My Lords, I, too, am most grateful to the noble Baroness for securing this important debate. I am pleased to follow the noble Baroness, Lady Randerson, in talking about procurement.
I should like to ask Her Majesty's Government whether there is a clear evidence base for the use of a
mixed market in services for the care of the elderly and of vulnerable adults and children; whether there is not an overreliance on large, private equity-based providers of care; whether more might not be made of giving third-sector care providers preferred status and promoting enduring relationships between those providers and purchasers, provided that outcomes measures are met; and, finally, whether more might not be done by Her Majesty's Government to prioritise their workforce development responsibilities?
Having sat on the board of a not-for-profit adoption and fostering agency, I know how tough the competition for placements is. I would be most grateful to be reassured that the voluntary sector is not being put at an unhelpful competitive disadvantage with regard to large, equity-funded providers. How can we maintain the smallness to which the noble Baroness referred in circumstances of competition with large, equity-based companies?
The Parliamentary Groups for Looked after Children and for Runaway Children, chaired by Ann Coffey MP and Edward Timpson MP respectively, this week launched their report into children who go missing from care, a report made by possible by the support of the Children’s Society and the Who Cares? Trust. The first of its five key recommendations was that there should be:
“An independent investigation into children’s homes in England which are failing to manage and protect children who run away or go missing. This is despite spending £1 billion a year on just under 5,000 children cared for in children’s homes averaging £200,000 per child”.
I should declare an interest as I was involved with the report’s production and am an officer of the one of the parliamentary groups involved.
Local authorities now own only 24% of children’s homes and large equity-based companies are the largest providers. From the report’s key recommendations, we can see that this particular mixed market does not appear to be giving value for money and quality care outcomes. I recently met Eva Lloyd, reader in early childhood at the Cass School of Education and Communities at the University of East London. We discussed her book on the mixed market in early years provision, Childcare Markets: Can They Deliver an Equitable Service? The book is to be published on 25 June and is jointly edited by her and Helen Penn. She emphasised to me that the evidence strongly indicates that our model of mixed market for early years provision in the early years area does not give the best value for money. Indeed, we have among the most costly early years provision in the world. This may in part be because we rely so heavily on large, equity-based providers for our childcare.
I contrast this with a non-market approach and the best education system in the world. Finland tops the PISA international charts for education outcomes in literacy, numeracy and science each year. An important aspect of its service is the quality of its teachers. There are 20 candidates competing for each teacher training place. Every teacher, in primary and secondary schools, has a master’s degree qualification. Teachers are trusted. As I understand it, there is no school inspection system in Finland and very loose national curriculum guidance. The analogy perhaps is that each school is
like a small enterprise, run by people who are genuinely committed and highly trained by the Government to do an excellent job and who are given autonomy.
The comparison between us and Finland is said to be flawed because our nations are so dissimilar, in particular since Finland has a far more homogeneous population. This is true, but every school class is of mixed ability and I understand there are no exclusions from school. Teachers have to work with the mix of children that is presented to them and they get these fantastic results.
The experiences I describe above lead me to wonder whether we have an overreliance on a mixed market of provision in services for the vulnerable. Should we be looking more at enduring relationships with particular providers and give preferential treatment to not-for-profit providers where they can demonstrate high quality and value for money? Should the Government’s role be more to ensure that the high-quality workforce—the teachers, early years workers, social workers and so on—is available to meet the demand for services for the elderly, children and vulnerable adults, as part of the local and national infrastructure the noble Baroness referred to in her introduction? Do we overprize our system of regulation and inspection but underprize ensuring that there is a high-quality, autonomous workforce available to meet the needs of our children and of our elderly and vulnerable adults? I ask the Minister what the evidence base is for mixed markets in social care provision providing value for money and best outcomes. I look forward to his response.
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