Outsourcing public services, especially to the private sector, has been the model of choice in the UK for around 30 years. Nowhere has this been more the case than in adult social care, where private companies account for the vast majority of provision in both the care home and homecare market.
There is scant evidence from any sector that the outsourcing model works, and social care is no exception. From the collapse of Southern Cross in 2011 to the handing back of contracts, the model is struggling. In addition, scandals such as Winterbourne View, the Morleigh Group in Cornwall, and Mendip House are far from isolated incidents.
All of this adds up to a daunting charge list against those commissioning services in admittedly difficult times. Weak contracting, inadequate budgets, poor supervision, insufficient regulation and overweening providers have all been identified as factors contributing to the fragility of the outsourcing model. Much less attention, however, has been given to the ethics of decision-making among public services commissioners – and the need for an ethical commissioning strategy. This could cover a range of requirements.
- Ethical employment: Commissioners must be able to distinguish between the workforce practices of different providers and prioritise those acting as ethical employers. This might include prioritising those companies that are accredited by the Living Wage Foundation; have effective training, development and supervision; sign up to an ethical care charter; outlaw false self-employment and zero-hours contracts; and encourage staff to participate in collective bargaining.
- Tax compliance: The ownership of all companies contracted to deliver public services should be available on public record. At the same time, a taxation test could require contracted private companies to demonstrate that they are based in the UK and subject to UK taxation law.
- Transparency: A transparency test could stipulate that where a public body has a legal contract with a private provider, that contract must ensure full openness and transparency with no recourse to the cover of "commercial confidentiality". A private member's bill in the Commons to require companies engaged in public services to be subject to Freedom of Information requests is under consideration, with a second reading in October.
- Localism: A focus on smaller and more local commissioning is needed – a challenge for public services commissioners who generally favour dealing with a small number of large organisations with established contracting infrastructures. Smaller organisations hold vast expertise about the precise issues affecting people in their area and can serve very small or isolated communities or specific communities of interest.
- Ethical vision: To create change in adult social care, we need a guiding vision, rooted in ethical considerations of promoting good lives well lived, and protecting the wider economic, social and environmental wellbeing of a local area. Procurement legislation in Scotland seeks to promote just such a vision but has no real equivalent in England.
Introducing effective ethical commissioning means the skills, attitudes and behaviour of public services commissioners must change. The Cabinet Office and its partners have developed the Commissioning Academy for senior leaders from all parts of the public sector and Skills for Care offers a certificate in principles of commissioning for wellbeing, but these barely scratch the surface. There is much to be done to develop and spread accredited qualifications embedded in a culture of ethical commissioning.
More broadly, the cultivation of ethical commissioning should be part of a wider strategy for developing ethical standards across every aspect of public life. It is almost a quarter of century since John Major established the Committee on Standards in Public Life, which led to the seven Nolan Principles: selflessness, integrity, objectivity, accountability, openness, honesty and leadership. A 2014 review by the Committee on ethical standards for providers of public services concluded that:
- The public want common ethical standards regardless of sector, supported by a code of conduct
- How services are delivered is as important to the public as what is delivered
- Public and stakeholder views of what should constitute ethical standards are broadly in line with the Nolan principles
- Commissioners expect providers to conform to ethical standards but rarely explicitly articulate these
- Commissioners want guidance and training on how to embed ethical standards in the commissioning and procurement process
These findings have important implications for supporting commissioners of adult social care. It is too easy for commissioning to become an "ethics free zone" in which values get lost in the maelstrom of everyday practice. The question facing commissioners is whether they are merely following rules or are members of a profession committed to ethical practice.
Bob Hudson is a professor in the Centre for Health Service Studies at Kent University. This article first appeared in Guardian Public Leaders.