Editorial Comment: Take the strategic view

The messages from the white paper Our Health, Our Care, Our Say are clear: more resources must be shifted into prevention, more care provided in people’s own homes, more joined up services established, and more innovation achieved to ensure that services fit the user instead of the user always having to fit the services that happen to be available. If these intentions become reality – and it’s a big “if ” – every page of the rule book will have to be rewritten and the authors of this revolutionary document will be that most unassuming of breeds, service commissioners.

For at the heart of all these changes, if the government has its way, will be service commissioners in health and social care.  t wants to say goodbye to the self-effacing purchasers of care who watch from the sidelines and welcome instead the commissioners who plunge into the game and make a decisive difference. The radical reconfiguration of services that the Department of Health has in mind was on display in this week’s Commission for Social Care Inspection report on home care. Many councils, it said, had set out to transform home care and this required a “commitment to cultural change”.

As an engine of cultural change strategic commissioning has already shown itself capable of high performance. But it will have  to move up a gear if the inadequacies of home care are to be overcome – inflexible services, short visits and chronic  recruitment problems among them. These weaknesses, says CSCI, are “a consequence of some short-sighted and ineffective approaches adopted to strategic planning and commissioning”.

Another problem it identifies is lack of training for home care staff, a failure which Skills for Care chief executive Andrea  Rowe broadened to include workforce development as a whole when she claimed this week that commissioners should make better use of government grants. These are relatively small challenges, but the big prize will be moving 5 per cent of hospital funding into the community by 2014. Without effective strategic commissioning in primary health and social care, the prize is likely to remain elusive.

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