Lighthouse project goes into administration

[Jim]

Hi I think this is one for the alliance to be aware of.   Its all over the papers in merseyside that the lighthouse project is to shut down tommorrow with apparently no contingency yet agreed.  Given that they provide pretty much all the services in Sefton, St Helens, Knowsley and most of Liverpool then this is a massive concern.   I'm sure that something will be put in place so I don't want to scaremonger. It does also raise the question of contracts being awarded to organisations that might go bust, I know the NHS has often not provided good services but at the same time it doesn't go out of business.   Small (ish) organisations are much more likely to and when we are talking about services like community prescribing this is a very important concern.  Should there be some regulation as to how  'essential' (as defined by our trust) medical services are contracted outside of the NHS?

[mcdermott]

Hi Jim,

We are aware. For the time being, I'm currently seconded from The Alliance to Sefton DAT so I'm privy to the process that's being thrashed out as we speak. The DAT in Sefton have had six weeks worth of scripts printed for all patients, and we'll be publicly announcing contingency plans for all patients first thing in the morning.

No idea how the other DAT's are dealing with it though.

The doctors at Lighthouse have promised to help deal with any issues that arise where they can.

The other issues that you raise are all fascinating, but for the time being, I'm not going to go there. Having said that, I actually don't know any more than has been printed in the Liverpool Echo today:

http://www.liverpoolecho.co.uk/liverpool-news/local-news/2009/09/08/merseyside-drugs-charity-the-lighthouse-project-at-centre-of-financial-irregularity-probe-100252-24630631/

Hardly a small organisation though. Lighthouse have a turnover of around £9m a year, and were employing well over 200 people on Merseyside, and they've been around for almost 40 years now. Ian Wardle at Lifeline has been shouting about the issue of governance in the non-stat sector to anyone who would listen for a good few years now.

It seems he had a point.

[simon]

And for some reason these re-tendering processes are forced upon us, who gains? I'm afraid I don't agree with private organisations being involved in health care. This is public money and our taxes.

[mcdermott]

I don't particularly have a problem with charities being involved in health care. They've actually been doing it for much longer than the NHS has, and some of them do it very well. Nor do I have a problem with the idea that services should be forced to engage in a process of competitive tendering. Done properly, there's every reason to believe that competition can be a vehicle for improving quality and delivering value for money.

Those of us who have been around for a few years still recall the bad old days of NHS services who believed that they had a divine right to deliver drug treatment, regardless of how poor a service they delivered, or how unresponsive they were to patient need. Hopefully, those days have now gone for good.

However, in my view there still needs to be more attention paid to the process of commissioning. To ensure that those organisations that are commissioned operate to proper quality standards, are fit for purpose and have proper systems of governance in place -- both clinical and financial. IMO, this is one of those areas that the NHS, because of its size, generally does rather well, whereas smaller charities often struggle and nobody notices until the brown stuff hits the extractor.

[simon]

It feels to me that there is so much re-commissioning at the moment that i'm worried quality will be on a downward spiral. I keep hearing some horror stories of things going wrong.
I'm not sure every commissioner is able to understand healthcare and wider holistic care and to some degree commissioners don't want this.
I fully agree that more attention needs to be paid to the process and when i've looked at some tender documents i've thought they can't deliver that service - but the bids were cheap and this is where things go wrong. Cheap is not often good.

[Jim]

I think Simon is right about going for the cheap option.   Also the voluntary sector has usually been at and advantage when it comes to tendering as the local NHS trust is often out of favour, other NHS services only bid for contacts in their (or at a push neighbouring) localities so you end up with a field of bidders made up purely from the voluntary sector apart from he out of favour NHS trust.  Also the voluntary sector nearly always finds it easier to be cheaper than the NHS.  Another issue Simon touches on is that contracts are often unrealistic and what is being asked is unrealistic for the price.

[mcdermott]

Yeah, I don't disagree at all with the points about commissioning on price -- though part of the reason that the NHS is so uncompetitive is that you've got a pile of nurses who are insisting that every job has to be done by a qualified community psychiatric nurse -- many of whom actually bring very little to the table in practice.

I also know that many contracts are unrealistic. The Alliance has been bitten by more than it's fair share of those, where commissioners give us some paltry sum and then expect the earth for it. And sometimes, smaller, newer charities may not have the experience or the resources to deliver on the prices they quote.

Ultimately though, you expect commissioners to perform due diligence on the fitness of the organizations that they commission to perform the tasks that they're paid to do. That's what they're getting the big bucks for, surely? One of my concerns here is that people will be less likely to take a chance and commission smaller, newer charities like our own who are more likely to be engaged in innovative, cutting edge work in the future.

We find it hard enough as it is, but an incident like this (and bear in mind that Lighthouse was running five or six tier 3 services, umpteen tier 2 services and a range of other stuff -- it wasn't a small player) is likely to mean that organisations like ours will find it much harder to pick up contracts in the future.

[will-c]

Its a shame to see any organisation fall into administration, especially when employing so many people in this current employment market and supporting so many area's, individuals and communities.
I often think, the re-tendering process falls in its face through the Tupe of bad staff and adoption of negative reputations. at best it will take a new organisation a few years to re-establish its authority and confidence in specific areas they have adopted. In most cases the smaller charities which have become the lead agencies like addaction, turning point or CRi aside from the merged charities like Cranston and Richmond fellowship etc etc all fall short in local knowledge and generally employ staff with next to no experience outside of on sight training. I said it years ago on the smmgp website that GP should be given the support to take on the complete prescribing responsibility for opioid substitute medications, with the GP contract not allowing for an opt in or opt out of treatment much like asthma or diabetes. The negative section of my brain believe most drug services will eventually implode through over stretching their resources and growing beyond their strengths and capabilities. Lets have it said 'its extraordinary how much money goes into the head office costs of these charities, PR and Funding teams.

In many ways, I agree in part with Simon around prescribing and who is now best able to run these services. In saying that, with the NTA and what not; you would think we would not return to the disgusting practices Peter has witnessed and clearly described. I am 41 and have been in and around drug services since I was twenty and I couldn't say I have ever had a good experience. The best I have found has been either private prescribing or a well known doctor in the North of London. 

We have drug courts and what not. I don't see why we can't have drug doctors surgeries for every community...

[will-c]

When looking at treatment trends, Key performance targets and out come funding its interesting to see how new ways of commissioning spread from one government body to the next. First went the bags of cash and in came performance targets; initially pushed through the rough sleepers initiatives purchasing and providing drive. It all became numbers and people didn't like but it worked for the mathematicians. Then came the NTA to govern and direct the drug and alcohol system. hence the push by hungry or greedy organisation to win tenders come what may, dressing their tender proposals up with more makeup than lilly savage. Ultimately when viewing most completions of tenders the predicated target will always dwarf the actual targets. God I wish i could write the way otehr do on this forum as I get frustrated with my trains of thought against my inability to turn it into actual type on screen.

Currently Supporting people (SP) who commission the vast majority of mental health tenders is radically changing its commissioning process and taking the control away from services and placing them with the client (service users; which interestingly there is becoming a back lash against the term SU) The name of this new funding system is Personalisation, its were the client gets to say which organisation it would want SP to pay for the services they need and require. Now most services users in the mental health system don't really care about care plans and what not they just want to know some one is gonna turn up each week to help them pay their bills and what not. Also most services users are oblivious to what service is actually working with them, especially when it comes to charities with abbreviated names. It makes me wonder when personalisation will hit the drug field and who the service users would want the money paid to for the services they receive. I would also assume their would be less blaming of the service users for not attending and greater emphisis placed on the service to go to the client.   

[lynseyrachel]

omg,
       now im panicking.i go to the lighthouse project in st.helens.......fortnightly.Now, the strange thing is( and now i know why, after reading this....), that when i arrived yesterday,at first, walked straight past the small doorway, as they all look the same(the doorways, i mean), cos it didnt say 'the lighthouse project' on the door.
     
       When i realised id missed the doorway and walked up too far, i turned and walked back ( obviously, lol !!  ) When i found the right doorway, there was a little handwrittten notice stuck to the door, saying 'only opening at 11am'......and quite quickly a small croud had gathered, of ppl waiting for thier allocated appointment.

 I thought absoloutly nothing of it, thinking that they were mainly short-staffed, or something like......oh dear. This is the first time ive been on the forum for months......and for ppl who have read my previous posts, will know that when i first came here, i was on a £100 habit, of the brown stuff.(always smoked, never injected) Now a £10 bag can last me 2 days...........in fact, last week, i went 5 days without using AT ALL. Just kept to my sscript.i were fine, just kept myself busy. And it wasnt cos i was skint.....i could've gone and bought some, had i wanted to. This to sum1 else, might seem like nothing, but 5 days to me is a great achivement, Lol!!

            I just hope the lighthouse project stays open. They are a lot of ppls saviour......
                                           FINGERS CROSSED!!!! love from LR xxxxxXXxxxxx

[mcdermott]

St. Helens has already been taken over by a new firm, LynseyRachel. I can't remember whether it's Addaction or Arch -- pretty sure it's Arch in St. Helens, actually -- but all existing staff have been TUPE'd over, so you'll probably keep the same keyworker and nothing much will change other than the name over the door.

Will-C: personalisation should be hitting the drugs field real soon now. Some of the systems change pilots have a personalisation component to them -- though it's hard for me to see how that's going to work unless there's more genuine choice in the system. After all, if all you have to choose between is a single tier 3 service, what's the point of a personalised budget?

On the other hand, if I can spend it at my local RIOTT clinic... :-)