This blog is written by someone who has found themselves working in the arcane and often insane world of social care commissioning. I would explain what social care is, but if you have read this far you probably know. It is all the bits of care that are not officially designated health (free at point of delivery, at the moment anyway). Following the helpless descent of the NHS into a commissioner/provider split – or purchaser provider split as it is often known, Council run Social Services, never willingly left out of a bad thing that really smart people have already realised does not work, have hitched themselves irretrievably to the same wasteful, lunatic form of organisation.
The theory is of course, that seperating the provision of services from the planning and purchasing of said services ensures business like behaviour, using drivers of competition and the skills of the private sector to reach the sunlit uplands of efficiency.
In practice we have the prospect of small highly efficient local voluntary organsiations having to enter into tendering processses, more suited to international businesses, every three years just as they have established themslves within the local ecology of statutory, independent and voluntary health and social care. Just as they have established a service, got known, recruited volunteers, trained them, gained skills and found the best way of working, they are thrown back into the tendering process. Then, someone better at writing tenders may win the contract, leaving the first organisation struggling, perhaps unviable and with three years of wasted work and effort (funded by the taxpayer) as the new provider struggles to go through the same process. This, of course, is done to achieve efficiency.
I wonder which firm, having found a reliable, good quality and reasonably priced supplier of, let us say some specialist process, decides after three years to end their dealings with said excellent supplier and enters into a paper exercise to choose another supplier of whom they have no knowledge which could quite easilyresult in a more expensive and poorer quality service.
Another snag is that people who know about social care, i.e. trained as social workers, are not generally whizzes with spreadsheets, accounts, statistical forecasting and judging the effectiveness of private businesses. Whilst those who possess such skills, generally are about as uninterested as it is possible to get in what makes a good care home or respite service, and generally regard people who chose to work in care as pathetic losers .
There are quite a few doctors and nurses blogs around, and interesting reading they make. Expressing a dissenting view has never been a good route to career success in the NHS, its management style does not foster open debate and discussion. Social Services used to be pretty relaxed about staff who expressed disagreement about policy, like rather soft middle class parents who overlook the teenagers raiding the drinks cabinet, but in the last six or seven years the tendency has been towards repression, through isolation and sidelining if not actually fitting people up. The Social Services adult care staff I know are exhausted, demoralised and browbeaten into accepting whatever is imposed on them however mind bendingly stupid it may be. Worse they may have ‘integrated’ with the local PCT, much as Poland ‘integrated’ with Hitler’s Germany in 1939.
Through this blog, I like many other bloggers will occasionally offload my frustrations and maybe give the odd chuckle to those who come across it, especially if they have some passing interest in the area. Sadly most people think they need the NHS but few think they will ever need adult Social Services, until suddenly one day Mum has a stroke …
