Professional Services
 

What is the Role of Social Care Commissioning? (Commissioning Leadership)

Commissioning is everywhere in the public sector. From the new Clinical Commissioning Groups in the NHS, the white paper proposal that local authorities become commissioning organisations and Justice Commissioning. In social care in the area of youth services, OFSTED has said, “ In the less effective practice, the process of commissioning was poorly understood; confusion between procurement and commissioning impaired planning.”

IoCP’s experience suggests that commissioning is poorly understood within local authorities. Apart from a few areas, it is not being seen as a tool for leaders to use to reshape provision. It is often seen as a support service which follows process. Clearly, OFSTED would like to see a change.
Further evidence of poor commissioning practice comes from a recent Nuffield Trust Report which concludes that ‘In other words, a new generation of commissioners should seek to craft an environment in which providers are both encouraged to put new processes in place to deliver high-quality care for a particular population and are put at risk for failing to do so. There is also a need for more robust and sustained studies of integrated care initiatives, to develop measures of success that can be used in tendering, contracting and monitoring new services in the future.’

At the Institute for Commissioning Professionals, our goal is to improve commissioning standards, an objective shared by Dame Barbara Hakin, National Managing Director of Commissioning Development. If asked, what is commissioning? It is simply, ‘What to acquire?’. How it is acquired is open to a wide range of routes including, in the NHS, right to provide and in local government, soon the right to challenge and form a community based mutual.

The UK Government is making moves to simplify the onerous EU procurement directives and is entering into negotiations with the EU:

  • to free up frameworks which lock out suppliers;
  • eliminate processes which discriminate against SMEs; and
  • award contracts to new community based mutuals for 3 years before undergoing a test of competition.

If commissioning is to be objective, it needs to be further professionalised and develop improved leadership. Currently in Social Care, it is a function for which the Director as budget holder is responsible. In the NHS, NICE is working hard providing evidence based research to determine for care pathways, what should be commissioned. We see no evidence that SCIE is performing a structured and parallel task on Social Care.

Without a professional focus on what should be commissioned and a drive to improve the understanding and the practice of commissioning, then the current reforms will become discredited. More importantly, the Castlebeck situation where actual harm was caused has not been perceived as a failure of commissioning, it has been seen as a failure of regulation. Our view is that it was primarily a failure of commissioning as ‘he who pays the piper calls the tune’. No one from the commissioning authorities seemed to be listening to the very expensive tune or designing a more appropriate service package.

The major challenge in social care is how to meet the needs of a growing aged population with limited resources. So where is the leadership in social care commissioning that will challenge existing practice and learn from other sectors which have integrated the client and delivery side of the business with substantial  savings? In social care terms, this already happens in aids and adaptations where the Red Cross can assess and deliver. What it would mean is to put the purchaser provider split under the DASS and integrate assessment and care management, contracting and the provider arm, probably with a social landlord. How much bureaucracy and cost would be eliminated in that move?

The evidence from other sectors is savings of 10-15% of costs. We ask where are the social care commissioners who are willing to initiate an employee led mutual to deliver this vision?

So leaders have a choice, to use commissioning as a tool to deliver more appropriate services and use it to rise to the economic and support challenge or keep it as a low level support service with a focus on procurement. I know which I’d prefer and so I think does OFSTED.

Doug Forbes
Director
Institute of Commissioning Professionals
Tel: 0208 8191563
Email: Doug.Forbes@baronyconsulting.com
www.commissioning.org.uk

Notes: The Institute of Commissioning Professionals is a member owned not for profit dedicated to improving commissioning standards.

For the individual, we provide coaching and mentoring towards passing our entrance exam which is based upon meeting the National Occupational Standards for Commissioning set by Government Skills. This is designed to produce more rounded commissioners suitable for the new landscape.

For the group, we are discussing the introduction of voluntary professional registration with CHRE who currently regulate Clinicians and will have their role extended to cover Social Workers.

Organisationally, the publication ‘Achieving Commissioning Excellence’ uses EFQM® to consider the key enablers and processes which must be developed to embed “Commissioning Excellence”. This is available from www.commissioning.org.uk

 

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