As with many aspects of our public sector, party politics and robust tightening of the nation’s purse continually have a significant impact on the levels of service delivery our society can expect to receive today. Too often, strategic and local administrative upheaval also cause a great deal of collateral damage to services. Add reductions in organisational funding and almost monthly changes to policies and it amazes me, how any part of our public infrastructure actually delivers anything anymore.
If not for hard-working frontline professionals, many who’ve had their pay frozen for half a decade or more, we really would be goosed. The saddest part of all this is that the most disadvantaged and least well off in our society are often the ones getting shafted the most.
A bit of a soapbox missive perhaps however; for anyone who spends most days, trying their hardest to make life a little better for the disadvantaged in our society, all the political/financial crap is hard to swallow. Despite the arguable needs of austerity, cost efficiency or VFM etc much of this constant change isn’t actually required but it’s been going on for years, long before the banksters and financial crash in our economy.
In my 40+ years of delivering services to the public, the often self-serving management and administrative monster of that sector has enjoyed exponential growth. Much of this constant change has actually been suggested, authorised and implemented by those who are the largest drain on the public purse. All of this has a detrimental impact on public service delivery. Start by looking at the higher echelons of the civil service and our MPs, people who often have the ability to ‘rubber-stamp’ their own salary increases almost, and you can start to understand the issues.
The substance misuse treatment field isn’t immune to many of these issues. If anything, due to constant flux in commissioning process, the revolving door of career aspirations and the constant competition between providers for contracts, it’s another one of those services that is probably wholly reliant upon its frontline delivery staff for survival.
Most drug treatment providers and the specialist staff working in them are subject to frequent retendering exercises. The sector has faced savage cuts in the last decade which have resulted in a rapid turnover of providers and staff. An environment that doesn’t lend itself to engaging with NICE on treatment guidance when survival is the priority. (The Mental Elf)
Service users and our wider society, along with all the businesses and public services within it, will never see any significant improvements until we kill the PIG.
The Problem of Immediate Gratification (the PIG) is the universal principle that immediacy is much more important than magnitude of a payoff when it comes to influencing our behavior. We live in a world full of instant self-gratification and we have little patience. We want results NOW and we want MORE. This is especially true for animals, children and impulsive adults… and clearly many organisations, self-promoting aspirational business managers, executives, civil servants and members of our parliament are PIGcentric!
Mostly we are far too focused on short-term instant results and the long-term consequences of our decisions and planning can go to hell in a hand cart. In today’s business world the only thing that matters is the last quarter’s balance sheet – and importantly who is deemed to be responsible for it.
Apart from all those ‘normal’ issues resulting from a staffing ‘revolving door’ within treatment services, the other major impact on effective service delivery is; a state of almost constant flux born out of commissioning processes.
Good practice for commissioning substance misuse: Given the very substantial reductions both in commissioning resources and in funding for local substance misuse services, this advice is likely to be even more important than usual. – russellwebster.com
Despite the ‘good practice’ (intentionally or unintentionally) often being ignored, we also see a myriad of regular change in the staffing of treatment services. This is mainly (but not exclusively) due to personal development and individual aspiration factors. Now I would never suggest that anyone shouldn’t have the right or capability to improve their lot however; when your service is so reliant upon human resources who are often in the early stages of employment and/or personal development, it’s often a factor which isn’t given sufficient consideration. Add commissioning failings, a reluctance amongst ‘partners’ to communicate with each other, never mind the need to actually work together, to the transient nature of staff within recovery support services and you can start to understand the problematic issues.
Since the introduction of health services commissioning process and Payment by Results (PbR) for drugs and alcohol services across the country, as opposed to delivery by a state owned and funded service like the NHS, these services are often impacted by perverse and negative outcomes. Negativity which is actually born out of the specific process. Many of the ‘unexpected’ outcomes shouldn’t really come as any surprise for anyone.
Many of those factors which have a negative impact upon addictions recovery were also covered by a recently published independent report (see here). Addiction treatment services received several strong critical findings. A concise summary of the report can be found at www.russellwebster.com
Fractured commissioning responsibilities and lines of accountability can make co-ordinated action challenging. Yet it is only by working together across these boundaries that improved recovery outcomes, including jobs, can be achieved for people with a drug and/or alcohol dependence. – Professor Dame Carol Black
This blog (along with others) is littered with angst about individuals and organisations cooking the books for personal and financial advantage. That’s bad enough when it involves commercial enterprises but when the same sort of immoral dishonesty overflows into public services (see example), ones designed to help and support the often disadvantaged and least well off in our society, you should agree that it stinks!
It has to be remembered, many of the ‘charitable’ organisations commissioned and charged with delivering ‘social’ services in our new ‘cost-effective’ era are actually in competition with each other. Their long-term stability and growth is wholly dependent upon undercutting and beating their adversaries into submission. It’s a major factor behind so many smaller organisations going to the wall.
Commissioning in Crisis: A new report published by Lloyds Bank Foundation for England and Wales finds that central and local government are using shockingly complicated and inappropriate contracting and commissioning processes to secure vital public services. The experiences of small charities taking part in commissioning processes reveal a system in crisis which leaves charities threatened with closure and the future of public services, including homelessness, domestic abuse and mental health support, at risk. (See HERE)
Irrespective of any arguments around ‘economies of scale’ and all the logistical support issues that suggest bigger is better, you often find delivery quality actually fails as an organisation grows and the people impacted the most are the service users.
The unexpected consequences of PbR: Whatever your perspective, there is a consensus that unexpected, often perverse, consequences are commonplace in PbR contracts. – russellwebster.com
Considering the whole commissioning idea was supposedly designed to improve services and realise greater value for money (VFM) for the public purse, during an extended period of (arguably) enforced austerity the sad fact is; there is growing evidence that many of these services are actually getting worse, rather than better. You only have to look at the (politically unspun) issues evident in the NHS, along with many constituent parts of our social health care system, to understand why you should be worried.
I understand that VFM is relative, a factor considered in relation or in proportion to something else i.e. service/cost however; your perception of VFM is totally dependant upon how you view it. Do you have an objective perspective, one that isn’t influenced by emotions, opinions or personal feelings and based in facts that are quantifiable and measurable? Or, are you more prone to a subjective perspective, one open to greater interpretation based on personal feelings, emotions and aesthetics? From my vantage point which is based on experience, knowledge and evidence with an added portion of passion for helping and supporting the disadvantaged in our society I would have to say… things need to change, sooner rather than later!
It’s sad but… service delivery and its ultimate quality doesn’t appear to be that important to anyone anymore, especially those that don’t use or need it. Just so long as you can disguise justify your inadequate reduced performance with some engineered statistics to quantify your failings. It also helps when any reduction in service delivery can be blamed on attributed to factors out of your control or better still, the failings of another organisation or individual employee… preferably one from the lowest possible rungs of the corporate management ladder!
Dave's Bankside Babble 