Thursday, 5 August 2010

Progressive Cuts?

I am getting some interesting feedback from my email to ACEVOmembers about how to deliver more cost effective services.

A couple of examples demonstrate the dilemma for government. Indiscriminate and unthinking cuts will seriously damage the very civil society they want to promote and expand. And the very cost effective services we could provide will not be expanded, but cut.

Here is a note I got from Stephanie Meikle who is the General Manager of the Harrogate Skills 4 Living Centre. She gives a concrete example of the type of person they can support better through their own service delivery as well as saving money. Here is a typical case study fictionalised for our purposes :

Miss V.
Miss V is a 48 year old woman with learning disabilities and diabetes,living in her own tenancy with supported living services, domiciliary care and daily personal care provision.

Miss V is known to the NHS as disabled because she uses an electric wheelchair to get about.
Miss V visits the GP, the Dentist and the Optometrist on a weekly basis. She is currently accessing community psychiatric services for behavioural support. She also attends our 3rd sector day service, where she attends 5 adult education sessions per week.

Miss V has been attending our service for several years and we are fully aware that she has no physical disability, does not require personal support, manufactures health problems etc in order to obtain the attention of health service providers. When she is not taking part in our day services she self-harms, makes repeated telephone calls to her support services, emergency services and others as she feels lonely and desires attention.

We are uniquely placed to be able to co-ordinate a care packages for Miss V, as we have knowledge of her history, contacts with her family and knowledge of her daily routines and behavioural issues.

If Miss V could access our support all week, she would not be impacting so heavily on NHS and other statutory services. The cost difference would be an increase of £55 per week for day care but a major saving on GP and related health care services.

We would be able to provide holistic support including getting her to relinquish her wheelchair use, and supporting her to reduce her self-harming. We could liaise with her CPN to address her behavioural issues and work with the GP practice so that she contacts them on a more appropriate basis.

A smarter contract with ourselves would enable us to carry out collaborative work with statutory services. Feedback mechanisms would enable us to follow any protocols established by the CPN and would mean that services such as personal care are not put in place unnecessarily.

This case is but an example of the 102 adults with a learning disability who currently attend the adult education centre.
The dilemma is that this would require more money to be spent on the Miss Vs to save money elsewhere in the system. How can we move to a spending system that works across Government. The danger is that centres like this will be potential target for council cuts rather than expansion .

Now let's look at prisons and rehabilitation that has been such a focus for the new Government.
Patricia Rogers is the Chief Executive of Kainos Community. She writes,

"We have delivered the ‘Challenge to Change’ Programme now for over 13 years, to great effect in contributing towards a real reduction in re-offending, with 87% of those who complete the programme not returning to prison.

This reduction of re-offending against what would normally be expected, has also made massive savings . We have a paper showing a conservative cost saving of £8 million from our programme. Any cost associate with delivering our programme can be exceeded several times over by the savings made.

Although the policy of the government would be to commission programmes, that have a proven ability to make changes to offenders and to reduce costs, it would seem that ‘on the ground’ there are great risks to programmes such as ours because of the need to make large savings. This is in spite of the fact that we can show that we do reduce the risk of re-offending as well as make long term savings to society through the work we do.
I received a letter only a couple of weeks ago from the DOMS office in one of the regions where we work which included this paragraph:
‘As you know, NOMS will be looking to make significant savings over the next few years, and we cannot rule out the possibility of de-commissioning in the future, even if the programme is delivered as we would wish’.
This concern has been heightened by a recent meeting which focused on knowing exactly how much notice was needed to give us to terminate our SLA.
At another prison the governor told me that although he wanted our programme to remain as it brought great benefit to his prison as a whole he feared that the cuts that he needed to make meant that our programme could be asked to go.
Informal discussion with various people in the prisons seems to indicate that prison staff feel threatened by this new approach and those in the prison psychology service fear that their programmes will be cut as they can’t show cost savings or reductions in re-offending . Consequently they will not take on new external programmes and are actively trying to de- commission external providers such as ourselves to protect their own programmes. "

And a similar problem is demonstrated by the health service and a response I received from a CEO of a hospice

"The hospice this year has a budget of £5m, employs 150 staff and has 1000 volunteers to help the people in its community. The NHS employs some 25-30 people in palliative care. The logic is that we could achieve a far better integrated service if the hospice absorbed those NHS staff, which we could do very easily and quickly.

NHS are trying to decide where their community services are due to go with the demise of the PCT itself. It has produced an "Engagement Document" asking for views about where some £90m of services and 2500 staff should go, within which is its Palliative Care Services. The document is hugely weighted towards finding an NHS solution and the option of allowing independent sector providers is quite erroneously dismissed as "Unlikely to be deliverable in the timescales allowed".

So we see a bureaucracy and a system that will undermine any attempt to secure radical change. Unless the Government gets to grip with this cuts will be regressive and damage the fabric of civil society. Not the progressive cuts that we have heard so much about.


Anonymous said...


Anonymous said...

We may have heard about progressive cuts but have we seen any? The ones, to date, seem to be regerssive and damaging in the extreme.

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