April 6, 2016
Hard to fathom
Last week’s account of City of Edinburgh Council’s decision to end a long standing relationship with a number of community based addiction services, struck a chord with many people as being entirely wrong-headed on many different levels. Commendably, the Council webcasts all of its meetings. This deputation from two GPs representing their colleagues from across the city who work with this vulnerable group of patients, will be uncomfortable viewing for those Councillors who dug their heels in.
Before Christmas I wrote a blog, full of hope that the risks of competitive tender were being taken seriously by Edinburgh Council. The decision of whether to award contracts to a UK wide organisation in favour of three local organisations, which had grown up from within their communities over thirty years, was deferred. Another meeting was set for 14th December to allow the issues we raised to be explored in more detail.
On behalf of Edinburgh’s Substance Use Network (SUNE), EVOC had voiced the extent to which the principles underpinning an 18 month process of collaboration had been undermined by a starkly one-dimensional competitive tender process. A tender process which was presented by procurement officers as the only way forward, when the reality was not so black and white. Investigating further we discovered additional concerns. Service users had not been consulted about the decision to put the recovery hub service out to tender, as the Scottish guidance makes clear they should be. GPs, who have very close working relationships with these organisations, had not been consulted either. The considerable risks to vulnerable service users of the likely transition of services had not been raised in the Equality and Rights Impact Assessment, nor had they been taken into account in any other part of the process.
Procurement decisions are being wrongly presented as black and white, with the phrase ‘EU legislation’ being used to intimidate people out of arguing for an alternative. But EU procurement legislation does specify that contracting authorities may take into account factors such as the need to ensure continuity, specific needs of different categories of users, and the involvement and empowerment of users. Aside from this, EU legislation is broad, it has social as well as economic dimensions and compliance with procurement law is not to be allowed to hinder social justice and protection.
The local communities in question objected to what was being taken from them. In one of the three areas over 500 people signed a petition in the space of a week. Signatories included Richard Simpson MSP (a psychiatrist with a history working within addiction medicine), as well as many service users and family members.
One person commented:
“A community service should be exactly that, something that has grown up in the local community. What the decision makers don’t seem to appreciate is that when we are not well, we struggle with change, familiarity and consistency keeps us well, it is important for us to be able to trust the service that we confide in”.
We raised these concerns on 14th December in a deputation to Edinburgh’s Finance and Resource Committee.
We asked that in the rush to avoid the risk of not going to tender, the risks of going to tender were not ignored. The risks to locality working, total place and coproduction, the risks of losing organisations which have grown out of communities in response to their needs, the risks to the relationships carefully built with the third sector and moreover the risks to the very outcomes these services work to achieve for vulnerable people. We asked that in this balancing act, these risks be recognised and given the weight they deserve.
Also making a deputation was John Budd, a GP speaking on behalf of the Deprivation Interest Group (DIG) – a broader group of GPs working with the most deprived communities. He did not mince his words and spoke of the shock expressed by DIG members about the way in which this decision had been made. Among a range of points he relayed the concerns expressed about both the decision but also the attitudes it displays about the Council’s approach to partnership working.
“I would suggest that you are putting the goodwill and faith of GPs at risk through this decision. And certainly they will think long and hard before they commit their time and efforts into engaging in a process that seems so easily undermined. Now I have never had a response from GPs like that before”.
In the end, it seems that the points made were not deemed sufficient for the Council to admit that they had made a mistake. With the exception of Green councillor Gavin Corbett, whose amendment was not seconded, councillors stood firmly together behind the decisions already made. The Council’s main point of rebuttal seemed to be that coproduction does not mean co-delivery, and this is entirely accepted by all involved.
Surely though this is not what coproduction looks like either? Working in partnership with small organisations understood as being ‘not equipped to handle a full tender process’ to the point where their expertise and local knowledge has been downloaded. Whereupon a procurement process is implemented which firstly cannot take into account their (apparently valuable) local knowledge and secondly which was identified in advance as being likely to exclude them from future business. This is not the griping of one organisation which lost a contract. It simply illustrates that a rigid insistence on competitive tenders will systematically wipe out the diversity of service providers, and favour large organisations which write slick tenders.
It is very disappointing that the contradictions of this process were not fully acknowledged. In the struggle to find a balance between coproduction and competitive tender, coproduction has undoubtedly lost this match and made casualties of NEDAC, CHAI and Castle Project (and possibly the goodwill of GPs to boot). I would like to use this opportunity to recognise the immensely valuable work these organisations have delivered for the communities of Edinburgh.
It’s a new year and so we will look ahead. We have an offer from the Council to participate in a review of these issues, as well as new guidance due from Scottish Government. At EVOC we hope to use the lessons learnt here to work with partners to show what coproduction should look like, improve the way decisions are made, and ultimately the outcomes for the people of Edinburgh.
Watch the 14th December webcast here.
 John Budd is also a board member of NEDAC, and he stated this during his deputation but offered evidence of broad concern expressed by DIG members and other GPs.