Tony Hunter on the future of health and social care commissioning

Tony Hunter (pictured), executive director of community services at Liverpool City Council and co-chair of the ADASS resources committee, gives his view on the future of health and social care commissioning

Consultation on the Department of Health’s Commissioning Framework for Health and Well-being ended last week. The Association of Directors of Adult Social Services, working alongside the Association of Directors of Children’s Services and other bodies, is determined that the people-centred principles set out in the health and social care green paper and subsequent white paper are now translated into reality.

The litmus test will be the experiences of those who use services. Only they will be able to tell us if a real and sustainable shift of power and control to those who use services is happening. Only they can say whether a range of high quality services promoting quality of life really is in place.

Delivery of these laudable policy objectives is everyone’s business. People who use services, carers, representative groups, central and local government bodies, commissioners and providers across all sectors and disciplines must get involved. Local strategic partnerships and local area agreements can give direction and coherence to this range of interests.

Community capacity

What must happen to ensure success? First comes the message. If services are delivered in an “it’s good for you”, top-down manner, then at best the message will be ignored and, at worst, it will reinforce dependence.

Instead, promotion of health and well-being must be presented as a means of enabling people to participate in and contribute to local life, thereby increasing overall community capacity for everyone’s benefit. As one person with profound disability said to me recently: “If the services are not right, I cannot play the active role I want. But if they are right, I am not vulnerable and don’t want to be treated as such.” So the way in which the agenda is rolled out is vital.

Second, letting go is vital. We must turn traditional thinking on its head. In a world of direct payments and individual budgets, it is people who are the commissioners. Councils along with primary care trusts and others are there to support self-care, responding to people’s preferences by helping create flexible markets that enable choice. Investment in workforce development at all levels and across sectors to deliver major change is essential.

Budget pressures

Third, and no surprise, resources need to be in place. Without adequate and focused resources, policies will not be implemented. Despite ever closer joint working, PCTs’ and councils’ budgets are under serious and well-documented pressures, which the ­comprehensive spending review must address. Of course, resources must be used to best effect, and the government’s stated intention of a 5% shift of funding from acute to primary and preventive services must happen in phased and tightly managed ways generating confidence across the system.

Moreover, a national debate is surely needed around the thorny issue of charging for social care but not health services. Having to contribute to the cost of one part of increasingly joined up services and not another makes no sense to the public.

Fourth, outcome based performance assessment systems for health and well-being need to extend way beyond the traditional health and social care interface. The shift to practice based commissioning, and the increased profile for public health locally in shared council and PCT arrangements, are key considerations in developing coherent systems over the coming period.

Consultation with older people in Liverpool (and I’m sure elsewhere) also shows the important contribution that accessible city centre toilets, effective street lighting and well targeted winter gritting make to feelings of safety and ­confidence. Strategic needs assessments should be key sources of information, driving partnership priorities across all the local area agreement blocks, not just the one entitled “health”.

Councils, alongside health colleagues and broader local strategic partnerships, are well up for this agenda. Given the tools and the support, we will deliver.

For more on the framework