are structurally incapable either of properly evaluating quality or testing a bidder’s capacity to deliver it (and, please note, from which inefficient and ineffective in-house provision is invariably insulated) and our staff are still regarded by commissioning authorities as worth less than their own employees.

This new government is much stronger, and can afford to be much bolder. So is it going to stand by and watch for another five years, while third sector excellence is rejected in favour of adequacy? Or will it commit itself to fostering and supporting a genuine public service ethos in the third as well as the public sector, supporting and enabling us to resist the downward slide towards casualisation, zero hours contracts, statutory minimum T&Cs and pay cuts?  I’d like to think so.

Tags: Audit Scotland, CCPS, Christie Commission, TFN 635 - 13 May 2011, Yet Best Value