Not an awful lot to say about this snippet from the paperwork prepared for the next Governing Body meeting of the Oxfordshire Clinical Commissioning Group (30th Jan).
Other than what other part of the NHS would/could possibly report such statements?
Because STATT closed, commissioners have had to place patients in the Ridgeway Centre in Wycombe. A unit they’ve had ongoing safeguarding concerns about. Seriously? We’re talking about a hugely vulnerable group of patients here. So there were concerns about STATT that were ignored for a few years. The CQC (pah, pesky interfering bunch) identify serious failings, so patients are sent to another Southern Health provision where there are, er, ongoing safeguarding concerns. Am I missing something?
The decision has (now?) been made not to place in the Ridgeway Centre. Blimey. So a service is being commissioned that isn’t fit for purpose. How does that work?
A few questions that bounce around my (lay) head:
- Do the commissioners give a flying fuck about the patients they seem to be consistently consigning to substandard care?
- Have they considered commissioning effective support that might prevent the need for admittance to an assessment unit?
- Has any thought been given to commissioning services that aren’t crap?
- How crap do Southern Health have to be before decisions are made about not commissioning them at all? The evidence is stacking up like billy-o.
- Does Southern Health have some sort of hold over Oxfordshire commissioners, local authority, safeguarding board? Some skelos in the cupboard? There must be an explanation for this consistent audit trail of utter shite.
Answers on a postcard please. You can buy some cracking ones here; http://sarasiobhan.wordpress.com/fundraising/
Sorry it’s not on a postcard, but….
The trouble with commissioning groups is that they cannot be in a position, when they make commissioning decisions, to think of patients as people – certainly not in specific terms of a lanky young man with dark hair and a big smile, who likes buses, loves London and needs x, y and z types of specific support to manage his neurological differences.
Commissioning as currently conceived is a ‘top-level’, ‘broad-brush’, ‘big-picture’ activity. It doesn’t do detail. Patients are generic, they are units of budget consumption, and therefore budgetary considerations come first in commissioning.
This in turn means that budgetary considerations, not personal or clinical ones, are paramount when it comes to evaluation. Failing to provide adequate care? It will take a long time, or a major incident, to be noticed, and even then there is considerable scope for stalling and prevarication. Overspending the budget or failing to submit paper returns on time? It will be noticed in short order and sanctioned promptly.
In theory, detail gets added in once budgets get handed down to the people providing the face-to-face care, but that’s assuming the face-to-face care providers have the will and knowledge to do the detail, and the wherewithal to deliver it. Hmmn.
If the budgeting doesn’t take sufficient notice of the detailed needs, then it’s highly likely the wherewithal will be insufficient. Knowledge and skills will be devoted to paper-trail arse-covering instead of the doing the detailed stuff like ensuring in-date equipment, working batteries, and care tailor-made to keep a person safe and supported to recover/improve.
Does the difficulty of doing the parallel-processing needed to keep broad-brush and detail in view simultaneously, excuse the focus on broad-brush and the neglect of detail? Of course not. But it won’t get better until commissioning is done with good personal/clinical outcomes at the heart of the process. Not holding my breath.
Thanks Kay, for this response. This whole commissioning lark is new to me (and I’m sure to some/many other parents). It’s really helpful to get comprehensive and informative detail to help make better sense of it all. Is there no onus on the commissioners to check whether their commissioned services are actually delivering? Or does that fall to the likes of the CQC? It seems obvious from various minutes reported online, that the commissioning group were aware of problems with learning disability provision/STATT in Oxfordshire, but took no action to do anything about it.
And then chuck into the mix, the email I posted a week or so back, about a commissioner saying he/she knew there was a problem but didn’t want to dent confidence in Southern Health as they were a ‘large provider’. Shudder.
I don’t expect you to answer these questions Kay 😉 I appreciate your thoughts and contribution to these issues. xx
I don’t know what the monitoring remit of the particular commissioners may be in respect of monitoring patient outcomes. What I can say with absolute confidence is that in ANY public procurement or commissioning in this country, there WILL be stringent financial monitoring, as developed, refined and pretty much universally agreed (hell, there’s even an International Public Sector Accounting Standards Board) over the past 500+ years since the invention of double-entry bookkeeping.
Monitoring of other, less quantifiable, outcomes is newer; therefore less formally developed. Unsystematic. Probably specified (if specified at all) at the level of each contract. KPIs. The costs of monitoring a contract will have to be included in the budget for that contract. How likely is it that a contract would include close monitoring analogous to the financial monitoring? After all, the accountants don’t just pop in briefly every couple of years or so, or a few months after somebody whacks them over the head with a large quantity of alarming and unpalatable facts. They *track* the money, on a monthly, quarterly and yearly basis. Properly to track other outcomes won’t be cheap. It will require a significant investment in organisation and staff, and the funding required will probably be subtracted from the amount put into the direct service. So the budget ends up dictating the services, again.
Turning to that hideous ‘large provider’ comment… yes, nauseatingly fucked up. That’s what you’ll get when there’s a monopoly, or near-monopoly, but it’s outwith the control of the people supposed to be running the whole shebang. Desperate pandering to keep Hobson sweet. Recipe for disaster every time.
Aaaaand once more, we don’t see the wood for the trees. As the prophet says, “Where there is no vision, the people perish:
I refer you to Sir Terry Pratchett for a succinct exposition on the evil of thinking of ‘patients’ or ‘service users’ as units of budget consumption, rather than as people: (from ‘Carpe Jugulum’):
“There is a very interesting debate raging at the moment about the nature of sin, for example,” said Oats.
“And what do they think? Against it, are they?” said Granny Weatherwax.
“It’s not as simple as that. It’s not a black and white issue. There are so many shades of gray.”
“There’s no grays, only white that’s got grubby. I’m surprised you don’t know that. And sin, young man, is when you treat people as things. Including yourself. That’s what sin is.”
“It’s a lot more complicated than that—”
“No. It ain’t. When people say things are a lot more complicated than that, they means they’re getting worried that they won’t like the truth. People as things, that’s where it starts.”
“Oh, I’m sure there are worse crimes—”
“But they starts with thinking about people as things…”
So we have a growing “care industry” incapable of caring. And the obscene nature of what happened here (and elsewhere) gets brushed aside and nothing changes. But the paper work and the covers up get better.
Sara, I so admire your rage. So painful and necessary to express it.