The document (which follows) has been produced to support the West Midlands Market Shaping Project.
Contact: Paul Johnston, telephone: 07847 318 672, email: paul.johnston@impactchange.co.uk
A new paradigm for commissioners?
This paper looks at the policy direction emerging from central government’s vision for adult social care and the response of sector leaders (in the form of the new partnership agreement). Finally, it anticipates the likely legislative changes affecting commissioners of health & social care solutions to provide a summary of the challenges – and opportunities – facing commissioners. The paper concludes that the region’s Market Shaping programme provides an opportunity for commissioners in the West Midlands to embrace the new paradigm and to deliver lasting value for people who use care services.
Capable Communities, Active Citizens
A new vision for adult social care.
The new vision is built around the government’s core values of Freedom, Fairness and Responsibility. It sets out seven principles on which the new social care paradigm is intended to be built and provides a number of clear pointers for councils and commissioning teams.
On prevention & early intervention:
“Councils can play a vital role in leading change and stimulating action within their communities. Their broader role in promoting health and well-being will be enhanced by the new public health functions outlined in the White Paper Liberating the NHS, and by joint working with GP consortia on planning and commissioning services.”
“At its broadest level, prevention depends on promoting health and well-being at a grassroots level. The Coalition is committed to giving local authorities the power and influence they need to lead change within their communities. Following the NHS White Paper Liberating the NHS, local government will take on new health improvement responsibilities. Councils will also take the lead role in drawing up joint strategic needs assessments (JSNAs), which will shape the commissioning of health, social care and health improvement services. These developments offer councils a huge opportunity to shape local services to promote health and well-being and prevent dependency.”
“Councils should exploit the many opportunities to improve preventative services by:
- developing community capacity and promoting active citizenship, working with community organisations and others across all council services, establishing the conditions in which the Big Society can flourish; and
- commissioning a full range of appropriate preventative and early intervention services such as re-ablement and telecare, working in partnership with the NHS, housing authorities and others.”
“Our vision starts with securing the best outcomes for people. People, not service providers or systems, should hold the choice and control about their care. Personal budgets and direct payments are a powerful way to give people control. Care is a uniquely personal service. It supports people at their most vulnerable, and often covers the most intimate and private aspects of their lives. With choice and control, people’s dignity and freedom is protected and their quality of life is enhanced. Our vision is to make sure everyone can get the personalised support they deserve.”
“To have real autonomy and choice people need information and advice. Lack of good, accessible information to help support their choices is a real concern for people. Councils’ role here is to ensure that everyone – whether using a personal budget or their own funds – can get the information and advice they need.”
“Councils should focus on improving the range, quality and accessibility of information, advice and advocacy available for all in their communities – regardless of how their care is paid for – to support their social care choices.”
On plurality & partnerships:
“There should be a fair playing field for providers, particularly for small providers who often struggle to engage with formal tendering processes but can offer very individualised solutions. Commissioners of services should work with suppliers in the independent and voluntary sectors to better understand market capacity and capability, and decide how innovation and best value can be incentivised effectively.”
“JSNAs will form the foundation of priority setting, encouraging greater involvement of local voluntary and community organisations. JSNAs will help local people to hold providers and commissioners to account, agree local priorities and inform a range of commissioning strategies and plans. This will be underpinned through new statutory duties for local councils and GP consortia to work together to promote the health and well-being of their local population.”
“Joint commissioning, pooled budgets and place-based budgets allow the focus to shift away from funding streams and onto people’s needs.”
“Simplifying the commissioning and contracting landscape by merging or sharing back office functions across councils and NHS commissioners can develop a more accessible, less costly process for suppliers.”
“Local councils should:
- exploit the opportunities of the NHS White Paper to play a lead role in their communities, ensuring local services are more coherent, responsive and integrated. Together with the NHS and other partners, councils should agree a shared view of local priorities and the outcomes to be achieved, and deliver commissioning strategies to meet the needs of their local populations – including the most vulnerable;
- work with the NHS and other partners to pool and align funding streams at the local level and alert the government if there are any barriers to this local flexibility;
- work with private providers, charities, voluntary organisations, mutuals, social enterprises and user-led organisations, and move away from traditional block contracts; and
- critically examine their arrangements for contracting service providers to ensure that the rules are fair, proportionate and enable micro and small social enterprises, user-led organisations and voluntary organisations to compete to deliver personalised services.”
“Providers and commissioners of services are responsible for their quality and safety. They should ensure their staff provide safe, high quality care. This includes rigorous pre-employment checks and monitoring of their work. Equally, all staff need to see safeguarding and providing a high quality service as central to their role.”
On productivity, quality & innovation:
“There may be exceptional reasons for the council to retain services, but separating responsibility for commissioning and providing services should become the norm. It is crucial for providing choice for service users and carers, and increasing competition amongst providers. Evidence from a wide range of public services shows that choice and competition can be a powerful tool to drive up quality and reduce and control costs. Local councils with substantial in-house provision should look to the market, including social enterprises, mutual and voluntary organisations, to replace them as a local service provider. Benchmarking both quality and unit costs provides a useful reference point for councils as they grow a broader market of local care providers.”
“The current annual assessment of councils as commissioners of adult social care will be ended and replaced by a new sector ledapproach. Where concerns are raised about services, CQC will continue to be able to inspect councils. We envisage a robust system of triggers that can lead to inspection. For example, local HealthWatch organisations will be able to report concerns to HealthWatch England. It could request CQC to undertake inspections where it has grounds for concern about the quality or safety of social care or health services.”
On people:
“Local councils will play an important role, working with local employers in the independent sector and other partners, including healthcare workforce planners, to commission the workforce of the future and lead local changes for existing staff. Continuing training and skills development is a vital investment in the future. The Department will work with BIS and others to increase uptake of professional standards.”
“Local councils should take a leadership role in workforce commissioning in their area, including integrated local area workforce strategies linked to JSNAs. Central government will support and coordinate developments only where and when the sector demands this, with a particular focus on the smaller employers who predominate in this sector.”
Think Local, Act Personal
The New Partnership Agreement
Where the vision describes the desired ‘future state’ for adult social care, the new partnership agreement is intended to guide short-term focus and action aimed at making the vision a reality. It champions a new relationship between public, independent and community sectors, adding colour and texture to the “big society” rhetoric. At its heart is a “Framework for Action” that balances universal approaches with targeted support:
The agreement also makes clear the priorities for local action:
“Experience has shown that most progress in implementing personalisation is made where:
- Local leadership focuses on cultural change, just as much as systems change, encouraging concentration on outcomes determined by people and communities and engaging solutions beyond the narrow definitions of social care.
- People have real control over the resources used to secure care and support, with commissioning strongly guided by their decisions.
“In bringing together health, well-being and social care, councils and their partners will need to integrate health and social care commissioning around agreed outcomes to support independence and enable the joining of social and health personal budgets wherever possible.”
“Councils and their partners need to understand their local context regarding care and support needs, and the relative supply position, if they are to develop a diverse range of high quality provision that people want. ‘Market Position Statements’ (of the kind recommended by the National Market Development Forum) and market development strategies can be produced to assist this. Commissioning and supply partners should collaborate across public sector boundaries to achieve better efficiency and support innovation.”
“Co-production is integral to commissioning activity at all stages in the cycle, rather than an add-on or one-off process. This will mean the range of support commissioned meets both identified need and people’s aspirations for the future within available resources.”
“Personalisation implies less council purchasing overall and less block contracting. Some existing contracted services may become unviable and will need to be downsized or discontinued, in partnership with people affected and the relevant providers. Arrangements that enable the individual (or their representative) to agree directly with the provider the what, how, who and when of any support provided, are a good way to do this.”
“Local councils will...wish to consider...The potential for self-directed support to deliver efficiencies in the business process of councils. For example, by focusing social work time on key functions and thus freeing up care management resource; and by enabling councils to better understand costs at an individual level.”
“The care and support sector employs 1.7million people and will grow to meet the future needs of an ageing society. It is a key part of the national economy. Social care is primarily about ‘person-to-person’ support, requiring the right people in the right numbers in the right places. Planning and development must therefore be adequately focussed on the needs of this sector to ensure its sufficiency during the coming period, with the right dialogue between employers and commissioners.”
Modernising Commissioning
A Green Paper published in December 2010 poses questions around four issues:
- In which public service areas could Government create new opportunities for civil society organisations to deliver?
- How could Government make existing public service markets more accessible to civil society organisations?
- How could commissioners use assessment of full social, environmental and economic value to inform their commissioning decisions?
- How could civil society organisations support greater citizen and community involvement in all stages of commissioning?
Conclusion
It is clear that commissioning is central to the delivery of the new vision and its associated partnership agreement, and inevitable that the White Paper will seek to shake up the role and processes of commissioning. The region’s Market Shaping programme provides an opportunity for commissioners in the West Midlands to embrace the new paradigm and to deliver lasting value for people who use care services.
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