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Wednesday, 31 August 2011

Would a Council REALLY pay someone more than the Prime Minister and then ignore their advice?

Following yesterday's post, we've been asked for more information about the advice (of a man paid more than the Prime Minister) that was ignored (by Bristol City Council).  The ex-executive Director of the Care Quality Commission (CQC - the government's regulator of care standards) was employed by Bristol City Council for ten months as the interim Director of Health and Social Care. His name is David Johnstone and his appointment marked the first occasion that anyone from outside of Bristol City Council had been appointed to lead the Directorate.[1] He advised in October 2010 that homecare packages commissioned from the private sector by Bristol were larger than those of comparator authorities.[2]  One of his plans to save money was to focus on the external contracts the Council had made with private care providers.  In his opinion, contracting and procurement could be improved because the size of home care packages purchased from the independent sector was too high.[3]  Johnstone was employed as a consultant from May 2010 and departed unexpectedly in March 2011.  He received a total payment of £159,250.[4]  If he worked every day for those ten months (and we still dont know that he did), he would have been on approx £723.85 a day.  He was only a part-timer, his daily rate would work out to be much higher.

Specifically, Johnstone:
1. Submitted a report to Cabinet in October 2010 (which they accepted) in which no reference was made to discontinuing in-house Homecare services
2. Personally held meetings with Homecare workers across the City to assure them that his plans did not mean the closure of the service, but its retention with a specialist dementia-care focus
3. Promised workers specialist dementia care training and security of employment
4. Confirmed his plans meant they would retain 80% of their existing client base because dementia affected such a high proportion of older people in Bristol

Johnstone left the Authority suddenly, what followed:
1. In April, Bristol City Council wrote to all homecare workers and service users to inform them that the service would close
2. Withdrew those notices in May when the unions highlighted that such a move was unlawful
3. Proceeded to remove service users from the care of local authority care workers and transfer them to private providers (a process which is ongoing)
4. Wrote again to Homecare workers asking them to identify their preference either for voluntary redundancy or redeployment elsewhere in the Council with an end August 2011 deadline

Why Johnstone left Bristol City Council so suddenly remains a mystery.  But its a mystery which perhaps makes a little more sense when the behaviour of the Council before his departure is compared to their behaviour towards Homecare workers and service users after he had gone.

[1] Bill McKitterick transferred from Avon County Council to undertake the role when Bristol first became a unitary authority in 1996 until he left amid a financial crisis. From 2005 the role was undertaken by Annie Hudson, who had previously been divisional director of Children’s Services  January 2009 Cathy Morgan was appointed as Interim Director of Health and Social Care, she had spent most of her working life at Bristol, working her way up from being a mental health social worker.  David Johnstone took on the post in May 2010 having previously worked as Director of Operations at the Care Quality Commission and prior to that as Director of Adult and Community Services at Devon County Council
[4] Annual salary for directly employed Director of Health and Social Care would have been £101,226 per annum.  See FOI request response about Johnstone’s salary at

Monday, 29 August 2011

Ex-Executive Director of CQC paid more than the Prime Minister as Bristol’s Head of Health and Social Care

A freedom of information disclosure reveals ex-executive director of CQC (Care Quality Commission), responsible for regulating the private care sector, was paid more than the Prime Minister’s annual salary for just 10 months work as Bristol City Council’s director of Health and Social Care.  David Johnstone left Bristol City Council very suddenly in April. Unite claims his advice was ‘ignored’ by Council leaders. As interim strategic director of Health and Social Care, Johnstone was paid £159,250 for only ten months work between May 2010 and March 2011: equivalent to £191,100 per annum.[i]  David Cameron’s salary is £142,000. Johnstone’s fee was £89,874 more than he would have received if formally appointed to the role through the Council’s standard recruitment practice. Unite claims that because his advice about the future of homecare services for older people in the City has been ignored, the Council’s Homecare workers will lose their jobs and the service will close.

Unite’s Steve Preddy commented: ‘Unite had no idea Johnstone was paid so much.  The only possible explanation for his enormously inflated wage is the expertise he offered as a specialist in the management of care services.  Johnstone personally assured all Homecare staff that their jobs were safe.  He recommended savings be made through better commissioning and more effective use of staff time.  This advice has been ignored by a Lib Dem administration who are now hell-bent on privatising all homecare in Bristol instead of managing this precious service in a responsible fashion.’

Johnstone was not the only person concerned about staff being ‘under-utilised’.[ii]  The Executive Member for Health and Social Care Dr Jon Rodgers has previously admitted ‘we can save £1000’s by using services effectively.  At the moment we commission services we don’t currently use and there is waste in the Council.[iii]  However, rather than turning these wasted care hours into productive time spent with service users as recommended by Johnstone, Unite claims Lib Dems quickly dispensed with Johnstone’s services because they were determined to maximise the proportion of the Council’s care budget spent privately.

Johnstone had a ‘strong and successful record in leading and developing adult social care services’[iv] and replaced the previous interim director of health and social care who had worked for the Council for nearly 20 years.  Johnstone himself has been further replaced by another ‘interim’ Director.  His advice to the Council confirmed that ‘services would not be changed, good practice would be put in place instead’.[v]  In early 2011 the Lib Dems approved his budget plans to find savings from the Council own homecare service by reducing the use of agency staff, reducing sickness levels, and reducing management overheads.[vi]  However, days after Johnstone’s unexpected departure, the Council sent homecare staff letters informing them that their jobs were to be scrapped.  Although the Council subsequently apologised and withdrew the letters when trade unions made clear that the Council’s actions were unlawful, the process of transferring service users from Council provision to private companies has continued unabated.

Unite’s Steve Preddy commented: ‘The Council continually claim that private sector care is cheaper than that provided by the Council’s own workers but it is a failure of leadership and management that is the most significant factor in the disparity of costs.  Bristol people will be astonished to learn that the recommendations of a man considered to be worth more than the Prime Minister have been so callously ignored.’

For further information contact: Steve Preddy, Regional Officer, Unite

Mobile: 0776 446 7443, email:


Why Bristol City Council's Homecare Service Must Be Saved

If you care to look through the older posts on this site, they tell the tale of our campaign to save Bristol's Homecare Service from privatisation 4 years ago.  By campaigning effectively, the decision was sucessfully overturned by Homecare workers, service users and the electorate.  In the local election, the Lib Dems paid the price for treating Homecare with contempt.  They lost many seats and consequently lost the confidence of the Council Chamber.  A new minority Labour administration, supported by the Conservatives, worked with the trade unions to agree a viable way forward for Council Homecare.  The service was too expensive because staff time was under-utilised.  Managers argued it was a consequence of high sickness levels and inflexible hours of work.  Homecare workers quickly agreed to change their hours and supported plans to reduce sickness.  In return, the Council would commissioned work from its own Homecare Service in such a way that labour efficiencies would be radically improved.   

Fast forward to 2011: The homecare workers did everything required of them and the response from the Council was one that can only be described as betrayal.  Workers moved to flexible contracts and sickness absence was halved: close to target by mid 2010.  The Council failed abysmally to deliver on their side of the bargain and did not effectively commission work from their own Homecare Service.  As a result, labour efficiencies are now breathtakingly bad.  Back under Lib Dem control, Bristol City Council again plans to privatise all of its Homecare service. Perhaps the Lib Dems have decided to exact revenge for their defeat in 2007.  Perhaps the management and supervising politicians are so astonishingly incompetent that they don’t understand that paying Homecares for doing nothing for 40% of their time dramatically increases unit costs.  Whatever the cause, we are faced with the nauseating spectacle of Homecare workers, service users and the Bristol electorate being punished for having the collective courage to challenge care privatisation back in 2007.

Since 80% of the homecare currently provided for older people in Bristol is commissioned by the Council from private sector outfits, what we are faced with in 2011 is not a case of in-house versus market-led services.  The arguments against wholesale privatisation are two-fold: both concern the protection of vulnerable people.  Firstly, the homecare workers themselves and secondly, the older and disabled people they care for.

Women (because it is an almost exclusively female workforce) working for private sector homecare agencies have some of the very worst terms and conditions of employment of any workers in the UK.  Hence it is difficult to recruit women to work in homecare and staff shortages are endemic.  In terms of traditional economic theory, one might think that labour shortages would push up wages.  However, the homecare market is 'monopsistic' - this means that in the local market for homecare services, there are many providers but only one customer.  The single customer, in this case Bristol City Council, prevents effective competition by exerting monopoly control over how much it is willing to pay. 

Instead of producing an improvement in wages, the labour shortage in homecare makes the working conditions worse. Workers are cajoled or bullied into working long or unexpected hours to cover for staff shortages.  Corners are cut.  Care companies go bust, workers get into serious personal debt.  The vast majority of women working for private sector homecare companies are employed on contracts that deny them the employment rights which many other workers take for granted - like the right to take unpaid time off work in a family emergency, or maternity pay, sick pay or the confidence that accompanies a regular income and stable hours of work.  The very basic rights they do have, like entitlement to the national minimum wage or basic holiday leave, are routinely violated.  Official statistics show that 10% of all homecare workers are paid below the National Minimum Wage, and these are only the reported cases.  However, Council employed care workers, although not highly paid (in Bristol they get a basic wage of £7.11 per hour), do have employment rights, do have a trade union to represent them, enjoy sick pay and have much greater economic security than their private sector counterparts. 

Homecare markets are localised: the controlling customer for the entire local market is Bristol City Council and the women who work as homecares live near to the service users they care for.  The most significant element in competition for labour supply is the existence of work opportunities both with the Council and with private agencies.  If the better paid and more secure jobs provided directly by Bristol City Council disappear, terms and conditions will deteriorate even further in the jobs that remain in the private sector.

This impacts on the second group of vulnerable people in the homecare market: the older and disabled people who receive services.  Labour shortages in the private sector mean that staff turnover is so high that older people often don't know who their carer is, who the next person knocking on the door will be.  If a carer does not show up, older people can find themselves left sat in their own urine or faeces, or unable to take the medicine they need, or left without a drink all day.  They get frightened. 

Only a couple of days ago a very elderly, incontinent and immobile service user had his care package taken away from Bristol's own homecare service and handed over to a private agency.  He was distraught at losing his trusted Council homecare worker and cried for many hours because his new agency carer had forgotten to give him a hot drink and had not changed his sheath catheter.  He was left at risk of dehydration, urinary tract infection and skin ulcers.   Older people who need care know how vulnerable their lives are. 
They have little faith in a system in which their only point of social contact or their only source of personal assistance is based upon an unstable commissioning arrangement between faceless bean-counters at the local authority and the local franchise of a multi-million pound care company. 

Sometimes these companies fail.  In high profile cases, take for example Bristol's Winterbourne View as exposed by Panorama, owners decide to shut up shop because appalling, institutionalised abuse is uncovered.  Not infrequently, business failure means going bust - look at the precarious state of Southern Cross care homes.  Most often though, homecare agencies fail their service users by cutting corners, employing untrained staff, failing to complete Criminal Records Bureau checks, mixing up service user's medication, not putting in the time they are supposed to, or simply failing to turn up at all. 

This market instability is the price we inevitably pay when we (as a society) collectively concur that markets can run things more efficiently than centralised, highly bureaucratic, publicly-owned services.  True, the care market is regulated, but the Gordon Brown inspired 'era of light-touch regulation' did not only impact goings-on in the City of London, it also shaped the regulation of care markets.  The regulation of private sector care has been progressively watered down at every opportunity.  The Care Quality Commission, the current regulator of care services, now has such a poor reputation for quality control that in June of this year it even lost the confidence of the very private sector companies it was designed to oversee at the National Care Homes Association annual conference.

It's too late to turn the clock back on the privatisation of care services.  Not all private sector care is bad.  However, we must deal with the reality that, in fact, all these companies operate within a care market which is based on weak regulation, routine abuse of employment rights and a desperate clamour for cheapness from a monopoly customer.  In such a system, the retention of (some) Council run, secure, reliable and democratically accountable homecare services becomes an absolute necessity.  When the market fails, as it inevitably does, the Council's homecare service picks up the pieces.

When two private homecare companies in Bristol ceased trading earlier this year, it was the Council's homecare service that stepped in to take on the abandoned service users.  The Council's emergency homecare team provides round-the-clock cover, intervenes in case of missed appointments and at times of critical need.  Bristol City Council's homecare workers are, without doubt, the most experienced and capable carers in the City.  Despite being low paid, homecare is a highly skilled job.  These workers apply a wealth of knowledge about medication, medical equipment, physical disabilities and older people's health needs.  They pay attention to the signals that warn of a person becoming weaker, take preventative action and build proactive relationships with their service users.  There are huge outstanding care needs within our City: take for example the 50% of dementia sufferers who live in their own homes or the 20% who live totally alone - as yet there are no specialist homecare services for them.  Consider the needs of the terminally ill who do not wish to die in hospital - their expectations of a dignified death in the comfort of their own home are only just beginning to be taken seriously.  Think of your own Dad or your Grandma, what do you wish for them?  Surely, at a minimum, you want a care market that does not dump its inherent failures on people who are too weary, too frightened and too dependent to do anything about it?

Bristol City Council, as the architect of the care market in the City, has the power to make or break care providers.  Its approach to its own Homecare Service has been to try and break it.  Despite the best efforts of the workforce, they have been betrayed.  The Council has failed to use the time and expertise of its own staff in a determined effort to claim the service is too costly.  A Council employed Homecare earns £7.11 an hour, each hour of care bought from the private sector costs at least £16.  Homecare is not a technical enterprise, it's a business based on organising skilled women in such as way as to make sure that as much of their time as possible is spent with an older person in need of care at home.  Bristol City Council have been doing that task so badly of late that they calculate their own service now costs £34 for each hour of care delivered.  This is simply not good enough.

The solution needed in Bristol is not to de-regulate homecare even further, putting every last pound of public money into private hands, but to retain the service and manage it properly.  For the sake of vulnerable people in the City, both those who work in homecare and those in need of care, Bristol's City Council's own Homecare service must be retained.

Thursday, 18 August 2011

Four years later and the Council come after us again!

This blog is reactivated for a new campaign to save the inhouse homecare service in Bristol.  We won the argument to keep the service back in 2007.  The Liberal Democrats are now back in control of the city council. They have lied and cheated their dedicated team of homecare workers by promising them that their jobs were safe yet have recently announced that the service is to close.  More updates soon