Special report on measuring commissioning practice

The Commission for Social Care Inspection wants to measure local authorities’ commissioning practice under its performance assessments.

CSCI chief inspector David Behan told the recent Association of Directors of Social Work spring seminar such a change is necessary to delivery the health and social care white paper’s policy goals.

The news that how councils undertake service commissioning will be assessed is a step change in the CSCI’s approach to performance monitoring. It follows the organisation’s pilot Capturing Information at the Local Level in six local authorities whereby the quality of their commissioning was reviewed. The pilot may be rolled out to all councils from this July.

Criticisms of existing arrangements include that they unduly focus on the quality of providers and planning rather than commissioning, choice and control. This is why Des Kelly, National Care Forum executive director, supports the CSCI’s move and says his agency and other bodies have lobbied for over some time. He argues the current arrangements for contracting and commissioning have been “used as if they were interchangeable” but stresses the commissioning of services is much broader. Kelly explains: “Local authorities work to tight budgets and contracting is about getting the best rates and it’s not always the highest quality of service.”

Another voice backing the CSCI’s proposal is that of the English Community Care Association. Martin Green, ECCA’s chief executive, says there has long been a need to “further the relationship between quality services and funding.”

So what is the consequence of this change? For Andrew Cozens, the Improvement and Development Agency’s strategic adviser for children, adult and health services, it is simple: “A more risk-based approach to services, so hopefully a lighter touch for good performers.”

He adds one of the main impacts will be to steer the sector’s discussion to what councils are trying to achieve strategically and if this is reflected in better outcomes and more relevant services for clients.

Kelly believes the step will result in a wider debate about the dilemma between the push to drive down the price of services and the quality of the services being delivered. “It is about recognising that best value is more than just the price, there is a cost attached to quality,” he says.

The benefit of local authorities being judged on how they commission services is, according to Cozens, the provision of better services. He adds that it could also result in more clients exercising their choice and becoming self-funders and funding their own care.

In order to provide better services Green adds the sector needs more widespread, well-trained commissioners who are flexible and innovative in their approach. “It is essential that local authorities commission for outcomes and do not get stuck in the complex labyrinth of bureaucracy that tends to stifle effective commissioning.”

Despite this potentially positive step of assessing local authorities’ commissioning practice, there are problems with it. One is that some local authorities and some providers will fail to meet basic standards set out by the CSCI. Cozens says this means they will still be offering poor services and thereby failing “to think or act strategically”. He adds it could lead to more of inspectors’ time being taken up on judgements.