Bridging the commissioner-provider divide to improve care for people with learning disabilities

A new paper discusses how councils and learning disability providers can work together to contain cost pressures and improve support

Learning disability services are councils’ biggest cost pressure in adult social care. While overall gross expenditure on adult social services fell by 1% (in cash terms) from 2011-12 to 2012-13, spending on learning disabilities grew by 0.5%, according to the Health and Social Care Information Centre.

This is perhaps not surprising given that many more people with learning disabilities are living well into adulthood thanks to medical advances, that people with learning disabilities tend to be poorer than other service users and less able to pay charges for care, and that a learning disability is lifelong.

However, it is also clear that existing patterns of services for people with learning disabilities need to change. For example, councils have struggled to develop an equivalent model to reablement to help people with learning disabilities become more independent and less reliant on services; there is scope for more people to move from residential care into supported living; and the government’s post-Winterbourne View programme illustrates that institutional care remains a reality for too many people.

These changes should result in better outcomes for people and less cost to the state. But they rely on strong collaboration between commissioners and providers in an environment where trust has been strained in recent years, as resources have become stretched.

Last month, both representatives of both sides – the Association of Directors of Adult Social Services’ learning disability policy network and the Care Providers’ Alliance (CPA) – got together to develop some solutions. Helpfully they have now produced a paper on their discussions, with the apposite title, Finding Common Purpose.

The problems

The paper starts by identifying the causes, real and perceived, of distrust in the commissioner-provider relationship:

  • A loss of specialist commissioning and procurement expertise within councils leading to decisions being taken by generalist staff who lack expertise in learning disability care and relationships with providers;
  • Procurement practices that create barriers to entry for providers, for example charges of (in some cases) £15,000 for organisations to get on to framework agreements, in order to gain council business;
  • Commissioners loading disproportionate risks on to providers in their contracts, leading to some providers accepting low-price contracts that are unsustainable in the longer-term;
  • The use of fee negotiators by councils to drive down the cost of high-cost placements, which providers saw as adversarial;
  • Providers not understanding the cost pressures on councils and the need for services to adapt to these;
  • Providers not grasping the role of elected members in council decision-making and how they can be opposed to services changing because of risk aversion.

The solution

It then sets out some possible solutions both to improve trust and understanding between the two sides and drive service improvements:

  • Secondments between commissioners and providers, joint training sessions for staff from both sides and the establishment of communities of practice to discuss issues;
  • Making better use of learning disability partnership boards to facilitate dialogue between commissioners and providers, as well as service users and family carers;
  • Developing local market position statements that describe the role of commissioners and providers explicitly and set out how risks can be fairly shared;
  • Developing a national strategic market position statement to provide local providers and commissioners with a clear direction for services, setting out demographic trends, the likely funding context and good practice examples.

It will be interesting to see how Adass and the CPA take this forward. Do have a read of the paper if you get a moment; there’s also a useful blog post from John Adams – chair of the Voluntary Organisations Disability Group – summarising its findings.

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