The area covered by the 14 West Midlands local authorities ranges from inner city Birmingham and Wolverhampton to the river valleys of rural Herefordshire and Staffordshire’s peak district. Over the border in East Midlands the nine local authorities are equally diverse.
The idea that social services could be commissioned jointly by authorities covering such varying needs at first appears fanciful. Yet the authorities of both East and West Midlands have clearly taken the concept of regional commissioning to heart and begun to introduce several innovative schemes that are encouraging collaborations right across the region.
West Midlands, for instance, has been chosen to set up one of the six pilot regional commissioning units to secure residential placements for children in care and children with special educational needs.
In the East Midlands a regional framework has been set up to support the commissioning of children’s and young people’s services, bringing together health, social services, education and voluntary agencies.
Sense of identity
Smaller joint commissioning programmes are also under way to secure high-cost placements for people with learning disabilities and to provide independent advocates for people with mental health needs.
According to Linda Sanders, director of adult, community and housing services in Dudley, one of the major benefits of this collaboration has been a strengthening of regional identity.
“As a West Midlands region we now have a stronger sense of identity,” she says. “Contributions to national Association of Directors of Adult Social Services’ policy work, sharing, trust and supportive relationships have developed across the region and we have reversed the previous net loss of staff from the West Midlands.”
However, it is also evident that many of the regional commissioning projects are still in their infancy, struggling through a tortuous procession of meetings in which professionals from widely different operating cultures search for common ground.
One man with the unenviable task of oiling the wheels of this process is the Care Services Improvement Partnership regional social care change agent for the West Midlands, Robin Cowen.
He explains that while most of those involved agree on the potential benefits of regional commissioning, actually putting this theory into practice involves a lot of hard work. “Obviously the idea is that if you’ve got several authorities all purchasing small then it would be a logical possibility that by teaming together you could drive up your purchasing power and also the quality of the service. However, getting people to actually do that is very difficult for all sorts of reasons – different standing orders, differing accounting systems and also I think a historical reluctance.”
Cowen also believes that because commissioning services has changed so dramatically in recent years, many of those who have the job of commissioning don’t actually have the skills to do it.
“Nobody ever grows up saying ‘I want to be a commissioner’. So we’ve got a rapidly changing landscape in which a lot of people end up commissioning services without necessarily knowing a lot about it. That’s why one of the things we have been doing is to run a series of workshops on how to develop commissioning skills and the strategic skills that you need. We’ve brought in people who are commissioning across health, children’s and adults’ services because there are a lot of common agendas.”
One of the tangible outcomes of CSIP’s work has been the introduction of a “fair pricing tool” that can be used to commission services for people with learning disabilities. Originally devised by the South West England Regional Centre of Excellence, the tool is claimed to help councils achieve a 5% saving in the cost of their residential placements.
Any cost savings in this area would be welcome indeed. It is estimated that councils and the NHS in England spend around £5bn each year on services for people with learning disabilities. In 2005-6, three-quarters of councils reported facing significant cost pressures in services for adults with learning disabilities, with a combined budget overspend of more than £80m. About 70% of these funds are spent on residential, nursing care or day care services.
Clearly it is hoped that regional commissioning using the fair pricing tool will result in a significant reduction in these costs.
“It’s a procurement tool really,” says Cowen. “A kind of smart spreadsheet that allows you to break down providers’ costs into their various components. It’s useful in high cost learning disability placements.”
Richard Webb, director of adult social care in Telford and Wrekin, also stresses that successful regional commissioning requires the learning of new skills and having the necessary tools in place. He cites West Midlands’ development of a mental health “commissioning tool kit” that allows commissioners to assess their own commissioning capabilities and develop their skills accordingly.
“We have moved to a commissioning-led approach so it’s important that we look at what commissioning actually involves. The commissioning tool kit is an entirely voluntary self-assessment rating kit. What CSIP is then able to do is collate that information and then put in place a commissioning development programme that supports the areas that need it most.”
While Webb acknowledges that regional commissioning in adult social services is taking place on a much smaller scale than in children’s services, he stresses that neighbouring authorities are increasingly collaborating on the procurement of services.
“I’m not sure there’s much that involves all 14 authorities across the region but there are a number of historical allegiances – in the Black Country for instance – and a shared heritage that ensure we do work collectively with neighbouring authorities.”
For instance several authorities have been collaborating to meet their new duties under the Mental Health Act 2007 to provide independent advocacy services for people with mental health needs. In the East Midlands one of the most impressive examples of cross-regional co-operation has been the launch of a regional commissioning framework to improve services for children, young people and their families.
This has involved the collaboration of several agencies, including health, social care, education, and voluntary organisations.
Officially launched in May this year the project was co-ordinated by the regional partnership and funded by the East Midlands Centre of Excellence. It consists of a website (www.regionalcommissioning.com) and handbook offering resources and materials, and a guide specifically designed to “encourage more consistent commissioning practice across the region, establish principles and guidance to underpin the commissioning of services for children and, for particular population groups, promote greater collaboration in procurement between commissioning organisations”.
Development of the framework will be aided further by East Midlands’ involvement in a cross-regional pilot commissioning unit set up to help commission the residential placements of children in care. This is being carried out in collaboration with the Eastern, South East and part of the South West region and is one of six pilot commissioning units being set up around the country.
Originally proposed in the government’s 2006 green paper Care Matters, these pilots aim to “improve commissioning and market management, thereby improving the service offered to children, young people and their families and also leading to efficiency savings for local authorities”.
The West Midlands has also been chosen to set up a pilot and, according to the Department for Children, Schools and Families, will be aiming to develop a “prototype matching engine” that will facilitate the sourcing of care providers. Jointly developed by the West Midlands regional partnership and business consultants Comensura, the aim is to provide real time information about placements, transparent quality assessment and details on contractual compliance.
It will also standardise billing arrangements and provide information to service providers about gaps in the region and the potential for developing their service.
However, like many of these regional commissioning projects, it is clear that the pilot is still very much in the conceptual stage. Project manager Mark Thomas stresses that “We are really only just having the first meetings”.
So, while it is clear that the commissioners of East and West Midlands have made remarkable progress in setting up the machinery for regional commissioning, the actual processes have yet to be tested for any length of time.
10 years in the life of one unitary Midlands council