Care service procurement alliances between neighbouring boroughs undoubtedly please local authority finance chiefs, but are they such a good deal for providers and clients, asks Mark Hunter
Collaborative commissioning is nothing new. Councils have long been joining forces to bulk-buy specialist services, including adoption placements, services for people with autism and residential care for people with learning disabilities. But as the strings on the public purse pull ever tighter, collaborative commissioning has been taken to a new level.
The West London Alliance, which comprises Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon and Hounslow councils, has agreed a joint procurement and commissioning plan for £220m worth of adult care services each year.
Between them, the councils commission 70,000 hours of personal home care services a week across a sub-region that includes Heathrow Airport and Wembley Stadium.
Over the next four years they expect to spend between £500m and £1bn on residential care for older people and people with specialist needs.
All this has now been divided into “lots” and providers have been invited to bid for contracts covering the next four years.
The WLA estimates the plan will result in savings of 5%, or £11m, a year.
“We are improving the strategy of provision so that we achieve as much value as we can,” says WLA director Ian Nichol. “We are probably the largest collective [of local authorities] but it’s likely that we will see a lot more collaboration and sharing between authorities in the future.”
So is the WLA initiative a portent of the future? Commissioning specialists are waiting to find out.
“A lot of people will be watching with great interest,” says Janet Crampton, national commissioning lead for the Department of Health’s older people’s programme. “West London is not particularly representative of the rest of the country so it’s possible that their experience may not be relevant elsewhere. Nevertheless, I don’t doubt that we will see a lot more collaborative commissioning of specialist services, simply because of the economies of scale.”
Andrew Cozens, the Local Government Association’s group strategic lead for adult social care, agrees there is more scope for collaboration, building on precedents such as regional purchasing of services for looked-after children.
But both Cozens and Crampton acknowledge there is an inherent tension between large collaboratively commissioned contracts and the government’s agenda to personalise care, including through users purchasing care directly.
“Providing for service users with personal budgets is hugely intensive,” says Crampton. “So some providers have taken the decision to stay small so that they can remain responsive to the individual needs of service users. But this can leave them at a disadvantage if their local authority teams up with several others and expects them to bid for huge contracts. They are being pushed and pulled in opposite directions. The danger is that, if only the larger care providers can go for these contracts, you end up with one bureaucracy dealing with another.”
“Collaboration can extend to self-funded services with a strong element of personalisation,” says Cozens. “But you need a strong framework to guard against locking service users into services that they may not want.”
One move that may boost collaboration between councils is the increasing use of commissioning tools. For instance, the Care Funding Calculator, developed by the South East Regional Improvement & Efficiency Partnership (RIEP), is used by a growing number of local authorities to manage the costs of residential care and supported living for adults with learning disabilities.
It provides a model for costing an individual’s care based on his or her needs and has recently been used in a collaboration between six councils in Berkshire (see box).
According to CFC project manager Suzanne Gale, the fact that so many councils now use the same tool makes it easier for them to collaborate. “I am sure more joint working will develop as the tool is used more widely,” she says.
“Also the provider sector is becoming increasingly positive about the CFC as it’s a transparent tool – we see at least 50% of attendees at training coming from the provider sector.”
In theory, providers stand to benefit from collaborative commissioning because they must deal with only one commissioning body rather than several scattered around the various local authorities. In practice, however, many remain to be convinced.
Martin Green, chief executive of the English Community Care Association, says the practice encourages “bullying tactics” by councils eager to weald the might of their purchasing power.
“Collaborative commissioning is fine as long as it doesn’t descend into a cartel,” he says. “Unfortunately, in practice that’s what tends to happen. We have already seen this with the London commissioning hub in which PCTs use their joint purchasing power to intimidate and force down costs. It just becomes a price-fixing exercise.”
Service user organisations have also expressed their concerns about collaboration. Sue Bott, director of the National Centre for Independent Living, says she “struggles to see any advantage in it at all.
“I have to ask where on earth is the service user in all of this. It’s hard enough as an individual to influence commissioning when you are just dealing with one local authority never mind five or six. It strikes me as going completely against the idea of personal budgets.”
‘Councils could become irrelevant’
Indeed Bott believes that if collaboration goes too far it could leave councils increasingly irrelevant to service users’ needs.
“What councils need to understand is that the future of commissioning is us, the service users. We are the commissioners now.”
‘It’s difficult to keep everybody sweet all of the time’
In early 2008, Bracknell Forest, Reading, Slough, West Berkshire, Windsor and Maidenhead and Wokingham councils joined forces to reduce the combined £51m they spent on residential services for adults with learning disabilities.
Negotiating with individual providers, the Berkshire Procurement and Shared Services Unit initially focused on hotel and staffing costs. It then used the Care Funding Calculator to ensure that each provider undertook a detailed care needs assessment of all their clients. By July 2009 this approach had saved nearly £1m a year.
Care quality the key
According to procurement manager Rob Atkins, the key to the project’s success was that it not only produced savings but also improved care quality. “At the core of the project was a very detailed assessment of care needs,” he says. “This provided a greater visibility of the data so that the local authorities could see exactly what care was being delivered. Obviously that makes it easier to ensure that people are getting the kind of care that meets their needs. So it’s not a case of the level of care going down. In many instances it actually went up.”
The project wasn’t all plain sailing, however. Although each of the authorities made savings on their care costs, some achieved significantly more than others (ranging from £30,000 to £400,000 a year). This did cause friction between the partners, says Atkins.
“Everybody always wants to get their slice of the pie,” he says. “I’ve done a number of these collaborative projects over the years and it’s always difficult to keep everybody sweet all of the time. It’s a juggling act. But it’s an ongoing project so it evens out in the end.”
More on the alliance
Published under the heading ‘Social Care by the Job Lot’ in the 5 November 2009 edition of Community Care
Illustration by Colin Elgie at Illustration