The Social Care Institute for Excellence looks at how the service-user led approach to purchasing is changing the role of commissioners
Changes to the world of social care have transformed the role and workings of commissioners.
Personalisation places the individual at the heart of the provision of services. It recognises that people who use social care services have individual needs. They should have choices about the ways they are supported to live their lives and control over the way this is organised. It is broader in scope than just giving people personal budgets; it stretches into the community.
Commissioners need to consider market-shaping so that people have a variety of options to choose from. They should commission services informed by knowledge of the local population and existing (often third sector) care and support services and ensure that everyone, regardless of where their funding is from, has access to the right advice, information and advocacy to make informed and positive decisions about what support they need. As such, transformation of adult social care is required so that all processes, systems, staff and services put people first.
Two main tasks
Through the use of personal budgets and people’s own private funds, some purchasing decisions will transfer from councils into the hands of individuals and consortia of people who use social care and support services. Commissioners need to develop new methods of working in partnership with providers to ensure personal budget holders and self-funders receive the widest range of choices and access to the most suitable forms of support. This includes new and innovative methods tailored to individuals’ purchasing decisions.
The two main tasks for commissioners delivering personalisation are:
● Ensuring the right balance of investment between different services.
● Shaping the market to ensure that high-quality, flexible and responsive services are available for personal budget holders and self-funders.
These tasks must involve a co-productive approach to engaging people in their design, delivery and execution, and be underpinned by a joint strategic needs assessment (JSNA).
Commissioners must ensure there is a good balance between specific interventions such as early intervention and re-ablement; universal services such as information, advice and advocacy; and self-directed support, which includes personal budgets and direct payments.
To achieve the right balance there may be need for de-investment and decommissioning, for example moving funds from residential care towards community-based support. It remains imperative that commissioners secure value and financial sustainability which may involve exploring innovative approaches and working more closely with service providers. The key to this is focusing on outcomes and commissioning services that people really want.
● Universal services, for example transport, which benefit the whole community.
● Joint commissioning across health and social care.
● Commissioning health and well-being services, both of which individuals are unlikely to purchase themselves.
● Widely used services, commissioned to flexible specifications.
● Specialist and crisis intervention services.
Shaping the market
Commissioners need to collaborate with partners and providers to positively influence the health and well-being of communities. Jointly, they should ensure increased access to an improved range of services and supports for personal budget holders and self-funders.
They need to focus on:
● Supporting people to make good budget decisions.
● Helping people to jointly commission support through consortium arrangements.
● Making information available about the needs and purchasing habits of buyers of support, so that providers can adapt and reflect their needs.
● A constructive partnership with providers so that they can be assisted to move to new ways of working.
● Working with providers to stimulate the creation of the new services people want.
● Encouraging third sector innovation.
● Recognising and supporting the enhanced role that people and families can play in the commissioning of services.
● Building social capital: that is, the informal networks that people create within their communities.
Contracting and procurement
Where commissioners continue to play a direct role in specifying and procuring services, there should be a shift from task- and time-based contracting towards outcomes-focused and person-centred approaches.
There remains a need to strike a balance between cost, quality, innovation and value. Some newer forms of procurement, such as reverse e-auctions, could result in cost taking priority. This would work to the detriment of people using the service.
Contractual models that support the move to personalisation include:
● Framework contracts and approved provider lists. This applies when people who select the council to manage their personal budget can draw upon a range of “approved” services. People need information, support and advice to purchase services from outside these contracts if they wish. They need to be supported to understand the potential implications of doing this.
● Person-centred contracting. Anonymised information from support plans is used in mini-tenders. People and families are provided with the tools to evaluate the bids.
● Individual service funds. The personal budget is held by the provider and the person using the services determines the timing and the tasks to be carried out.
● Personalisation is a person-focused approach that places the individual at the centre of decision making about the provision of services.
● For commissioners personalisation means ensuring the right balance of investment between different services and shaping the market to ensure the provision of high-quality, flexible and responsive services for all people, including personal budget holders and self-funders.
● People should have access to information and advice to make good decisions about their care and support.
● Commissioners need to develop new skills for collaborative ways of working that supports people to actively engage in the design, delivery and evaluation of services.
● Local partnerships should be created with health and social care to provide a range of services for people to choose from and opportunities for social inclusion.
● Prevention and well-being services, which promote the public good but which would not be purchased by individuals, should also be commissioned.
● Commissioners should ensure that all citizens have access to universal community services and resources.
➔ Scie At a Glance 06: personalisation briefing – implications for commissioners
Author Department of Health
Title Commissioning for personalisation: a framework for local authority commissioners
Reference Department of Health, 2008, 37p
Abstract This a report to help councils re-conceptualise commissioning in a self-directed support system.
Author TYSON Andrew
Title Commissioners and providers together: the citizen at the centre
Publisher Care Services Improvement Partnership, 2007, 27p, bibliog
Abstract The vision which underpins self-directed support will only become a reality if commissioners and providers find new ways to work together,in order to support people in their desire to become active citizens. To do this it is suggested that we need to think anew about how we conceptualise the groups of people who use social care, now and in the future. Commissioners then need to change their response: they need to shift resources into meaningful community development (or preventive strategies); they need to develop mechanisms to empower citizen-commissioners; they need to understand and help to shape the local market for support; they need to identify and deploy bridging funds; and they need to act as community leaders to help to create the underlying conditions for success.
Author COOPER Owen et al
Title What are we learning about developing individual service funds?
Reference Community Connecting, Issue 14, May/June 2008, pp12-16
Abstract An individual service fund (ISF) is used when someone wants to spend their individual budget on support from a provider. Providers can develop ISFs by responding to individual commissions from care managers, individuals or their families, or through the commissioning process. The second way is to proactively transform the block contract monies that they receive and commit to using that money in an individualised way. Ideally this would be done in conjunction with the commissioner. This article describes the approaches that IAS (a provider of services for people with learning disabilities in Greater Manchester) has used in order to develop more individualised services. Their development of ISFs is a natural extension of the work that IAS has been doing to provide individualised services. The article includes a number of short case studies and also highlights the importance of creating and reviewing support plans.
Author ROWLETT Nick
Title Letting go of the power: why social care authorities need to start from scratch to deliver choice and control
Reference Journal of Care Services Management, 3(4), July-September 2009, pp334-356
Abstract This paper proposes that local authorities must completely transform the way in which they approach the provision of social care services in order to achieve genuine self-directed care for all people who require those services. It demonstrates that the current centralised approach to providing services is designed to place control in the hands of the local authority, both at the assessment and care management stage and through the application of strategic commissioning. The article asserts that this model will never be able to achieve true self-directed care. It argues that, although significant progress has been made in assessment and care management, equally radical change is required in relation to commissioning practice if the above aims are to be achieved. The paper proposes a new model, the service gateway. This that takes both operational and strategic decision-making out of the hands of the local authority and puts power in the hands of individuals. This changes the role of the local authority from that of controller to one of facilitator, supporter and safeguarder.
This article is published in the 10 September 2009 edition of Community Care under the headline “Commissioning for personalisation”