Social care must be “insourced” too

In the run up to a Labour Party conference which may well debate social care policy, Malcolm Hunter (Leicester South CLP delegate) make the case for drive to bring the sector into public ownership.

Having recently retired from mental health social work I was delighted when I heard that John McDonnell was pledging that a future Labour Government will ensure that provision of the vast majority of council services is brought back in house. I have since discovered that this pledge, while still very welcome, doesn’t actually cover health and social care services, because provision of these services is covered by different legislation.  

It really does need to be extended to include them; however, because, in my experience contracting out of social care services is doing even more damage to service provision than inadequate funding is and the NHS is starting to go the same way.

Ever since Thatcher there has been a drive to create a market in social care provision and to encourage, or even require councils to buy services from external providers, rather than providing them themselves.  

This process has often been promoted as being about providing service users with more “choice” and some service users have undoubtedly welcomed the opportunity to choose who they want to provide their service, from a range of options.   However, in my experience the vast majority would far rather just have access to good quality services provided directly by their local council and this choice is increasingly denied them.  

Instead they are just allocated a budget, based on a very crude assessment of their “level” of need (not the actual cost of meeting their actual needs) and asked to choose for themselves, between different private sector providers, with little or no reliable information on which to base their choice.   In theory workers are not even supposed to advise them, as this would “distort the market”, even though market theory says that markets only work properly when buyers have perfect understanding of the pros and cons of the options that they are choosing between.

In reality, mind you, the opportunity to choose between providers frequently doesn’t actually exist anyway, because the budgets that councils can afford to allocate are not enough to support spare capacity in the market and, far from standards being pushed up by competition, people just have to accept what is available (if anything) even if it is poor quality.

This system is a very inefficient and wasteful way of providing what often turn out to be substandard services.

There are a whole range of reasons for this:

1) There are some good quality external services, but good quality services require adequate numbers of properly paid, well trained, well-motivated staff.  If someone is also creaming off a profit then such good quality services invariably end up costing more than a similar quality in-house service; and a lot of the services that actually end up being used (which are usually not that cheap either) are provided using poorly paid and poorly trained staff, who as a result are also often poorly motivated.   Not only does this mean that service users get a poor service, it also means that ultimately councils often end up paying even more, providing further services to compensate for the failure of the original service to deliver what they were being paid to.

2) Externally provided services tend to be inflexible, in that if you haven’t commissioned it then they won’t do it.  This means that councils often end up having to massively over commission, to allow for every eventuality that might arise as a result of fluctuating needs, meaning that a lot of time we are paying for things that aren’t needed.  This is unlike in-house provision, which deals with fluctuating needs by shifting input between service users in response to their fluctuating needs.

3) Further unnecessary expenditure is also incurred when councils become stuck in contracts for things that are no longer needed.

4) Where there is potential for people to achieve greater independence external providers tend to be particularly poor, because it is not in their interests to get people to a point where they no longer need services.  What is more, once people are involved with external services, those external services can sometimes be actively obstructive and undermining of attempts to help someone towards greater independence, even if they are not the ones being asked to do the work.

5) Buying in services from external providers often also leads to a proliferation of different providers being involved with someone, making it harder to provide properly joined up services.

6) Buying in external services also creates massive extra bureaucracy, around contract negotiation and compliance.  This doesn’t affect just the admin side.   It also means that much of the time of highly trained social workers is now taken up with shopping around for services and negotiating what those services are going to do.   Even more time is then taken up with fighting ongoing battles to try to ensure that what is being paid for actually happens and with investigating safeguarding concerns, arising as a result of the poor quality of much private sector provision.   Very little time is left for them to use their skills actually working with people.

Let us know what you think? Write a reply?

• For motions to conference on social care, see the motions document here, starting p185.

• For more articles making the case for public ownership and provision of social care, see here.

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