Why the social care tender was flawed – and what happens next.

Posted on 25/11/2009 by

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Analysis by Tom Allan

Last thursday, the SLD-SNP administration that runs Edinburgh city council lost its first ever vote.

The issue?

Whether or not to use competitive tendering for care services for disabled and mentally ill people in the city.

What many thought would be a rubber stamp for new contracts and new private companies instead became a dramatic victory for grassroots democracy and local community groups.

Care groups like Garvald are woven into the fabric of the local community.

When I interviewed Councillor Edie the next day, he was bullish about the defeat.

He said that the tendering process was still necessary. He spoke about the wide disparities between the rates charged by some voluntary care providers and others – between £11 and £32 per hour.

His strongest argument was that the money saved (£1.8 million a year) could be put towards disabled people who currently have no provision in the city. And he said that if these savings weren’t made then there would have to be substantial cuts in care provision.

But when I asked him why he had so spectacularly failed to communicate this to the care groups during the council meeting, he said that he was trying to persuade his fellow councillors – not the audience in the gallery.

And it’s that failure to communicate – and above all to listen – that has got the council into this mess in the first place.

Individuality

The tender was meant to rationalise and homogenise the care provision in the city. The argument was that market forces – competitive tendering – could raise standards, and lower costs.

But whilst the cutting edge of procurement may be competitive tendering, the cutting edge of working with disabled people is about choice and empowerment. It’s about recognising that every person with a disability or mental health issue is different.

“Individuals with a learning disability water ski, play backgammon, get married and have children. Individuals with a learning disability can also need help 24 hours a day to eat, drink and go to the toilet. Don’t assume! Everybody is an individual.” Learning Disablility Alliance Scotland

There’s clearly a tension between these two processes. One is about simplification and standardisation – reducing the number of service providers, harmonising prices, reducing social care to units, hours, pounds and pence.

The other is about recognizing and respecting diversity, and the unquantifiable interactions of humans with complex needs.

Community

There’s a reason why social care in Edinburgh is a patchwork. Many of these organisations were pioneers in the city, creating services where none had existed before.

Some, like Garvald, have their own unique philosophy and ethos. These places are not just services, but organic entitities, interwoven into the community.

The bread made by people from Garvald Edinburgh is sold in my local corner shop. Organisations like Health in Mind manage to attract huge numbers of volunteers – around half their workforce – including students, housewives, and mental health clients on the road to recovery.

The people who work and volunteer at these organisations do not generally see it as just a job. They feel an allegiance to both the people they care for, AND the organisation they work for. They feel a part of something with integrity, based in the community.

And because of that, they are willing and able to give 110%.

Councillor Dawe believes that some workers will transfer to the new companies. This may be true.

Many carers will feel torn between abandoning the vulnerable people that they work with, and losing the organisation that they are a part of. But these people will not transfer because of market forces, but because of a kind of emotional blackmail.

Councillor Edie says you can reduce costs and raise quality…but is he right?

A question of quality

There is a more hard-headed reason to examine the social care tender – one which suggests that the process was not only wrong, but was also deeply flawed.

Throughout this debate, the phrase “70% quality, 30% cost” has been repeated by council leaders as their strongest argument – the shield that stops them being accused of a mere cost cutting measure.

Councillors Dawe and Edie both explained tender process to me. One group had independently assessed the quality of the organisations bidding for contracts – another group the cost. The two assessments were then put together, with a 70% quality, 30% cost weighting.

Existing providers lost that competition.

At first, I wondered whether the process had been politicised somehow. Perhaps the council leadership had created a methodology that would favor the new, more cost effective private companies?

After looking into it, I think that the process was honest, but flawed.

Here’s how it worked. There was a questionnaire for the applicants to fill out, with 23 different quality criteria. Then there was a interview where organisations were given a “confidence” score.

It sounds pretty exhaustive, but the main problem is that this was a heavily paper based assessment method. 96% of the assessment was based on what the organisations told the council in writing. The remaining 4% was based on reports by the Scottish Commission for the Regulation of Care.

The Care Commission actually go and inspect organisations on the ground, examining whether what they say they do and what they actually do match up.

The result of the paper based assessments, according to Annie Gunner Logan of the Community Care Partnership Service, is a botched process.

“What you’re assessing is the quality of the bid, not the quality of the service, or it’s capacity to deliver.”

Continuity of care

There are other problems with the assessment method, particularly the points allocated to continuity of care.

Speaking to service users like Maggie at thursdays council meeting, I learnt that stable relationships with people and organisations are of fundamental importance to their health and well-being.

In fact, as far back as february, the council’s own equality impact assessment for the tender acknowledged that “for people with mental health issues, anxiety about the change may contribute to deterioration in health.”

Councillor Edie pointed out to me that continuity was one of the 23 quality criteria – question number 7;

“Please demonstrate your proposals to ensure that service users can transition smoothly to your service. This should take into account the spectrum of needs which service users show.”

But this question – which again has a 4% impact on the application – is a loaded one. It clearly implies that clients will be moving to a new service.

So even the question about continuity is about change.

What comes next?

All this begs the question of whether competitive tendering was ever the right approach.

Now, because of the vote on thursday, the council leaders have been forced to reconsider.

A special working group of nine councillors – two SNP, two SLD, two Conservative, two Labour and one Green – is examining the tender from top to toe, and will make a report to the finance committee.

Like the full council, the finance committee it is finely balanced – with seven councillors from the ruling coalition, and seven from the opposition. But the chair, Phil Wheeler, has the casting vote, and he is a  Liberal Democrat member of the ruling coalation.

Meanwhile, groups like the Learning Disability Alliance Scotland and the Consultation and Advocacy Promotion Service are encouraging as many service users as possible to apply for direct payments from the council.

These allow disabled people to choose their own service provider, and pay them directly – effectively opting out of the changes. But with a backlog of around two hundred applicants, and the council saying they can only process 11 a month, this is unlikely to solve the problem.

The finance committee will have to make a decision on the 3rd of December – just two days before the tender process is due to expire. So far, no-one knows what will happen.

Keep following the nose for more updates.

Extract from interview with Paul Edie


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