Memorandum from Mental Health Providers
Forum
The Mental Health Providers Forum promotes voluntary
sector providers as first choice partners in the design and delivery
of modern mental health services. We have 27 providers in membership[163]
who have a combined turnover of over half a billion pounds and
provide direct services to over 30,000 people.
The issues raised by the Public Administration
Select Committee's inquiry are highly relevant to the Mental Health
Providers Forum's work. We are pleased to submit these responses
to your questions as evidence and would be happy to assist further
with any matters if so requested.
1. What are the benefits of contestabilty
to the users of public services?
(a) Have services which have been transferred
to third sector organisations shown improvements in quality?
While there is a shortage of hard data, transferring
services benefit from:
1. increased staff morale;
2. increased management flexibility;
3. more cross organisational working; and
4. high levels of user satisfaction.
(b) Is loss of accountability a threat of
commissioning services? If so, how can this best be managed?
Third Sector organisations in general and our
members in particular are:
1. accountable to funders;
2. have active processes to involve and be
accountable to users;
3. are inspected by the regulators such as
the Healthcare Commission, CSCI and Supporting People; and
4. should be required by their contracts
to be transparent and publicly accountable.
2. Is the third sector more likely to provide
better public services than the state or the private sector?
(a) Is there evidence that where services
are provided by the third sector, that they are popular with those
that use them?
— Most of the larger third sector organisations
carry out user surveys and receive positive feedback.
— Users value the person centred approach,
destigmatising locations and attitudes and the potential for involvement
and acceptance.
(b) Is there evidence of demand for more services
to be provided by the third sector? If so, who from?
— Most third sector organisations come
into being and are developed because users and carers are seeking
a different and more responsive service.
(c) Do public services provided by the third
sector more accurately reflect the changing needs of those that
use them?
— Unfortunately funding models often
reduce third sector ability to respond to changing needs.
(d) Is there evidence that contracting to
the third sector leads to greater scope for innovation in public
service delivery?
— Many innovations in service delivery
have originated with the third sector.
— In the more competitive environment
fostered by commissioning and tendering it is important to protect
the development and sharing of good practice and new approaches.
3. Does commissioning benefit the third sector?
(a) Will contractual relationships with the
state improve stability within the third sector?
— They should but often they do not.
Commissioners are very powerful and difficult to challenge.
(b) Will close involvement with service provision
prevent third sector organisations retaining the ability to be
critical of government?
— It is the responsibility of the Trustees
to ensure this doesn't happen. Third sector organisations with
a member base focus on the concerns of their members.
— There are many examples of third
sector organisations which deliver services and campaign actively.
Mental Health Provider Forum members who exemplify this include
Rethink, Mind, Turning Point.
(c) Is there a risk that the service providers
will become increasingly bureaucratic?
— A lot of bureaucracy is determined
by government and commissioner requirements. Often there is too
much tight regulation which stifles organisations and makes it
difficult for smaller organisations to meet the requirements.
This is where the focus needs to be to enable flexibility and
local responsiveness.
(d) Is there a risk that third sector organisations
will lose their independence, their identity or their distinctive
ethos?
— This needs to be protected in the
way that commissioning and funding is handled.
— The emphasis on Trustees retaining
independence is right.
(e) Might the third sector become polarised
between large service providing organisations and more radical
groups? If so, would this matter?
— There is a range of sizes. What is
important is to promote co-operation and collaboration and to
protect diversity in the face of commissioners seeking easier
to manage contracting.
4. Does commissioning services from the third
sector have any benefits for the state?
(a) Does the state risk losing control of
service delivery in a way which might be damaging?
— The possibilities for appropriate
control are within the commissioning and regulation processes.
(b) What capacity will the state need to ensure
that it can be an intelligent customer of services?
— More ability to assess, understand
and value outcomes which are meaningful to users.
(c) How is duplication of effort in order
to monitor and manage contracts best avoided?
— Have one lead commissioner.
— Ensure that monitoring is based on
valued outcomes and indicators kept to a sensible and useful minimum.
(d) How good is the state at managing bidding
processes and defining contractual obligations when commissioning
services?
— The over rapid changes in structures
and personnel and lack of clear central guidance often mitigate
against good processes.
5. What are the financial implications of
providing services through the third sector compared with directly
provided state services?
(a) Are services cheaper to provide?
— The aim should be for them to be
better value not cheaper.
(b) Are there "hidden costs" such
as contract oversight?
— Transaction costs are there for the
commissioner and the provider—these need to be taken into
account, properly funded and accounted for.
(c) Are the benefits of the third sector participation
in public service provision so great that it is appropriate to
have financial rules which encourage this, or should the aim be
to have "competitive neutrality" between public, private
and voluntary sectors?
— The rules should be fair and appropriate.
"Neutrality" can be unfair in a systematic and institutional
way.
— The third sector cannot play venture
capitalist or take the same financial risk on investment which
can make sense for a commercial player.
6. Are the costs and benefits to the state
the same when commissioned from the third and private sectors?
— The private player is not only focused
on private profit but will also be wary of sharing learning and
development. Third sector organisations often see sharing and
collaboration as part of their value base, though it is important
not to undermine this in a competitive environment.
February 2007
163 Members are: 2 Care, Advance housing and support,
Alternative Futures, The Avenues Trust, Carr-Gomm, Focus Futures,
making Space, Mental Health Care, Mental Health Concern, Mental
Health Matters, Mind, Mind in Birmingham, P3, Rethink, The Retreat,
Richmond Fellowship, St Andrew's Hopsital, St James's House, Second
Step, Sussex Oakleaf, Together, Tulip Mental Health, Turning Point,
Umbrella Care, United Response. Back
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