Privatising children's services - newspaper article

[appropriatelyemployed]

Saw this in the paper yesterday.

How does dumping complex service arrangements (which are already too bureaucratic and cost driven) on the private sector help out children?

I don't see how the direct payments idea is supposed to work if you get private providers working on cheap contracts on a bulk 'job lot' agreement for the LA/NHS. You could probably never demonstrate that your proposed arrangement would be more cost effective than the tuppence ha'penny they'll pay the private contractors per child.

There's precious little accountability as it is without another layer of complex outsourcing.

Scary stuff.

This sort of things is happening on a wider scale in the NHS through the "Any Qualified Provider" initiative. The 1st tranche of services offered out to the Private Sector is due to "go live" in October this year. Some areas have chosen children's wheelchair services in their 1st batch of 3 services they were required to choose. Continence services was also on the list so that will affect many children too. I believe that future lists include services such as Speech and Language therapy and CAMHS.
It remains to be seen whether services improve as a result of giving patients "more choice" about where they buy their services, or whether it just waters down the service too far.
As someone who received nursing care respite for my DD from a nursing agency for many years (which was paid for by the PCT) and then being forced to switch to a service provided by the NHS own service, I can report that the service we received from the NHS' own service has been far LESS flexible and I have been trying to get our service switched back to a private agency contract.
In our area the LA have contracted out childrens' residential respite care and shared care contracts to national charities for years and as far as I am aware the system works very well (I know lots of families who use them).
So all I can say is I will keep an open mind about the contracting out of services - it will work for some things but will be a total disaster for others.

I remain unconvinced it won't just benefit a new brand of entrenprenuers pockets. My last paid role was to role out the direct payments implementation on behalf of a charity provider for adults. The charity concerned was superb - I'd recc' a relative of mine to use their services.

However I looked at it though they were going to be forced to reduce the quality of care help availbale to users over the long term in future. Seeing this happen to an excellent provider whose staff went the extra mile as a matter of course daily left me feeling really worried about organisations with a less ethical culture.

It's what Del boy would call a nice little earner for the suits with empty back pockets. It's not about improvements to sevrices. and like academies removes a layer of already woeful accountability when services are not fit for purpose.

If Devon have started this then Cornwall wont be far off but then there is zero here anyway private or NHS.

I see a lot of insurance companies mailing households with insurance policies for child health needs. I see a monopoly on private practitioners, therapists battling and cutting each others prices. Maybe we will see private fees going to affordable rates?

Danger is though filtering the cowboys from the proffesionals..............

I take your point bigbluebus but I don't see where you get any choice at all in these arrangements. It's not choice v NHS but private providers taking over NHS roles. The end user has no say in this at all.

Take the piloted areas of SEN direct payments. You can only access these if you can show that the arrangement you intend to pay for will be more cost effective than the provision offered by the local LA/NHS partnership.

Say your LA has contracted with the local NHS SLT (as most do) to offer services to all the children in the area for £X a year. You are very unlikely to be able to compete with those economies of scale and so will be stuck with your local provider whoever they are.

This relationship between LA/NHS is opaque enough. Add to that another layer of 'contracted out' services and I think accountability and transparency all but vanishes.

I absolutely agree with you though that all private providers are not necessarily worse than NHS particularly those stuck in service level agreements with the LA to provide services at a rock bottom price. Their concern becomes the LA as client and not the child. Does this change if private providers take over that relationship?

I think if choice really were factored in, alot of us would jump ship with our money and use decent services who were focused on helping our child. But I don't see choice has any place in these arrangements. This is just privatisation.

Unfortunately appropriately these things are going to be forced upon us whether we like it or not.
'Any Qualified Provider' is happening within the NHS. I am currently 'working' with a parent forum and our local NHS Commissioners to try and ensure that we influence the proposed contracts for children's services in order to attempt to make sure that we only see an improvement in the services we get rather than a decline.
The question for me is for certain services 'Are there enough providers out there who can provide the specialised services in order to give real choice?'.
We are also raising the issue of accountability in the service provision because as you rightly point out, it is currently obvious who is responsible for the service if it goes wrong - but the last thing service users need is another level added into the mix when things go wrong.
Many services have been contracted out for years eg dental services. And look at how many people couldn't get a dentist on the NHS!