Delivering care

Immediately before working in social care I spent a long summer working for Royal Mail. Most of my routes were in a semi-rural area and despite my anxiety that I was wasting my newly achieved 2:2 it was looking back probably the most relaxing enjoyable job I have ever had; even the occasional rainy days weren't so bad.

Hearing stories about Royal Mail these days I wonder how much the job has changed, in particular I wonder about one of my former colleagues who was always cheerful and always smiling as he simply loved the job. I hope that's still the case, or else he's somewhere else where he's enjoying work, but reading this article in the Guardian about the poor conditions and low-pay within the privatised and liberalised postal service in Holland I do worry what the future holds for employees such as my old colleague.

I mention this all, not by means of reminiscence as I currently grind out a day-time living in the call-centre and nocturnal existence writing essays on research methodologies, but because the conclusion of the article struck a chord:

In this competition the power lies with the few, whose priority is cheapness, rather than the many, whose priority is regularity and universality; cheapness wins, and it is the postal workers who suffer.

Such a passage could easily be applied to care workers. Since the NHS and Community Care act created the purchaser/provider split local government commissioners have prioritised cheapness driving down the cost of both residential and non-residential care. In a labour-intensive industry it has been workers who have paid the biggest price.

Should we worry? Yes. Well-paid and well-respected staff members contribute to a better service. Another reason is that social care is up there at the vanguard having for a combination of reasons moved furthest, fastest when it comes to liberalising welfare markets. The question we really need to ask is do we want to see the social care model replicated in the NHS?

Mutuals: A blueprint for the future?

According to a recent article in the Guardian the Government are very much in favour of 'mutuals' this is the process where public servants can club together and effectively opt-out of the public sector.

As a former public servant I must say I always felt that myself and my colleagues could do a better job than our senior managers who seemed to be handpicked for their ability to lurch from crisis to crisis whilst maintaining a veneer of optimism.

The idea of mutuals trouble me though. Much of my interest at university (in fact I'm currently in negotiations about a potential Phd on this very topic) is around how organisational characteristics impact on the public service ethos; in other words is the profit motive found in the private sector inconsistent with public service ethos of the voluntary and public sectors? The answer you may be surprised to hear is that it is not necessarily the case, in fact the opposite may be true; that is in some circumstances for-profit organisations may contribute the public good more effectively that the private or public sectors.

This view is against conventional wisdom, but a great example is provided by the Body Shop. Seen as left-field and pioneering when they were first set up the virtues they champion have been absorbed into the mainstream. All that within a for-profit model which would have been inconceivable in the voluntary or public sector. I am aware that I have defended the public service ethos of the public sector in the past and my views have not necessarily changes, I still beleive that the public sector possesses a particular strength in this aspect, but rather I am more pragmatic about which sectors should deliver services. the way I see it is very much a case of 'horses for courses'; in some instance the public sector is best, in others the qualities of the private or voluntary sectors can be better.

The problems however, centre around the pressures such 'mutuals' may find themselves under. It appears they will be a hybrid of all three sectors and will need to balance public service with profit making. The example given in the article of Cleveland Fire Brigade presents one example; on one hand the organisation has a public service committment committed to providing services to the public, but this will need to be balanced against profit making activities. This means decisions will need to be made in the future as to how best to allocate resources, should a fireman be on standby in case of a fire, or would it be better if he/she was off conducting a paid consultancy to bring in extra cash. This is not far fetched speculation, but a real issue as in the voluntary sector the issue of 'mission drift'; that is abandoning an organisations core mission to chase the funding on offer has become a real and recognised issue in the voluntary sector, first through a glut of funding opportunities and latterly through a scarcity of funding.

The answer to these dilemmas is that there should be a level of accountability, but accountability to who? Local councillors perhaps, but what if an organisations area of operation overlaps several authorities boundaries then who takes the lead and is local government really an effective tool for this? In addition the more mutuals there are, the harder it is to trace accountability. In the NHS and public services as they stand there is a clear chain of command. Numerous mutuals operating in different areas may well be hard to keep track of and their opaqueness could prevent accountability from the public and local media.

I do beleive that there is a case for challenging the monopoly of the public sector, but any moves need to be done with extreme caution and lessons learnt from the experience of transferring services from the public to voluntary sector.

The rotten state of residential care

Well it seems a Social Care story has finally appeared...

Southern Cross Healthcare who own and operate 31 000 residential homes are in serious financial difficulty. The chairman has quit and the firm is threatened with possible insolvency.

According to the Guardian article Southern Cross came unstuck due to greed:

The company's problems stem from heady expansion when it was owned by the US private equity group Blackstone, which undertook the sale and leaseback of homes to bankroll a number of expensive acquisitions. Many leaseback agreements included upward-only rent reviews of up to 2.6% annually.

As the article also explains whilst this may have seemed like a good idea at the time it doesn't seem so good in the face of local government cutbacks. I know my old authourity a couple of years back went with a 1% increase in the maximum funding levels two years in a row, and for all I know this situation probably continued after I left. What this means is that as far as local authority clients went a company like Southern Cross could only expect the price they received per resident to rise by 1% Makes those 2.6% rent reviews seem like a very bad idea indeed.

But, isn't that the way markets work? Risk and Reward. Southern Cross won't be the first firm to have collapsed after overstretching itself to meet ambitious targets. Maybe we could shrug it off if it wasn't for the following passage of the article:

Paul Saper, chief executive of LCS International, the healthcare consultants, said that the cash-strapped group had not "invested properly in some of its homes, with doors falling off the hinges at some properties". He added that, a year ago, about 40 of the company's homes faced embargos from the regulator and that several had been the target of enforcement orders linked to issues such as hygiene and standards of safety.

This is the crucial difference. The state of the residential care sector affects lives; the lives of residents, of staff and of families. This episode serves as a reminder of just how rotten things are in the sector and just how thoroughly rotten the whole system is.

I don't think many people in social care would rush to defend the status quo. In the one corner we have the capitalists seeking to make a profit, in the other we have local authorities keen to cut costs.

Between these two implulses the standard of care in the sector, particularly for those least able to top-up with their own resources, is being driven down. Residents are put at risk and staff are expected to do a tough and demanding job for a pittance and without the right support and training.

There is an irony here that in the event of Southern Cross folding Local Authorities, most of whom have spent the past few years closing down their own homes to a great deal of local resistance, may well end up taking on responsibility for the homes.

A quiet time

A hectic schedule and a problem with internet access have conspired to prevent me from posting anything really meaningful over recent weeks, but is it just me or is the world of social care a rather quiet one right now?

The media is a fickle beast; like a channel-surfing teenager it has a short attention span rapidly flicking between channels to create some sort of post-modern collage. One second we're getting all worked up debating the big society, individual budgets and disability benifits and suddenly the channel is changed. A complete break. We're now talking about NHS reforms. The rest will have to wait patiently until events; a speech, confrence, report or scandal lead the media to return with our collective attention once again.

Just how well thought through is Government policy?

Just how well is policy thought out. If the current Tuition fee debacle is anything to go by then the answer has to be very badly if at all.

Just take one paragraph from the guardian today which tellingly says:

The number of universities declaring that they wish to charge students the highest amount from next year has caught ministers by surprise, with the majority of institutions planning to charge more than £7,500 a year.

Now, I clearly remember government representatives on television stating that there would be a wide range in terms of fees charged by institutions and that students would be able to then make a choice from this range. Let me just say that the commodification of education is not something I condone at all, in fact it is something I vigourously oppose, but also worryingly it seems that if ministers have got it this wrong on what is comparitively a rather simple market to analyse then what does this say about the basis of policy in other areas such as around social care a much more complex entity.

And the reason why universities are charging high fees... It's because they know demand will still be there even if they charge students extortionate rates. Why? Because university still represents chasing the dream to most young people. It is still seen as virtually the only the route to a career, home-ownership and the middle class. Universities know, even if ministers don't that with few alternatives, people will be prepared to pay for this dream.