Is there a treatment?

Council Finance and Resource Committee meetings are not normally known for drama, but a procurement decision stirred up controversy in Edinburgh’s Council Chambers recently. The issue of who would provide the city’s four Adult Community Treatment (otherwise known as Recovery Hub) Services in the city proved to be a very heated discussion. The decision to award three to the large UK charity Lifeline, and one to Turning Point Scotland, on the face of it seemed logical as these providers had scored highly in the bid process. However, its failure to consider the back story and local experience highlights one of the major problems associated with health and social care services commissioning.

The reality is that councils have far more discretion than they would have us believe. For the last two years a group of local voluntary organisations, including current providers Castle Project, Community Help and Advice Initiative (CHAI), North Edinburgh Drug and AlcoholCentre (NEDAC) and Turning Point Scotland have been working collaboratively as a Hubs Alliance to redefine the service model.

The Edinburgh Alcohol and Drugs Partnership (EADP) realised early on that the smaller third sector providers would lose out in a new competitive tendering process, and so it aimed to address this with a coproduction process that would ensure local knowledge and expertise wasn’t lost.

Throughout the process, the importance of the hubs being anchored in their local community hasbeen emphasised. Considering the stigmas around substance use and the sensitivities aroundgetting potential services users to a point where they are willing and able to engage, the need for aknown and trusted organisation cannot be underestimated.

The decision to recommend Lifeline, a UK wide organisation that has delivered the Edinburghand Midlothian Offenders Recovery Service in Edinburgh for just 18 months, for three servicesgoes totally against this. Its local knowledge and community links cannot compare to that of thethree smaller organisations, which have grown up within their communities over 30 years.Despite the narrative, it doesn’t seem that this element has been significantly valued in this process at all.

The experience of any provider in writing tenders has far too much influence on the outcome ofthe process. Large organisations have skilled teams for this, whereas for smaller providers itoften boils down to managers (who have often never before been through such a process) makingtime out of working hours to get it done.The outcome in this respect was entirely predictable – EDAP identified that many providers werenot equipped to manage a full tender process, and they were right. Providers have been left withthe distinct impression that for the council, coproduction takes you so far, after which time it’sback to business as usual.

Procurement decisions are often presented as being unavoidable, with terms such as “EUlegislation” thrown in to trump further questions about how to create a better system. The realityis that councils have far more discretion than they would have us believe and decisions areactually made after weighing up different kinds of risk.The Procurement Reform (Scotland) Act has picked out health and social care services for goodreason – they are often very complex, with human relationships at the heart of them. Competitivetendering is simply too blunt an instrument to take the broader spectrum of factors into accountto achieve the best results for all concerned.

The recommendation, if passed, will result in a massive loss to the community. Castle Project andNEDAC will almost certainly cease to exist without this funding and CHAI would be massivelyreduced in capacity. But beyond this there are broader questions to be asked about the inevitabletensions between coproduction and competitive tender in the longer term.We at Edinburgh Voluntary Organisations’ Council (EVOC) are left with some significantquestions. How can this decision possibly be in keeping with the transformation agenda andlocality working? Equally, how can the council commit to the principles of coproduction if this isthe likely result?

There is a real danger that rather than being a constructive process working with providers,service users and carers to get the best outcomes for all concerned, coproducation will be seen asa mechanism to leach local organisations of their expertise before they are then replaced by largerorganisations in a competitive tender. Another Finance and Resources Committee meeting has been called for 14 December to discuss this further. EVOC will continue to be involved both for the specific issue in hand and for the longer term review.

We accept that these decisions are all about weighing up risk, and that we need to achieve best value for services, but there are more creative ways of doing this. We firmly feel that the risk of undermining the principles of coproduction and collaboration, and the risk of losing trusted and effective local organisations rooted in their communities should rank far higher on the list of considerations.