Market management. Pump priming. Mapping needs. As in most aspects of management, don’t get put off by the business jargon. Commissioning means working out what you want to buy from whom. While contracting means agreeing with someone to sell it to you.
Commissioning is about demand and supply. To work out the demand side you need to know how many people there are in your area who are likely to be eligible for each service and how much the services will cost. Or in social services speak “identifying need” or “mapping need” or “needs analysis”.
This requires sophistication. We need to record, measure, assess, not just need but unmet need and future demand. But let’s tick the honesty box, data collection is not our strength. And form-filling is a chore. The best people to collect information must be care managers and reviewing teams, but if they don’t know what they are collecting information for it is unlikely to be high on their list of priorities.
Nonetheless, there are lots of readily available data that can help you estimate numbers and cost, but remember this can only be an estimate, a best guess. A number of social services departments experienced financial difficulties in the 1990s when their estimates of the number of older people in residential care who would die in any one year were wrong because improvements in care resulted in many living longer than expected.
Commissioning needs to be project managed with the right skills employed and most of all it needs time.
On the other side of demand is supply. This is made up of the in-house, independent and voluntary sector units that can provide good quality services. Commissioning is not just about finding out such details as what these units do, where they are and how much they cost. It is also about identifying gaps and developing the market to provide alternative services. For example, current supply may not be sufficient to meet the needs of black or Asian children, so work will need to be planned to recruit new foster carers.
There is a view that markets are often too complex to manage. Perhaps they just feel that way. But few relationships in social care are as important as that between commissioner and provider. Simply because the quality of service the client receives is strongly reliant on the strength of that relationship, which should be founded as a partnership of equals.
Successful commissioning and contracting requires the ability to forge and maintain effective ties with your providers. Adopting a heavy-handed attitude or attempting to use your position as customer to pressure providers into doing what you want will create a wide range of problems. There needs to be realism over the service you receive for the price you are prepared to pay. This applies equally to providers. Being realistic about the level of service your budget will buy will enable you to respond when providers are falling short of expectations. Before agreeing to a contract, put yourself in the other’s shoes and see how they feel.
There are a number of approaches to contracting, from arm’s-length agreements to provide services to a detailed specification, to contracts which are based on agreed user outcomes and a trusting relationship between purchaser and provider. The choice of contract model depends on what you want to achieve and what kind of relationship is going to be most successful.
And, of course, the results need to be monitored. In assessing the success of a contract, it is crucial that managers remain clear-headed about what really matters – the outcomes for the people who use the service. In a busy and complex environment it is all too easy to focus entirely on the processes and inputs of service delivery – and to lose sight of the experience of those using the service.
A major factor in determining quality of service is also the length of the contract. Quality providers who have the security of a fixed long-term arrangement have a strong incentive to make the relationship work as effectively as possible and to invest more in the service they deliver.
In conclusion, commissioning and contracting, although here to stay, are useful only in so far as they benefit users and carers. If you cannot show how what you are doing is going to produce better user outcomes, then stop doing it until you can. It is easy to get lost in the business processes and lose sense of the purpose.
John Belcher is chief executive of Anchor Trust; Claire Smart is purchasing manager, Gloucestershire social services; and Martin Willis is programme director, Inlogov, Birmingham University. Additional tips from Des Kelly, Vijay Patel and Kathryn Stone
- Always use the same provider. Stick with what you know.
- Don’t bother reviewing services until the end of the contract term – no point in making work for yourself.
- Don’t worry about asking service users what they think – they won’t have a professional approach.
- good contracting is simply a question of getting the cheapest price.
- Remember it has to work for both purchaser and provider to be successful.
- Give commissioning and contracting time and respect. It cannot be tacked onto the day job.
- Make use of existing guidance. For example, the Audit Commission’s Take Your Choice: A Commissioning Framework for Community Care – Management Handbook.
If you have a management case study or question that you would like our panel (below) to consider ring Graham Hopkins on 020 8652 3106 or e-mail email@example.com
John Belcher, chief executive, Anchor Housing Trust
John Burton, independent consultant
Christine Doorly, regional manager, National Care Standards Commission
Anthony Douglas, director health and social care services, Suffolk
Sheena Doyle, programme manager, Children’s Society
Jane Held, director of social services, London borough of Camden
Tony Hunter, director of social services, housing and public protection, East Riding of Yorkshire
Steve Jenkin, chief executive, Elizabeth FitzRoy Support
Des Kelly, partnership director, BUPA care homes
Andrew McCulloch, chief executive, mental health foundation
Daphne Obang, director of social services and housing, Bracknell Forest
Vijay Patel, consultant to voluntary sector
Mike Pinnock, policy, planning and performance manager, North Lincolnshire
Jill Reynolds, Open University
Claire Smart, purchasing manager, Gloucestershire social services
Kathryn Stone, director, Voice UK
Martin Willis, Programme director, INLOGOV, Birmingham University