More Bubb

I love Bubb's Blog and find it the perfect amusing antidote to normal blogs. Bubb obviously feels that the purpose is to record his thoughts for posterity and reader contributions are most unwelcome. The comments section is superfluous as he never reads or responds, so virtually no one ever bothers. Apart that is for the now infamous post 'Shawcross brings sector into disrepute' in response to the new Charity Commission's Chairman having a go at charity CEO's and their high salaries. 

Bubb's defence of charity CEO's high salaries included the oft-repeated statement that 'donors aren't bothered about the issue', which sort of belies the numerous negative comments that were left by disgruntled donors on that post. Of course in typical arrogant fashion Bubb's response was to delete the whole thing, together with all comments. He's made no further reference to its disappearance, so we must assume that either he now feels it was a little misjudged, or his members do. There's certainly been a few charities that have found donors walking as a result.

Anyway, Bubb has clearly been pleasantly surprised with the increased readership of his blog, and the media continue to take a keen interest in his tireless activities on behalf of his members. I notice that the Independent picked up on the Open Democracy revelations concerning Bubb's enthusiastic lobbying of the Health Secretary Jeremy Hunt in order to make sure there are lots more privatisation opportunities for his charity members. 

The charity and voluntary sector make up over a third of the UK private healthcare sector, and according to Sir Stephen Bubb represent a ‘bigger player’ than people think. Bubb told a 2010 voluntary sector conference "The third sector could grow by £2bn a year by 2015, just through increased involvement in offender rehabilitation and public health."

Shortly after coming into power the government met with the CBI to discuss privatisation strategy. Leaked minutes revealed that Francis Maude told the group that transferring services at least initially to “charities, social enterprises and mutuals” would be more “palatable” and carry less “political risk” than “wholesale outsourcing to the private sector”. However in reality charities cannot compete against the financial muscle of the private sector. Research conducted by campaign organisation the NHS Support Foundation shows that since April 1st this year 100 clinical services worth £1.5 billion have largely gone to commercial companies. Last month the Bain Consultancy revealed how private sector companies are now engaged in an ‘arms race’ to win £5bn of National Health Service contracts. Third sector advocates should learn from the experience of Surrey Central Health, where a much lauded transfer of NHS services to a “social enterprise” led within a couple of years to a takeover by Virgin, who were better able to raise bond finance.

Recent failings from private companies such as Serco fiddling data for their out of hours service, or G4S overcharging on their contracts, has done nothing to diminish the speed with which outsourcing is taking place. However, as the list of private outsourcing failures grows, the government will increasingly appreciate being able to emphasise the 3rd sector as a more palatable alternative, even if their involvement is not sustainable. In fact, David Cameron has already turned towards the voluntary sector in his hour of need. When asked by Ed Miliband who supported the government’s legislation he cited Bubb’s ACEVO.

Does Bubb’s vociferous support for privatisation benefit the 1,500 ACEVO membership of charity leaders (the members of whom are currently hidden from public view)? Or does it ultimately benefit the members of the NHS Partners Network, whose membership includes Virgin Care, United Health UK or Care UK?

I thought it misguided for the Daily Mail and Daily Telegraph to dwell on Bubb's Labour roots because in reality he's simply an arch opportunist just as happy cuddling up to the Tories as any other party. Wikipedia has this to say:-

From March 2011 to June 2011 Bubb was seconded to the Department of Health, as part of the team leading Andrew Lansley's National Health Service (NHS) "listening exercise".

Bubb is regarded as close to the UK government led by David Cameron, with his longstanding advocacy of charities replacing public services chiming with their policy of promoting competition and privatisation in areas such as healthcare. He has described criticisms of privatisation as belonging in the "last century". Liberal Democrat MP John Pugh has described Bubb's role in the NHS listening exercise as that of a "Trojan horse" whilst Anthony Barnett, of Open Democracy, has accused him of providing "charitable astroturfing for government policies" 

For those interested, here is Bubb campaigning again on his blog trying to make sure that his members get a big slice of probation work as part of the Rehabilitation Revolution Omnishambles. I wonder which party will end up giving Bubb his hard-won Peerage? 

Finally, thanks to Mike for pointing out that Hugh Muir of the Guardian is following the Bubb saga:-

Brotherly love is sometimes hard to find in the charity world and with the rivalry between the chief executives of the National Council for Voluntary Organisations (NCVO) and the Association of Chief Executives of Voluntary Organisations (ACEVO) one moves into Cain and Abel territory. But it's round two to the NCVO's Sir Stuart Etherington who seems to have got the upper hand over Sir Stephen Bubb of ACEVO. Bubb has been making waves saying charity hot shots should be paid the going rate, meaning £100,000 plus. In front of a Commons committee last year he and Etherington were involved in a public spat, with NCVO taking the prudent line. Now Etherington has set up an inquiry with the Charity Commission to draw up guidelines on senior pay. It seems likely to conclude that big money is unnecessary and Bubb is wrong. Still, things could be worse: ministers could start asking why the voluntary orgs need two membership organisations both led by well-paid knights, especially now that they share the same offices. One prays they won't.

The Scheme of Things

I suspect I've always had a slightly different view of probation and how it fits into the scheme of things. Quite early on I came to view my job as someone paid by the state to try and apply sticking plaster to the consequences of failed social policies of one kind or another. I've always felt this view has more relevance than the one often heard from the political right that people just 'choose' crime. In effect  they say it's just all effectively a 'lifestyle' choice.  Nonsense in my view, and as a consequence I'm always alert to any evidence that might come along that could support my own particular viewpoint. It just so happens that in the last couple of days, just like buses, three have come along.

First off here's news of a Parliamentary Committee confirming just how bad Residential Care can be for young people. All my anecdotal evidence collected over many years confirmed this ages ago, which is why I was so surprised to hear Martin Narey, the former Chief Executive of Barnado's, say a couple of years ago that more kids should be taken into the care of the Local Authority. I suspect all probation officers can recite many instances of where someones life really started getting much worse as a result of being in a Children's Home. For far too long it's been a Cinderella service, typically poorly paid, under-resourced and sadly the preserve of the most in-experienced staff. 

Then there's another report into the failure by the NHS to provide proper treatment for patients with mental health problems. Again, boy don't we know that as probation officers! I wish I had a pound for every Pre-Sentence Report I've written over the years, identifying significant mental health issues that are connected with offending behaviour, require urgent medical attention, but knowing full-well that it will not be forthcoming. Sadly the Medical Profession has never felt itself bound by Court Orders which make treatment conditional. To be honest I've always felt that Forensic Services have been a Cinderella branch of the NHS not fully understood by commissioning managers. Maybe they feel it should be funded by the Justice Ministry as being somehow for the 'undeserving'. I particularly note with disgust that £400 million ear-marked for the 'talking therapies' has been otherwise appropriated in the absence of compulsion. So much for local accountability.

Finally there is the news that nearly 7 million people in this country 'are just one bill away from disaster'. Yet again all probation officers will know just how precarious many of our clients financial situations are. Many exist from week to week by means of complicated informal borrowing arrangements involving friends and family. Having absolutely no access to any savings, as a consequence disaster is a common occurrence. This situation has not been helped since a decision was taken some years back to stop probation officers having access to the wonderfully named 'Befriending Fund.' Typically this money could be dispensed pretty much at will by officers, and up to £10 without management authorisation. These mostly small sums often provided food and shelter in emergencies and I'm sure helped to avert all manner of bigger problems for society. But, as with so much discretion, it was swept away in the name of probation becoming a punishment service and we are where we now are.

I firmly believe that all these recent examples show how offending and the work of the probation service fit into the wider context of society and quite often in my view demonstrate failings in social policy. It is completely unjust to blame us for not bringing down re-offending rates when many of the causes of criminal behaviour are not being addressed and we are not being given access to the tools necessary to do our job.   
            

Diversion From Custody

This report in the Guardian from Tuesday about a mental health diversion from custody scheme in London is extremely heartening. Based at Thames Magistrates Court, a female psychologist is available to interview and assess women coming through the system and in effect offer the court alternatives to prison, including on-going support during community sentences. 


This service is provided by a mental health charity 'Together' and part funded by the London Probation Trust and Primary Care Trusts. Without doubt an absolutely brilliant idea, but it raises a lot of questions. Why is the service not available to men and why isn't such a service available at all Magistrates courts and all Probation Trusts? Everyone seems to agree that the service has enormous beneficial effect - it was highlighted by the Bradley Report and Reforming Women's Justice -  so why isn't such a facility felt to be important enough for core funding?


I have spent years failing to persuade those in authority above us of the value of having access to psychological services for the benefit of our clients and to give expert support and guidance to officers supervising deeply disturbed clients. I well remember raising the issue with a senior NHS person in the lunch queue at a plush conference and was told that 'a Community Psychiatric Nurse was cheaper'. Such ignorance in high places still amazes me. 

Addiction

I can't help noticing that my mention of drugs the other day as having utterly changed the criminal justice landscape over my working life, generated quite a lot of comment. My most popular post ever was about the war on drugs having been lost, so I thought it might be an idea to add a bit more to the discussion. 

When I took up post in my small English town in 1985, heroin had yet to arrive. I found that most of my reports for court concerned offences that in some way were connected to alcohol misuse. Of course this legal, but potentially highly addictive mind and mood-altering substance, is so socially acceptable that its consumption is almost compulsory. This is despite there being loads of evidence to show that it's a dangerous substance, both in health terms and as a major ingredient in the commission of violent acts. If it was invented tomorrow, it would surely be illegal.

But of course despite being potentially dangerous, like many things in life, it's also very enjoyable and that's why I indulge regularly, along with many other people I know. What makes the difference is that despite being an addictive substance, alcohol can be enjoyed without it becoming an addiction. For the fortunate majority, they remain in control, not the other way round. Of course there is scope for any of us to possibly be deluding ourselves, but the key is whether or not a person finds that their life becomes adversely affected by a driving compulsion, the satisfaction of which takes priority over all else. I would normally assess someone as suffering from an addiction when their health is seriously affected and when they are unable to function normally in terms of shelter, nourishment, employment and relationships.  

Trying to supervise clients suffering from alcohol addiction and slowly killing themselves can be a harrowing experience. The same goes for heroin of course or any number of other illegal substances. But addictive behaviour can come in many forms and gambling, driving or sexual activity can all be just as potentially harmful or disabling and bring people into contact with the Probation Service through associated criminal activity. I have remained of the opinion that such behaviour should be viewed as a medical phenomenon and indeed back in the 1980's it used to be. In those days I was able to refer clients relatively easily to a Regional Addiction Unit that was based at an NHS hospital. In my experience it's not so much a case of an addictive substance, but rather a propensity towards an addictive behavioural trait.

In suggesting that society takes a radically different approach towards illegal substances, I'm basically wanting to highlight the utter futility of the present approach. Virtually no aspect of the current regime works, in fact much of it compounds the problem and is hugely expensive along the way. Even though politicians dare not talk much about the issue, tentative prescribing regimes within the NHS are beginning to prove what many of us have suspected for some time, namely that legal access to heroin can enable a person to live a normal life, either on a maintenance dose, or withdraw more easily if they so desire.

We've all known for years that the middle-classes can manage to keep a good job and hide their drug use because they have the means to fund the habit without recourse to acquisitive crime. In the absence of a chaotic lifestyle and criminal activity, there's also evidence to support the thesis that many can maintain a recreational level of consumption, similar to that of responsible alcohol users. 

So, just to be clear, certainly in relation to heroin and similar substances, I'm not advocating decriminalisation, but rather a return to the situation pre Misuse of Drugs Act when heroin could be prescribed and hence controlled by the medical profession. Alone it would not solve the drug problem entirely, but it would be an intelligent move in the right direction and help both those who have a problem addiction and those who might be termed to have a recreational need.
        

Probation and Psychology

I was really irritated by this piece in the Guardian from 22nd September about an initiative between Islington and Camden Mental Health Trust and the London Probation Trust. The project involves high risk personality disordered offenders and in particular their high recall rates to prison. Winifred Bolton, the lead clinical psychologist, helped set the project up. She explained that the idea was for "psychologists to train frontline probation staff to improve their skills and to work more effectively with offenders who have a personality disorder so they can better refer their difficult cases to the mental health services rather than be relieved of them."

She goes on:-

"Probation staff, who don't necessarily speak the language of mental health, have experienced difficulties in making timely referrals to mental health services. NHS and third sector staff often have concerns about risk when they work with offenders," says Bolton. "By bringing together expertise from both sides, we are able to bridge these gaps. It means that the psychologists get to understand the needs of probation staff in managing high-risk offenders in the community. It also gives probation officers a better understanding of personality disorder and ways to address offenders' individual psychological needs."


"A small number of cases do involve some direct working, for example, to provide a specialist psychological assessment."

I simply do not recognise the world being described in this article. In my experience community adult clinical psychology provision is virtually non-existent within the NHS. I sincerely hope the London Probation Trust hasn't paid for this 'initiative' as it should be provided by the NHS anyway. Incredibly an offender is far more likely to be seen by a psychologist when in prison than when out in the community. Over the last few years the Prison Service has funded a massive increase in psychology departments, but even then there can be long delays before many prisoners can be seen. Then there is the small problem of getting a diagnosis, possibly before clients get to prison. In my experience your one and only chance is at PSR stage and then you have to convince the Legal Adviser to authorise the significant expense of a psychology report. Psychiatric reports are often much cheaper. 

If probation officers are not felt able to recognise those people who might be personality disordered, then their training has been sadly lacking. What a probation officer needs are indeed the services of a clinical psychologist for diagnosis, assessment and access to psychotherapy for their client. But apart from possibly Camden, where is that routinely available in the community for probation clients? It is precisely for this reason that I have argued for psychologists to be employed directly by the probation service. As for "A small number of cases do involve some direct working...." What?! There's a significant number - we don't need an initiative, we just need a service from the NHS thank you! 

A Shocking Statistic

It has been estimated that up to 90% of the prison population have a mental health problem. This is an official figure from the Office of National Statistics, but unfortunately no distinction is made between those individuals with a learning disability, as opposed to those with a mental health problem. Or indeed how many that might be personality-disordered or emotionally disturbed. Of course they are all very different conditions, possibly over-lapping, but each requiring specialist diagnosis and appropriate intervention. With something so complex, it's perhaps not surprising that there is often confusion in all parts of the Criminal Justice System. I've known professionals in court admit that they have no idea as to the difference between a psychiatrist and a psychologist and as a consequence request the wrong specialist report. A psychiatric nurse is trained to deal with mental illness, but a clinical psychologist will be more appropriate for someone with a learning disability and a specialist counsellor might well be required for a client suffering emotional distress.

Unfortunately this confusion was compounded by the well-intentioned Bradley Review set up by the last government to look into the whole issue. Even this august body had trouble in agreeing on terminology and failed to decide between 'learning difficulty' or 'learning disability' as a definition. I think it's most unfortunate that the experts seem unable to clarify the matter, as it would be an assistance to the Criminal Justice System in deciding how to deal with such people appropriately. We know that many learning-disabled end up incarcerated, due as much as anything to a basic lack of understanding of the condition and how it differs fundamentally from a mental health issue. I firmly believe that 'learning disability' is the appropriate term as this accurately describes a state from which an individual cannot significantly improve. It is not a 'difficulty' which implies a minor condition that could be overcome. 

As part of the last governments' response to the Bradley Review, Jack Straw set up two experimental Mental Health Courts in Stratford, East London and Brighton and their work is being evaluated. They are modelled on the Drug Review Courts that have been running successfully in many areas, the idea for which having been borrowed from North America. The aim is to ensure that an offenders state of mental health and level of intellectual functioning are accurately assessed, prior possibly to the imposition of a Community Order with appropriate conditions. Progress is reviewed at regular intervals by either a District Judge or Lay Justices. In the case of a mental health issue, a Mental Health Treatment condition might be appropriate. 

Of course this type of condition has been around for a very long time, previously as part of a Probation Order and more recently a Community Order, but in my experience they are about as rare as hens teeth. This is borne out by the statistics. Between July 2008 and June 2009 there were 754 compared to 13,000 Drug Rehabilitation Orders and 5,800 Alcohol Treatment Orders. The discrepancy being basically because probation officers know only too well that it is pointless going down this route as the appropriate medical and social service provision will not be available. It would be especially naive to believe that NHS managers, GP's, consultants, psychiatrists or psychologists are the slightest bit impressed by Court Orders and that they might feel obliged to do their bit in ensuring their success. I think some believe treatment associated with any form of requirement goes against their professional ethics. 

Apart from mental health issues, I'm not at all sure how those with learning disabilities are intended to be dealt with by these experimental courts. Such people don't require 'treatment' but they almost certainly do require sheltered housing; ongoing community support; probably a social worker and ideally special help with employment. As someone who has tried to supervise such cases, I'm very interested to know how a court disposal will ensure these services are provided by Local Authorities and the NHS, because in my experience they are not available. As an example, I've been told in one particular area, there simply is no Adult Clinical Psychology provision at all. How can that be in what is supposed to be a national service? In my view, this particular field of professional expertise is so necessary for some probation clients that I have long-argued we should employ our own. 

 It has always amazed me how a learning-disabled person can pass through State Education, come into contact with various parts of the NHS and reach the age of 18 with no definitive diagnosis or assessment of IQ or mental capacity. It often takes a court appearance and possibly a remand in custody and a PSR request before a probation officer suggests it might be a good idea to get some answers to some very basic questions such as 'does this person have the capacity to understand what is going on?' or 'why don't we know the level of intellectual functioning of this person?' These experimental Mental Health Courts might well be a way forward, but the questions are firstly, will there be any money to fund them with court closures looming and secondly, will the specialist service provision they will undoubtedly identify as being necessary actually be available? I doubt it.