the swampy ground research project
a resource about partnership working for managers & educators in health & social care
Case Studies - 'Not Letting The Cat Out of the Bag'
Externalising day services for people with learning disabilities
The background to this case is local authorities deciding to ‘externalise’ services i.e. put them out to contract with other providers. This is a fairly well trodden path and in this authority had been going on for the last 5-7 years or so.
Following a series of Best Value reviews and the rationale of saving money, the Council systematically embarked on externalising almost all of its in-house services. Publicly stated in the committee papers that went to the Executive Committee [of the Council] was to save £1 ½ m. So already the Council’s residential homes for older people, the home care service, children’s residential homes, the Occupational Therapy equipment service are all externalised. Learning Disability residential homes have also all been tendered and externalised to external contractors. Without exception, these contracts have all gone to not-for-profit organisations.
About 2 ½ years ago the Council made the decision to externalise day services, not just for people with learning disabilities, but older people’s services and those for physically disabled people as well.
This case is about the project to externalise Learning Disability day services and how the manager in charge of the project in the Council worked with others including service users to achieve this. The local PCT and social services share a chief executive/director and the locality aims to integrate the structures of health and social care in this way.
People in this case:
The user group – young adults with learning disabilities
Julia - the advocate
Cynthia - a carer
Paulette - a team manager
Alan - the service manager
Martin - the Commissioner
also mentioned are:
The Carer’s Group
The Charsley Society and The Consortium – two not-for-profit organisations bidding for the day services contract
The Community Centre – this houses the advocacy project that employs Julia
Read or download a PDF of all the stories in this case study.
Researchers' Commentary
What matters to users and carers – users want continuity of same staff, seeing their friends along with activities in the evening, holidays and more of these. The team manager is willing to work evenings but not weekends – ‘flexible hours’. Users are attached to a particular member of staff and want them [team mgr]. They don’t like not knowing what is happening. People with severe learning disabilities need to be safe and have their changing needs met as they grow older [carer]. They want to be able to understand what people are saying [in the tender process] and ask do they keep their promises [users and advocate]? Parents/carers want a longer day [tm mgr] The staff perspective on user needs is different: ‘it would be tiring for them’ ; this is the professional view [tm mgr]. ‘Mainstreaming’ people with learning disability into, for example, work, although desirable requires a lot of people’s input to achieve the quality of life [carer]. There need to be services for a wide range of learning disabilities from severe to ‘on the cusp’ [advocate]. Users/carers want to be on the Board.
User involvement - The process of developing and letting the new contract illustrates a good process of involving users and capacity building with users from a low starting point [Martin] also involving carers [Martin]. ‘I appreciated it, it’s come form the right place, learn from my involvement’ [carer p4] It was ‘easier to involve service users in the decision than staff’ due to their interests in the status quo [Alan]. Charsley Society brought their current users and staff to present their bid. Limitations on involvement included carers having no time or energy [carer. They met socially not for a consultation group – ‘it was a bingo session’ [Martin] Consultation had been badly done previously using email - inappropriate for people with learning disabilities [advocate]. The ‘thorny’ issue of representativeness is also raised and [Martin] getting support ‘because I shout’ [carer]. The key point was that user involvement needs embedding in job descriptions as well as regular input and feedback from users and training for users [advocate].
Spotlighting current service – The externalisation process ‘put the spotlight’ on the service ‘not in a very good light’ [Martin] although there are positives e.g. carer’s sister received a range of services to meet her changing sensory needs. ‘Fantastic service’ [team mgr] with small groups and high ratios is a staff view [team mgr], but users report no Person Centred Plans [users] and difficulties with care plans exist [team mgr]. Users say it’s ‘like watching paint dry’ [link to this text]. Some staff want to make a difference but some simply ‘sit there …’ [quote advocate]. Carer’s assessment is offered but nothing else [carer], it’s not integrated with health and the GPs.
Externalisation – the debate about this policy is reflected in the different viewpoints. The service is seen by the council as no longer ‘core business’ [Martin] specialist groups are better providers. But ‘best value means the cheapest’ carer p3 and here one councillor will decide on the contract. This shift has grown over time - ‘not dogs for sale [in Social Work press] but expressions of interest’ see Alan. Even the voluntary sector has its own agendas – quote from carer. There is no policy nationally on externalisation – Valuing People did not recommend it [carer], but it requires more resources to put service users at the centre of quality services. The council is seen as avoiding a decision on resources [advocate and tm mgr] so this is ‘given to the [contractor] to sort out’ [Alan] People don’t/can’t talk about if they disagree with the policy: Alan refers to ‘not letting the cat out of the bag’ [Alan]. Staff views on the transition were ‘shock horror, devastating news, really anxious about the future’ [team mgr, Alan]
Process of assessing tenders – is it a checklist or gut feeling [carer]? Carers have their own list of issues. Difficulties included ‘commercial confidentiality’ [carer] ‘it’s like secret stuff’. Assessment also involved a mutual process of ‘dismantling’ the service and ‘due diligence’ [Alan] Although the local authority is moving to simply commission it is not addressing infrastructure like HR and payroll [Martin].
Managing [partnership] processes – The team manager was unaware of PCT/SSD integrated structure [tm] so communication of this partnership had failed. It is unclear where decisions are made as the partnership board is ‘not connected’ [tm mgr] – ‘not the union, not the staff, not the users, not the carers’ decide [tm mgr]. However the commissioner met service users and ‘would go anywhere’ [advocate] Pressure on managers stops them giving details to partners [advocate] and they need to use others such as advocates to access users [Martin]. It was important to ‘have dissenters inside’ [carer] and be open, not ‘cheesed off’ with ‘complaints [advocate] For managers ‘change management is key’ [see details for Alan] including managing emotions [Martin]
Managerial agency – council officers were able to recommend the service be transferred to the voluntary sector. Martin had ‘pressure to get rid’ but he resisted [link to quotes on needing time]. On the other hand Alan felt he couldn’t speak: it was ‘Kafkaesque’. Martin also chose to use his discretion to interpret guidance to include all current users [Martin, advocate] He felt the Fair Access guidelines meant all current users were included.
Rhetoric – elements of rhetoric and the power of prevailing discourses are visible in the case. TUPE is quoted as the saving grace for staff in contracting, it makes you ‘safe and sound’ but is also a ‘moveable feast’ [Alan]. There’s no long term’ [carer]. ‘Due diligence’ and ‘dismantling’ services and tenders [Alan] are striking terms here. Martin also talks of ‘business’ [ core business and partnership business]. IIP is seen by Alan as a rhetoric: ‘I’m stunned we got it. Could I believe it! I don’t know how. The organisation doesn’t consult, there is not a general understanding of the ethos, the communication channels are dreadful, decisions aren’t made. It certainly is not a learning organisation. ‘Best in class’: that is nonsense.’
A shift to lower paid staff and skills stratification – lower salaries seem from this evidence to be inevitable given the requirements of Valuing People. The holistic end of the scale needs highly skilled staff input to help people develop autonomy e.g. to travel alone. Extended hours through externalisation may mean more contact sessions are provided – apparently responding to users’ and carers’ wishes - but at the expense of quality input and individual attention: ‘warehousing’ may result, redolent of the ‘childminding’ people experienced in the past.
Importance of history- seen in the past as childminding [carer]. Also this change reminds people of bad changes in the past [users via advocate, Martin] and so they are not keen.
Read or download a PDF of all the stories in this case study