People: Capital or Commodity?

People: Capital or Commodity?

In this blog I am, for once, going to break off from my normal themes and give voice to my frustration at a recent decision made by a local authority procurement team. As is my way I won’t name names but the decision, no doubt made in good faith, has consequences which are so crass, so thoughtless, so procedural it failed to consider the central importance of relationships.

I have said it before and I will say in many more times: health and social care is all about people, always has been, always will be. It is not about systems, procedures, policies etc. Although there is a tendency to focus on the transactions between people we must never forget about the importance of relationships. Below is an example of what happens when we do…

The authority in question decided to re-procure a wide range of existing services for people with learning disabilities. My understanding is that they wished to rationalise the existing provision, remove some substandard providers and, where possible find financial savings. All perfectly reasonable objectives and not uncommon as many other cash strapped local authorities are, in extremis, having to do the same thing elsewhere. Procurement tends to a rather dry, distant, impersonal, transactional process at the best of times and a long way from the personalised, person-centred, outcome focused commissioning which is much more relational. I will spare you the details and cut to the outcome.

First I must declare a personal interest: I am the CEO of the charity MacIntyre and the tendering process impacted on a couple of MacIntyre services; small shared living homes for people with profound learning disabilities. The individuals are tenants and have need of 24 hour support from a team of care and support workers dedicated to their house. In one house most of the individuals have lived there for many years with a stable staff team, it has a good local manager and all-in-all it is a pretty happy place. With absolutely no consultation with either the tenants or their families the above process created a spreadsheet of scores, at the top end were those service providers selected and I was pleased MacIntyre was included. The deviation of scores across this group was marginal and allocated service by service. For many services the difference in the score which ranked a provider in first place rather than second was only a couple of percentage points but the consequences are huge. For one household this will mean the wholesale transfer of the service from MacIntyre to another care provider “x” (a good reputable organisation). However the same spreadsheet threw up another score that means MacIntyre is to take over the running of an “x” service a few miles down the road!

No doubt in the minds of the procurement analysts they didn’t see a problem with this as both organisations are good enough to contract with, the staff teams working in either house have legislative protection to secure their jobs and so all that was happening was a change of name over the door. The process was very expensive for all parties and although there is no financial saving in this particular instance no doubt there must have been some value somewhere to justify the whole exercise. Sadly, almost unforgivably, the process loss sight of the people- people with vulnerabilities, insecurities, loyalties, responsibilities not just the individuals with learning disabilities and their families but also the members of staff.

I went to meet with the staff team last week and they were incredulous and angry in equal measure. They were deeply conflicted between their loyalty and profound sense of responsibility for the tenants and their desire to remain with MacIntyre. Even though they know they have a right to continued employment when the service transfers to the new provider they also have a right not to be treated as a commodity like the transfer of the photocopiers! Many work with individuals supported by MacIntyre elsewhere and want to continue doing so, several have started training courses which they wish to continue and, as it happens they, actually like working for MacIntyre. Of course exactly the same concerns and conflicts are also held by the employees of provider “x”.

The upshot is that most, if not all, of my colleagues, with heavy hearts have asked to transfer to other MacIntyre services and we believe the employees of “x” will decide to do the same. Therefore on 1st April (sic) at least two households of vulnerable people with profound learning disabilities will lose the security of a team of people they know and trust- wholesale. New people will have to be drafted in- good folk who will do their best for the tenants in very difficult circumstances but they won’t have had time to build up the trust and communications skills that all of us need to allow people to be intimate with us. What a dreadfully frightening and destabilising experience for the individuals and how terribly worrying must this be for their families. Then to make matters worse the process has determined a new the maximum numbers of hours that the tenants will need from the new provider. The existing team told me that because of their devotion and commitment they frequently work well in excess of these hours- so people can stay out late, go on holidays etc. This good will is known as human capital and that doesn’t appear on the spreadsheet…

I wish I could end on a more positive note.  I said at the outset that the original intentions of the local authority were reasonable and given the unprecedented and continuing cuts to local government funding they have to make very difficult decisions.  But there is a better way: there are examples where meaningful engagement with all the people involved can maintain service standards or even improve outcomes and still save money.

By the way the whole process is said to begin again in three years’ time!