At first glance, the contracting out of social care services to providers in the private and voluntary sector is nothing new. Since the late 1980s, local councils have moved so far away from providing services themselves that the latest Skills for Care report reveals that just nine per cent of adult social care workers are employed by their local council.
However, if we look more closely we can see a change in the pace and extent of these changes. Among the best known of these is Barnet Council’s ‘One Barnet’ Programme. Like almost all councils, Barnet council faces rising demand for services alongside reductions in funding. It wants to become a ‘commissioning only’ council, directly employing only a tiny core of workers. While this plan has faced some local opposition, there is no doubt that other councils are following Barnet’s lead, leading to concerns that we risk the ‘Californification’ of public services, a reference to the dramatic financial crisis faced by the Californian state government during the years 2008-2012.
Another trend that can be seen is the contracting out of the traditional role local councils played as ‘gatekeepers’ to services. This can include contracting with voluntary organisations to undertake some types of assessment. A smaller but potentially greater shift in the way that councils operate is the establishment of social work pilots in Children’s and Adult services. The introduction of these independent social work-led organisations was criticised by some as the privatisation of social work but welcomed by others as a chance to free social workers from the restrictions caused by local authority procedures to work more closely with individuals and families. A joint team from the University of Central Lancashire and the Social Care Workforce Research Unit evaluated the Social Work Practices Children’s pilots
and concluded that they had produced mixed results. Notably, they found that some of the original principles of the pilots had been diluted and that the variety of ways in which different practices evolved showed that not all be described as independent of local authority control. We will have to wait until next year until the evaluation of the Social Work Practices with Adults is completed but the results from this research suggest that councils may find it harder to contract out some roles than others.
Most of the arguments in favour of contracting out services are based on the idea that expenditure will be controlled more easily and that people using services and carers will have increased choice. However what do we mean by increased choice? Has the system of contracting out acted as a barrier in terms of innovation? A few months ago, I was struck by a news item on the role of community nurses employed by the Dutch not-for-profit organisation Buurtzorg in which fewer but more intensive and longer visits by an individual who knew the person using services well were thought to be more effective than several short visits from a number of health and care practitioners. Why are there no examples of this type of service here (or if there are, why don’t I know about them)? Does the way local councils commission and contract social care services act as a barrier to developing more innovative models of support or is it simply that the funds available are not enough for providers to develop these sort of service?
What about quality? There is no doubt that contracting out has meant that people in care homes live in much better physical environments than their predecessors in traditional local authority homes or long stay hospitals. Who knows, perhaps if local councils had continued to provide large numbers of care homes, the media would now be reporting examples of expensive private finance initiatives (PFI) to build care homes alongside accounts of where PFI deals have gone wrong in schools, hospitals, and prisons?
The events in Mid Staffordshire or Morecombe Bay hospitals are also a reminder to us that public provision is no guarantee against unacceptable standards of care. Even so, last week the Care Quality Commission (CQC) released figures showing that the number of official warnings issued to care homes has risen to 600 in the last year. Is there a relationship between standards of care and the number of residents supported by the local authority? So far as I know, nobody has looked at this but the care home industry consistently complains that local authority contracts do not reflect real terms increases in the costs of providing care.
In some ways, personal budgets provide the most direct example of the contracting out of services. For some people, they have made a huge difference in terms of improved quality of life. For others, the way that they have developed presents a more mixed picture.
As councils continue to contract out social care services, we are left with some important questions.
- What social care services, if any, should councils continue to provide?
- Has contracting out been a barrier or a facilitator to better social care services?
- Can contracting out be used to secure better quality of services?
- Should local councils be held accountable when they contract services which prove to be of poor quality?