Getting to the ‘Organ Grinders’ – (part 1)

This a fairly average week, but barely a day has passed without another life being marred by the contemporary epidemic of the centralization of decision-making in UK public services.

Here are just two of this week’s examples:

Well over a year ago the family of a very autistic young man sought our help. They were, we believe correctly, convinced that unless robust and sustainable bespoke arrangements were designed and rigorously enacted for their son his prognosis was likely to be a life in secure circumstances. His time at a specialist, residential FE college, which acknowledged his complexity and the inappropriateness for him of congregate care was due to end. Some variation to his authority’s standard commissioning practice was negotiated and LivesthroughFriends was engaged to train and support the provider chosen by the family from the authority’s list. A few weeks before the transition was to commence the chosen provider backed stating the young man to be “too challenging”.  Despite the college being clear that he was inappropriately ‘placed’, and against burgeoning frequency of serious incidents involving restraint and trauma, his stay was extended. Over the subsequent year the family (and increasingly the professionals involved who recognise his need for a bespoke support arrangement with a well-led, well-trained, well-paid support team with well-planned and responsive ongoing professional and clinical support to the provider agency) have, given LivesthroughFriends’ track record in commissioning and sustaining such arrangements, petitioned the Health Board to engage LtF to do this work. It took time for the family to get the professionals on board. Then it took time for them to persuade the commissioners to take the proposal with lots of references and case histories to the decision-makers. Then they said “No”. Then the family, professionals and commissioners insisted on going back to the decision-makers who finally have agreed to meet LtF – next week.

This week, after a serious incident with an agency staff member, the college threw in the towel and the young man has been sectioned to an ATU where all are agreed he is at risk.

This is, in ‘technicolour’, a representative example of the consequences of centralization.

During the same week, disconnected ‘decision-makers’ decided to intervene in, what would seem to the uninitiated, a thoroughly bizarre way.

LivesthroughFriends have been engaged to operate a pilot project to, by demonstrating our approach and ‘infecting’ the participating statutory authorities, plan and implement the repatriation of local citizens to their own communities from inappropriate placements in distant secure units, ATU’s, and special hospitals. A key characteristic of LivesthroughFriends methodology is the imperative that our ‘Commissioners’ share our commitment to securing whatever is the best interests of the person for whom we are planning; despite unsympathetic systems, processes or interpretations of legislation/financial regulations. Our method rests simply upon identifying the direction of travel necessary for our ‘focus person’ to secure the best life that folk can envisage and then setting out on the journey, problem-solving and creating whatever is necessary as we go. This can be a hard sell to people immured into the standard, market-orientated, operating procedures that so obviously fail non-standard people. We have learned the hard way that we need to get the buy in, from day one, of the ‘executive’ leaders in the public services we seek to assist if we are going to be relatively unencumbered in applying what we’ve learned, significantly enhancing peoples’ lives, stimulating the generation of helpful systems, reducing failure demand, and reducing per capita costs.

So, at the outset of this work, we ran a number of very challenging workshops highlighting our critique of the mainstream system and explaining and securing adherence to our, we think, simple but very radical alternative methodology. We thought we had engaged with the decision-makers – but we hadn’t! They are “too busy” to leave their bubble.

We see every day that the folk we assist spend their lives in what very often amounts to custodial care and this has to be seen as an infringement of their human rights. So, we get on with things and, as has happened this week, it’s at the point when resources need to be released that the real decision-makers are ‘experienced’. 

So, this week, we’ve wasted long hours fending off demands to follow counterproductive systems and processes that are explicitly excluded from our operational agreement and explaining in no uncertain terms that we would not have taken the commission unless they had agreed otherwise. We’ve regularly observed that the Social Care market isn’t really into 2-way contracts. It works on a “we specify – you provide” assertion that flatters itself that the commissioning agency represents the service user – which, of course, is a rare and notable consequence.

So, I conclude … winning the buy-in of UK public sector leaders to pragmatic and sustainable solutions to the nation’s ‘transforming care’ scandal seems to be a forlorn hope.

Bob Rhodes