Month: December 2013

Challenging times

Time for another update, but sadly not a positive one.

On the good side, I got new accountants who sorted out the mess and applied for my tax rebate (though it is still to materialise), and moved to a new online system for keeping my financial records which is great. My AP got onto training and left in September. The diabetes project was Highly Commended in the FSJ Efficiency awards. We had lots of positive interest in what we were doing and put in 3 substantial bids. I’ve been invited to speak at a range of exiting national conferences, and I’ve been involved with quite a lot of national committees. The book has sold about 1000 copies and has received some lovely reviews.

The bad news is that none of the bids were successful, and none of the interest has translated into a contract for our services (yet). Legal aid fees for court work have come down another 20% and the maximum hours per case are also being squeezed. A high proportion of invoices are being queried, which generates extra work, and quite a few are not being paid at all (due to solicitors going out of business, or problems between them and the LAA, or disputes about who is responsible for the fee) as well as loads taking 12-36 months to pay. Although we have a few therapy cases, half of them are at our subsidised rate that barely covers costs. The diabetes project may be commissioned by the CCG or hospital trust at some point in the future, but there are no guarantees, and any contract definitely won’t be in place before the new financial year. Our finances were already tight, and I don’t really believe there will be a contract until it is signed off, and I can’t afford to keep the team employed until it comes through.

The CCG say that our service is too small to separate from the diabetes contract. The NHS trust made positive noises in public, but in private it was a different story. An NHS finance director told me that the trust would not consider subcontracting our service because it reduces crisis presentations that are income generating for them. That’s horrific to my thinking – that they have perverse incentives to want people to end up in diabetic comas, or with blindness, amputations or suicidality if it makes them money as an organisation. So I have to count on the service closing.

The reduction in work would mean that staffing costs will exceed our income quite substantially from January (about £5k/month) so it looks like the business has to shrink from me plus 4.5 whole time equivalent to me plus 1.6 whole time equivalent as quickly as possible, with the potential of me returning to work as a sole trader or taking up employment elsewhere in 3-4 months time if we don’t secure more work.

This is obviously gutting, and makes me feel horrendously guilty and stressed. I’ve been so upset about it that I’ve pretty much wanted to hide under my duvet and cry, rather than try to continue working. Its just horrible to feel I’ve let people down (even though I know logically that it isn’t my fault, and that I’ve always been clear with people that it is a small business and doesn’t have the safety net of the NHS, and that many of the staff were on fixed term contracts related to specific projects anyway). Of course, being self-employed I can’t just sign off sick with stress, and have to see through the court work I’m doing, but I can’t wait for some time off at xmas…

Basically, I’m having a bit of a ‘why am I doing this?’ moment, and I don’t really feel like I know what my goals are any more.

Revisiting why

I want to be a bit more candid than I was in my last blog entry. I’ve had some challenges recently in trying to run my business. So I have tried to weigh up my current path compared to the NHS. Things I loved about my NHS job were:

  • my team, as they were lovely people I could depend on to deliver the service and share a moment of (sometimes dark) humour with
  • designing, delivering and evaluating my group
  • doing complex assessments
  • doing consultation to the adoption/permanence service
  • doing consultation to the children’s homes
  • training others

You’ll note I’ve never really loved doing therapy. I’ve enjoyed it from time to time, but I much prefer shorter punchier things like assessment and consultation. Its an awful thing to say perhaps, but I don’t have the persistence for therapy, particularly with milder cases or as people get better, and I get bored unless it is a highly complex case and the first time I’ve worked with a particular issue/model. Neither do I really love supervision. Its alright, and I enjoy it if the person is bringing a lot to it, but I don’t universally look forward to it.


Things I hated about my job were:

  • pressure on throughput rather than providing a quality service
  • not being able to action anything new or innovative or to resolve problems due to the bureaucracy/lack of autonomy
  • them making promises and not delivering
  • horrible physical environment and cuts to everything that supported the clinical work (eg admin time, rooms, materials)

I can give or take being in management meetings and doing budget stuff and care pathways, it doesn’t excite me but neither is it something I dread or find soul destroying.

So I started doing more court work. Things I love about it:

  • being able to do a really in depth assessment, read the background, meet the people, write big reports, spend 50 hours on one case
  • the diversity and intensity of the cases
  • the importance of the role and weight given to your opinion
  • the chess game of the court room, and the need to be able to present your position clearly and with evidence
  • the better money

Things I hate about it:

  • heavy heavy cases full of grim content (incest, sexually abuse, non accidental injuries, violence, rape, sadistic emotional and physical abuse, chronic neglect – some of it with photos, or where I have to look at internet content that is grim)
  • increasing pressure to do it in less time, for less money and the looming prospect of a further 20% cut in fees bringing it down to below the pay rates of insurance funded therapy
  • reduced demand, so I can’t pick and choose and the cases are all at the heavy end of the spectrum
  • boom and bust demand, so I end up working 70 hour weeks to get things done on time
  • how slowly they pay (6m-24m being a typical range)
  • having to invoice and chase payments with the LAA increasingly arguing over every aspect of every bill
  • cases where there is no good solution and you have to leave kids with very disagreeable people (eg acrimonious contact disputes between unpleasant people who are still fighting with the children as pawns despite having nominally separated, or cases where the court decide the kids can stay with the parents or be placed with other relatives against your advice)

Then I’ve picked up some projects which involve researching efficacy and impact of an intervention, which I love (despite the hassle of writing bids and reports) perhaps because I do the thinking and other people do the leg work.

But to do all this stuff I’ve become a company and have premises and employ people. This is good because:

  • I like having people around so I don’t get isolated
  • I can delegate leg work to others
  • We are able to take on larger projects than I could do alone
  • I can potentially profit from work others are delivering meaning I don’t have to work as intensely myself to sustain a decent long-term income (though I feel bad writing that)

But it is frustrating because:

  • I’m paying out £150k per year on other people and premises before I earn anything
  • everyone around me is by far my junior and reliant on me for supervision and their income, so I don’t feel like I’ve got peer support or day to day challenge and conversation that I learn from (I’ve got a great peer supervisor, but we only speak once a month)
  • I’m the person whose name goes on the tin, so I want everything we do to be brilliant (this is turning me into a total control freak as everyone I employ has to to live up to my standards)
  • people have different aims and goals for what they want to get out of working for me, and it is hard to be supportive of everyone whilst also allowing myself to have a work life balance and benefit from doing this
  • it means keeping time and learning new skills to bid for projects, manage staff, balance the books and run a business

I’ve also got other responsibilities on me that I’ve chosen to take on beyond my day job; as part of the CYPF committee, editor of CFCP Review (annual journal of CYPF), committee member for the FJC/BPS group setting standards for expert witnesses, potentially writing more books, running this place. And of course outside of all that I’m a wife, a mother, a person who wants to have time to exercise, be creative, travel, read, socialise and enjoy time with my family.

I’d also had a strange point about a year ago where I realised I was older than any of my imaginings as a kid, and had no ambitions left that I hadn’t attained. Its like I had a list of things (get a job, get a consultant grade post, run a department, get married, have kids, get a nice home, etc) that are all ticked off and there isn’t anything left ahead of me to work towards.

I think the recent triggers to my angst are:
1) The first person I took on as a qualified CP to support my court work was a nice person and a good therapist but didn’t work out well. She didn’t pass her doctorate or get her HCPC during the 15 months she worked for me and thus couldn’t take any of the burden of court work off me. The parting of ways was messy and uncomfortable.
2) The AP I’d worked most closely with got onto training. He’d been brilliant at being cheerfully supportive, and I feel less prepared for each assessment without him around, and am unlikely to be able to replace him.
3) The court work has reduced in quantity and the hassle involved has increased, and I’ve been thinking a lot about what I want to bid for to keep our activities varied and ensure we have enough income to sustain the team I employ into 2014.
4) We’ve had trouble with our accountant and had to change to a new firm and now need to enter all the data into a new system (which will be great when it is done but has taken most of my best admin’s time).
5) My admin person went off long term sick for so long I had to employ someone else to replace her, and I need to tell her that I can’t have her back (which feels horrible, even though her health is not good enough to return for the foreseeable future anyway).
6) I always imagined I’d be the primary carer. But since I’ve been running the business my other half has been the one getting the kids ready for school, and collecting them at the end of the day. I always do the bedtime routine and spend time with them at weekends, but I’m not sure I’ve got my work-life balance right.

I’ve also had some health things. Nothing major, but enough to set me thinking because there really isn’t scope in the current set up for me to have any time off sick (or even for a holiday). Anyway, the net result is that today I just wanted a duvet day (give or take an appointment with the dentist which I messed up, and one with the doctor which is yet to happen) and although nothing on NHS jobs looks tempting because of the lack of autonomy and low pay, I am wondering what I really want to do from here on in.

I guess my choice is to fix it or do something different. I need to be clear which.