Southern Cross exposes flaws in the choice agenda
guardian.co.uk, 2 August 2011
Ministers imagine that by hiving-off services they can disentangle the state and leave failing outfits to go to the wall. But their transformation plan is plain impractical
Neoliberal ideas cling doggedly to the "neo" tag. From avowedly "radical" Thatcherite tendering, to "bold" Blairite private treatment centres, and on to the coalition's "progressive" schools policy, every assault on the bastions of public service is presented as a breath of fresh intellectual air. Whatever its merits, the first thing that ought to be said about this government's open public services white paper is that it goes with the drift of this familiar ideological tide.
What is new is the extraordinary sweep of the blueprint. The headline is that – save for the judges, soldiers and spooks – the assumption will henceforth be that everything could be hived off. Were it not for the phone-hacking saga, this is the sort of proposition that could have dominated the summer's politics, and probably not in a happy way.
The marketopian tide has been flowing less certainly since the financial meltdown, and this summer is an unfortunate moment for the government to try to advance it. The health secretary, Andrew Lansley, has only recently been forced into an extraordinary legislative pause and then partial retreat on his NHS plans, after Liberal Democrats insisted on limiting privatisation. Before coalition divisions over Rupert Murdoch, the public services paper was shaping up to be the next great splitter.
But there was another, more particular, problem with the timing of the white paper when it appeared last month. Residential care was one of the first state services to be provided by a "range of diverse providers", which the paper envisages right across the waterfront, and on the very day the white paper emerged, the biggest of these care providers, Southern Cross, announced it was shutting down. The 31,000 frail people who inhabit its homes are left facing uncertain times and the rhetoric of choice, in which every privatisation plan comes wrapped, is left ringing hollow.
Likewise, the white paper's language about entrepreneurs as "drivers of change" sounds less seductive in the context of the Southern Cross case. Private equity barons first sold and leased back care homes and then profitably flogged the business just a few years before it went bust. The recent Care Quality Commission report detailing shortcomings at many homes run by Castlebeck will redouble the unease.
The truth, however, are those public as well as private facilities can be callously run? And there can be particular problems with services run on top-down lines. Monolithic management can flatten creative thinking about doing things differently. Inflexible pay scales can inhibit the recruitment of, for example, excellent teachers into those places where they are most sorely needed. Like academy schools and NHS foundation trusts before them, the white paper's agenda, in part, reflects a real desire to grapple with these shortcomings.
The weakness in the remedy, however, concerns the greatest failure of traditional state-run services. Public bureaucracies struggle to root out bad practitioners and force bad institutions to close. Ministers imagine that by hiving-off services they can disentangle the state and leave failing outfits to go to the wall. In practice, it rarely works out that way. It is simply not practical to allow crucial services to shut down like unprofitable shops, as was seen with Southern Cross. Whitehall was forced to promise elderly residents that they would not be shunted out on to the streets, even before it had figured out how it could guarantee this.
Then there is the politics. Politicians can outsource managerial, financial and legal functions, but they cannot outsource responsibilty: if the voters want to blame Whitehall for closing a hospital, Whitehall cannot stop them. For all Lansley's talk of foundation trusts being islands of independence, within months of coming to power he felt obliged to sanction an £18m loan to a struggling trust in Berkshire.
The white paper promises "serious consequences" for managers who run poor services, but gives precious little detail. For all the seeming vigour – and danger – of the reforms, my hunch is that they will not live up to the transformative hype. We will still have to live with fuzziness about failure.
• Tom Clark is the Guardian's social affairs leader writer.
Please click on the link to see the original article
Castlebeck chief promises to overhaul management
Community Care, 1 August 2011
Castlebeck is to overhaul its management in the wake of the abuse scandal at Winterbourne View, chief executive Lee Reed has pledged in an exclusive interview with Community Care.
He said the company planned to improve oversight of its services by appointing 10 more senior managers after its quality assurance arrangements were slammed last week in a Care Quality Commission report on its services.
Castlebeck hit the headlines in May when BBC Panorama exposed alleged abuse at Winterbourne View, a hospital for people with learning disabilities and complex needs in Bristol. The facility has since been closed and 11 people arrested.
Reed, who became chief executive in January 2011, was "as shocked as anyone else" watching the programme. Although he has been a member of Castlebeck's board of directors since June 2009, his role was primarily in managing a subsidiary, MCA, a mental health service provider in Wales.
"Until I took up the chief executive job I hadn't even visited the operational services of Castlebeck," he said.
He admitted that commissioners had withdrawn five service users from Castlebeck services since the Winterbourne scandal, and that more placements may yet be terminated.
The CQC's report into 23 Castlebeck services said poor practice was a result of inadequate governance, with no clear system for communicating downwards senior management decisions to improve quality.
Reed said failings in this area derived from the company growing too quickly in recent years.
"Operational directors were not able to provide the level of oversight which I think is appropriate. [One of them was] trying to look after 15 units from Lincolnshire to Bristol and all things in between. That's a big ask."
He added: "The company grew quicker than the infrastructure did to support it."
However, Reed denied that the expansion was just to chase profits but was driven by a desire to meet the requirements of service commissioners.
In response to the criticisms, he said he was "revamping the entire company".
The additional 10 senior managers would boost oversight, he said. The company will have five regions, as opposed to three, with regional directors overseeing more manageable four or five services each.
The company will also appoint leads for audit and governance and senior nursing roles in each region. Reed said he hoped the changes would allow frontline problems to be communicated more effectively to corporate management because there would be three separate lines of accountability.
This would address failings exposed in the Winterbourne View case, when whistleblower Terry Bryan's concerns about the service were not reported to senior management nor properly followed up.
However, Reed said he was not currently minded to take disciplinary action against any managers for the failings, saying they went bigger than individuals.
The CQC's report also identified poor practice from staff and a lack of knowledge about restraint or deprivations of liberty.
Reed said training was available but staffing pressures prevented many undertaking it. "People were finding it hard to get to training sessions when they were organised because they had to cover shifts," he said.
Since his appointment, Reed has instigated reviews into staffing issues, the lack of activities for users and the slow progression of service users from hospitals into community-based settings.
He hoped that investment in all these areas would ensure that more people were moved from hospital and residential care settings and into the community. "When I look at some of the early admissions to some units I think people genuinely came in on the understanding it would be a home for life. That was probably their understanding, ours and the commissioners, but things have changed," he said.
Concerns about the length of time people with learning disabilities spend in hospital settings and the quality of care in these units has sparked calls from learning disability experts to end their use altogether.
A recent investigation by Community Care revealed that one in five people in learning disability hospitals have been there for five years or longer.
"There will always be a place for hospital accommodation and that has been recognised by those who criticise that model of care," said Reed. "But the number of learning disability assessment and treatment beds will diminish over time."
He envisaged Castlebeck becoming more involved in supplying services in the community.