Of all the cuts made by the Coalition, those to social care are perhaps the hardest to quantify. Precise figures are hard to come by, since it’s largely administered by local councils. Earlier this month the Association of Directors of Adult Social Services warned a “bleak outlook” was becoming “bleaker”, after its research showed £800m was to be taken from the central budget this year.
But this central cut is only part of the picture. Around the country councils are looking for ways to make savings under the radar. This video tells the story of how two people - John Sullivan and his daughter, Susan, who has Down’s Syndrome - will be affected by changes to social care provision made by their local council.
To understand why they are suffering this distress, you have to go back to early 2011. Tory-run Barnet Council, as part of a radical experiment in privatisation, was to put around £600m of services out to tender. It would be a hugely controversial initiative that lead to a High Court challenge from residents and trade unions. This was finally rejected last month after a judge ruled it had come too late: however, he also found the council had "never set out to consult about its outsourcing", and an appeal is pending.
Part of the plan involved creating a Local Authority Trading Company into which housing and services for adults with disabilities would be placed. In 2012, the company was set up: it was called The Barnet Group, and would act as a “parent company” to Your Choice, which would provide learning disability and physical and sensory impairment disability services. Your Choice has a “sister” company in The Barnet Group called Barnet Homes - this manages the borough's 15,000 council homes.
As John tells us, the name Your Choice was deeply ironic: “There was no consultation. We expected letters and so forth: in fact we never got a single phone call to tell us what was going on.” But nevertheless, hopes were high. The new company would apparently turn a profit. The figures were promising: according to the council, The Barnet Group would have surpluses of half a million by year four.
The trouble was that the detail explaining exactly how these profits would be achieved was conspicuous by its absence. There was a lot of waffle in the originating documents about Your Choice “generating business from a wider group of services users including other local authority areas, self-funders, and other vulnerable people,” as though people in far-flung boroughs who had severe disabilities and needed reliable transport were queuing up to spend their personal budgets and half the day travelling to Barnet to pay to participate in the borough's outsourced day centre and residential facilities.
John wasn’t impressed with the plans: “The first meeting for residents was a disaster. We asked what the plan was for the middle of Winter. It was clear there was no structure - Susan would be dragged around a series of shops and garden centres. She needs two things - continuity, and her friends: the people she’s been friends with since they were kids.”
Barnet Unison commissioned a report into the scheme, which it received in January 2012. In it, the academic Dexter Whitfield wrote: “The business plan concedes that the Your Choice company is financially vulnerable. There is no assurance provided on the quality or reliability of data and assumptions used.” He also warned that adult social services would be expected to produce the profit necessary to subsidise other services: And quite apart from the dubious financial case, he noted: “Ethical and moral issues concerning why adult services should be expected to have such high level of profitability are absent from the business case and the report to cabinet.”
The report was dismissed as trade union propaganda. One year later, the council presented unions and 170 social care staff with a redundancy consultation document. Clearly, the projected profits had not materialised. Or, in council consultation language: “If no changes are made with regard to efficiencies, the change from a block contract to payment-by-actual would create a gap of approximately £1m. This does not necessarily mean that people have stopped using [the] service, but rather that the arrangements for the block contract did not accurately reflect day-today usage.”
You read that right - in short: “We may be £1m in debt, but the business plan's fine: we just have too many well-paid staff.” So Barnet Homes would provide Your Choice with a loan. And in the meantime, Your Choice planned to slash staff numbers, wages and staff weekend payments. Or rather: “Our proposal is to radically change the structure, review its enhancement payment practices and review salary structure to be able to compete within the sector and to fully meet our aspirations of flexible, personalised and value for money services.”
The document was not formally given to service users and families, because the changes in it were billed as staffing, rather than service changes. But they were every bit as affected. Workers in the supported living service would be downgraded to an assistant support worker role: although the company admitted that staff in that service “supported service users with a wide variety of tasks to develop their independent living skills,” it claimed that “most of these tasks are not complex.”
Some statements caused particular outrage. In Supported Living, the company claimed, no service user had required waking night support since July 2012, “when continence support was changed to enable increased independence.” Your Choice claimed that the two waking night staff at the six-bed Valley Way respite centre were no longer required: “following monitoring of service users and their night-time needs, it is clear that support can be safely provided by one person....For continence issues, those who require changing in the night do not require the use of hoists as they are already in bed.” But the whole point of respite care is that it is staffed: families send their loved ones to respite care confident in the knowledge that the units are staffed around the clock. One of the reasons it exists is to give families a break from their own round-the-clock caring duties.
John says: “It’s bloody immoral. I’ve had run in with politicians before. But they could see the reality in front of them. These guys have no integrity. They denied profit was a motive, then they predicated their plan on making profit, and now it’s all about savings. In order to keep skilled staff it would cost a few pence every week. If someone asked the people of Barnet what they wanted I don’t think they’d have a problem with that money being spent.”
And John highlights another way in which savings are quietly being made. In the video you'll see him talk about how he feels the concept of a personal budget (a sum of funding allocated to service users after their needs are assessed) is not appropriate for his daughter.
As he explains in this blog, he's concerned that the buying power of people's personal budgets will diminish if companies like Your Choice increase charges for their services. It'll allow authorities to argue state spending hasn't decreased: but in effect, services will be cut. “We had these services in house for years without a problem and without any of this talk about staff cuts and problems and then they outsource and suddenly none of us have any peace of mind,” John says.
In a recent survey by Community Care, the journal for social care, respondents said the transfer of social care services from councils to private providers has been bad for the sector. Two-thirds said the quality of adult care had deteriorated because of large-scale outsourcing since the early 1990s. But it's not just misguided: as we've shown, it's sneaky. These secretive chips at local budgets won't generate the coverage a huge Governmental department cut will, but the impact on those affected will be every bit as significant.
In response to our report, The Barnet Group said: "We are pursuing a robust new business strategy, as detailed in the Operational Plan 2013/2014. We recognise that this process will take time to fully materialise." Parents and families, needless to say, have no faith in this claim of a viable business model at all. And after a year, who can blame them?
On personal budgets, the company says clients will "only get fewer hours if they are assessed as needing fewer hours by care management. We have no plans to increase charges across Your Choice." We also asked what would happen if Your Choice continues to fail - would the services be brought in house? The company replied: "We would be disappointed if this were to happen as we believe we have a viable business model, quality services and can offer value for money."
Barnet Unison said: "You can't downgrade staff jobs and cut staff numbers like this without causing real instability in the workforce. This is the most draconian attack on low paid social care workers since the infamous Fremantle careworkers dispute at Barnet." Today, service users and their families will lobby the Your Choice board.
UPDATE 30/05/2013 8.45am:
There were amazing scenes on Wednesday night as the Your Choice board refused to hear families' concerns about the proposed cuts to staff and services - because, as the chair said quite clearly - "this is a board meeting of a company. It is not a local authority meeting and therefore that right does not extend." In other words,"We're a private company and we don't have to hear you out on the cuts we're making, nor are you entitled to listen to confidential agenda items where we may or may not be talking about cuts to the services that your family members need and use."
Things kicked off when the board told family members and carers - who had not been invited to share their concerns about the board's plans to cut staff and services - that they would have to leave the meeting because the board was about to hear confidential items. An audience member observed that they wanted to hear more, because that was the reason people had turned up. The board said that wasn't allowed because they'd be discussing confidential items. The audience member asked what the items were. The board said it couldn't say. The audience member asked for the titles of the items. The board refused to give them. The audience member said: "I think there are quite a few of parents and carers of service users here that would like to you to listen to them." That when the board meeting chair said that this was a board meeting of a company and not a local authority meeting and that therefore the right did not extend to these families and carers. At which point the audience member said "this is exactly our problem with our services being outsourced." Indeed. They have nobody to appeal to.
You can see in the video below that family members got angry - as well they might - and that the board walked out. Let this stand as a warning for what can be expected as the NHS is privatised - companies telling you that they don't have to share information with you, or hear your concerns, and walking out when they don't like it. Of course councillors walk out as well and hide behind "confidential" items, but you at least have the option of holding them to account at the ballot box.
We have a very positive update to this story – as a result of a threat of legal action by John Sullivan, who is featured in this story, and pressure from John and campaigners, the private Your Choice Barnet care company in this article has backed down and acknowledged that it must consult with families and service users before going ahead with any changes. The 25 staff who have been offered and paid voluntary redundancy are being told that due to the potential legal challenge, the restructure involving their positions is on hold and that they are not redundant for now.
This is a far cry from the belligerence we saw at last month's board meeting when the board said it didn't have to discuss cuts with families and services users because it was a private company and wasn't obliged to talk to people. The success families and services have had this week in making the board back down goes to show that it is possible to pressure some companies into a rethink. It also goes to show why legal aid is so important. John Sullivan's daughter Susan was eligible for legal aid and that is one reason why it was possible to make the legal threat.
John Sullivan says:
We have achieved a pause in the rush to the bottom in service provision and quality of life for Your Choice Barnet service users. Where we can, we will make contact with ALL services users, family carers and parents to ensure we ALL have an input into the structure of the proposed consultation before consultation starts. One thing is for certain - we cannot trust Your Choice Barnet to make those contacts, or organise a meaningful consultation without our input. They simply cannot be trusted.