Another blot on councils’ copybook

Posted on July 28th, by geoff in CT blog. 8 comments

By Caring Times editor Geoff Hodgson

A High Court judgment handed down in Newcastle last week will place further tension on the already taut contractual relationships between care providers and local authorities.

In a contractual dispute between charitable provider Abbeyfield and Newcastle City Council, the court ordered the Council to compensate Abbeyfield for failing to provide ‘reasonable’ care home fees.

In making his judgment, Mr Justice Norris rejected the council’s view that the fees it had paid to Abbeyfield were the same as the “market price”, which was determined by the fact that 51 other providers (as from October 2011) had accepted the council’s rate.

“There is no true ‘market’,” the judge said.

“There is a dominant purchaser which, by virtue of its purchasing power and its ability to make unlawful threats (to ‘blacklist’ dissentient providers) which individual providers cannot counter, is able to secure for itself particular prices which are lower than ‘the market’ (comprising all purchasers of care homes services) is willing to pay.”

This bolsters a view I have long espoused – that the social care funding apparatus is unwieldy, expensive and open to cynical manipulation by local authorities. There is a better way, one in which local authorities would play no part – change the name of ‘Clinical Commissioning Groups’ to ‘Care Commissioning Groups’ and put social workers in every GP practice to carry out assessments.

I accept that it may never happen, but I don’t accept that it wouldn’t work.

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8 responses to “Another blot on councils’ copybook”

  1. I agree that social care providers working more closely with Clinical Commissioning Groups is one way forward. However, not all social care providers are sufficiently aware of CCGs and the role they play, and they don’t always know where to start in terms of building contacts and relationships with the relevant people in CCGs. The social care membership bodies have a potential role here in facilitating links. Likewise, some CCGs are more transactional and procurement-based than others, and not all have a clear view of social care and what it can do. There’s a real job for NHS England in bringing them up to speed.

    • Bob Ferguson says:

      It’s worth remembering that many of the CCGs will be managed by the same people who ran PCTs before they were abolished. Back then, all too many were happy to accept local authority prices unquestioningly when determining the rates they paid for NHS continuing healthcare. Is there any evidence that, in their new incarnation, they have become more sensitive to the realities of providers’ economics? And will they be any less inclined to use their “dominant” position to bully providers than the Geordie council did? I doubt it.

      As tempting as it sounds, simply changing the commissioner won’t be enough, not by a long chalk.

  2. geoff says:

    CCGs are still evolving their roles and, while I accept much of you say, Bob, we should bear in mind that, given GP practices are private sector enterprises contracting to the NHS, we might hope to see a leaner bureaucracy, with more of the budget being spent on service delivery. Certainly not a panacea, but a good deal better than what we endure at the moment.

    • Bob Ferguson says:

      You are confusing GP practices with CCGs – not the same thing at all. As for more enlightened commissioning, I ask again: where is the evidence. Dream on, Geoff. But while you’re at it, please pray for more money.

  3. geoff says:

    Yes, but GP practices are able to commission services even now (at least that is the case for my local CCG). Also, many CCGs cover much wider areas than do local authorities (again, this is the case in Dorset) and so one could expect the administrative apparatus to be considerably leaner.

    • Bob Ferguson says:

      I think you’ll find that CCGs are not just handed a pot of money and told to get on with it. Specific allocations are set (by NHS England) for commissioning and for admin and running costs. According to informed commentators, the latter are already “lean” to the point of being unfit for purpose. The ability of CCGs to tweak their funding to push resources “saved” from admin to service commissioning – which was your original point – is therefore non-existent.

      At bottom, your argument appears to be based on a distinction between: private – lean and effective; public wasteful and worthless. And I thought we had all moved on from such tired old stereotypes.

  4. geoff says:

    My proposal implies a dismantling of the whole Meccano set and building something better – this would include modifications to the way in which CCGs work. Re. the public/private dichotomy: there’s lots of evidence to show that, while it may be tired and old, it remains valid. More of an archetype that a stereotype I’d say.

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