How far is the drive towards personalised care being reflected in the commissioning of social care services, asks Anabel Unity Sale
Government initiatives to help councils may have moved commissioning to the centre stage but do the reforms reflect the drive to personalised care?
Last month’s Commission for Social Care Inspection report(1) said “current ways of commissioning services will need to change” if the personalised care and support the government envisaged in the joint Health and Social Care white paper and in Every Child Matters “is to be made a reality”.
In the report’s foreword, chair Denise Platt and chief inspector Paul Snell, wrote: “Commissioning for both children and adults must ensure that those with the most challenging behaviour and the most complex needs receive the right mix of general and specialist services to respond to their needs.”
They go on to explain that while some councils show a good understanding of the need for a strategic approach to commissioning services, too many commission “the same traditional profile of services”. The report’s chapter on commissioning concludes that although it continues to improve, “given the raft of guidance, improvement programmes and attention focused on commissioning over a number of years, it is disappointing that the change is not more dramatic”.
Tim Hind, an adviser to the Local Government Association and an independent consultant, says that this is not the case for all councils. “The report’s comments are fairly well-balanced in that it identifies things have been improving but we also have some way to go.”
He believes that this view of commissioning practice is, in part, a result of factors outside local authorities’ control. Hind argues that some of the government’s guidance has been helpful in getting councils to shift their focus, but others have not. “The current focus on self-directed care, such as direct payments and individualised budgets, means reshaping the services that are already in place.”
A similar view is held by John Coughlan (pictured left), Association of Directors of Social Services president and director of children’s services at Hampshire Council. He says that there has been so much rapid change in children’s services that local authorities are having to ensure they keep up with the pace of change as well as translating it into their commissioning practices.
One area the report criticises is what councils do for those members of their local community who are not yet using or who do not qualify for statutory services.
Anne Williams is very aware of this. The vice president of the Association of Directors of Social Services and Salford Council’s strategic director of community, health and social care says councils are “still on a journey” when it comes to commissioning, and some are at very different stages. She says they must ensure their commissioning plans look at “how we develop services we want but we don’t yet have”.
Hind also backs the report’s call for councils to take into account the users they do not currently serve, saying commissioners need to start commissioning for their entire community: “The challenge is how to ensure that very vulnerable people are looked after at the same time as developing resources for the whole community.”
The report says that the difficulties with commissioning are, in part, caused by “the challenge of dealing with severe cost pressures in the whole care system”. So does this mean that increasing the amount allocated to social care in the upcoming comprehensive spending review is the solution?
While the obvious answer may appear to be a resounding yes, Coughlan argues that what needs to happen first is a frank discussion about how local authorities spend their budgets in these difficult times. “We need a more transparent debate about what we can commission and what we can not. If we have a finite resource and want to change how a service is commissioned we can’t just look at that service in isolation but have to look at others services too.”
He adds that local authorities need to be more upfront with the communities they serve about the fact that they cannot realistically afford to provide every single service a community wants.
Williams also feels that a national debate on the funding of social care is needed, emphasising that there are “severe risks” for the sector, its development and meeting users’ expectations of it if this does not happen.
In order for local authorities to improve their commissioning practices there are a number of steps they can take. Williams says they need to increase user involvement to a new level and she supports initiatives such as the task forces and partnerships boards that many councils have already established. “Involving people in commissioning is absolutely right and we should listen to what people tell us they want all the time.”
For Coughlan it is essential that local authorities’ commissioning strategies contain a common definition of what commissioning actually is, which all involved parties are clear about and understand. He says: “There is a health version of commissioning and local authorities often have their own one.”
Hind is keen to see commissioners trained and supported to a level that reflects the diversity of their roles and so they feel more confident about their tasks. He would like to see commissioners have their skills broadened out to attract different people to the jobs, as well as production of good publicity to inform practitioners and users alike about what services are available locally.
Better commissioning practices will result in providing users with good quality services – which is what all social care practitioners want.
General Social Care Council chief executive Lynne Berry believes it is in the sector’s best interests to improve how it commissions. She says that abiding by the GSCC’s code of practice for employers will help commissioners increase the quality of services. “If organisations meet the national minimum standards for training, induction and qualifications, it will put them in a good place to meet the likely forthcoming registration requirements.”
If the sector wants to develop its commissioning practice so the next CSCI state of social care report praises it across the board then commissioners are going to have to raise their game. Involving all services users in consultations about services, challenging themselves to improve how they commission services and engaging service providers and developing good practice are all steps in the right direction.
(1) The State of Social Care in England 2005-6, Commission for Social Care Inspection, 2007
State of social care report
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Anabel Unity Sale
This article appeared in the 1 February issue of the magazine, under the headline “Mix and match”
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