How not to commission adult social care in 2021

When the Head of TLAP asked for a blog on “how not to commission adult social care” I thought I would go one step further and suggest why we shouldn’t be talking about commissioning adult social care at all, because for me, the process of commissioning is a part of the problem it’s trying to solve. In fact, I would argue that commissioning will never make us happy. 

So, with apologies to all the fantastic people working in social care commissioning, the experts by experience, those in associated service areas, or indeed those who provide commissioned services, let me explain. 

Thanks to the efforts of National Co-production Advisory Group - Co-production ... (opens new window), Think Local Act Personal (opens new window) and the many other people who have been involved, it’s now more common to talk in terms of “getting a life rather than getting a service”. Genuine, values-based co-production can start with this as a premise, but commissioning can’t. 

More often than not the definition of the problem or the parameters of an issue are set long before the involvement of people who access services and their families. Commissioning takes place within fixed budgetary and procurement cycles. It’s led by employees of a local authority whose job description and contract means they have to work within the formal constitution of that organisation, which controls the decision making and delegations.  They have to work within the Financial Standing Orders, Contract Standing Orders, as well as all the legislation that governs the functioning of a public body. 

There is also the small matter of the last 10 years of real terms budget reductions in social care and local authority funding. So, it’s not unusual for a commissioning project to start with a budget reduction target and a group of contracted services in scope whose legal agreement end dates set a time limit on the project. 

Through the process of briefing the Cabinet or Lead Member the project definition will have been honed down or altered and any savings targets affirmed. If you’re lucky enough to have a consistent senior sponsor who can make the case for the staff resources to manage the project, lucky enough to have a functioning and well-supported group of experts by experience, then maybe, perhaps maybe you’ll have a chance to pull off a piece of work where people feel at least involved and listened to. There may even be good services as a result. 

But my friends, even if this can be described as good commissioning, it is a long way from the sort of co-produced solutions that are needed. 

Only when these are the norm, when the scope and scale of problems and issues are defined by the people affected by them, when commissioning teams are seen as administrative support enabling the right stakeholders to be engaged from across the statutory, voluntary and community and private organisations, and the correct legal and decision-making paths are followed, only then will people have lives, rather than services. 

So, as a new year begins, I suggest commissioners focus on their commissioning-shaped problems and issues while the experts by experience, their families and supporters, and those working in voluntary and private organisations who share the same values, define for themselves what “good” looks like.  When that’s agreed, the people working in commissioning can be invited to be involved, just don’t expect them to make people happy, it’s not part of their job description.


Posted on by Janet Welch

I couldn’t agree more with Paul’s. comments. We are looking at issues through the wrong end of the telescope. As a parent carer whose responsibilities are lifelong I would love to see a seismic shift in shaping NHS and Care solutions. My biggest concern is that we need a bold cultural shift umbrella under which small incremental manageable changes can be brought about but the people who need to make these changes do not have an appropriate skill set. Some of the changes that need to happen and arguably are already within the remit of current legislation, regulation and policy are floundering because management and those on the ground are lacking in the key necessary skills to understand legislation, regulation and policy leading to serious breaches of duty.
I look forward to seeing Paul’s blog develop.

Posted on by Nick Fripp

Hi Paul, what a refreshing highlight in the start to a strange new year. You are so right that standing financial instructions are not a great basis for thinking local and acting personal especially when they are attempting the alchemy required to balance increasing demand with reducing budgets. Thank you!

Posted on by Angie Carter

Couldn’t agree more with both Paul and Janet Welch.
Sadly so many inside the system don’t even recognise the damage that not having a life has, on those it affects - which surely now as a society seems unforgivable given that we have the insights of those with the lived experience, through the voice of Personalisation. So much is now available to raise people’s and even written into the legislation.
However other change is also needed. The professional processes of assessment, planning and review are unhelpful, repetitive and organisationally led and the need for them has to be rethought. How can people be in control when they are led by processes, with so many tick boxes to fill?
We need a systematic cultural change - where those with helpful skills and knowledge become resources to those wanting to live a life, available when they need them. Work needs to collaborative, to explore solutions and how to make things possible - working within the legislation of the Mental Capacity act, supporting the person with their choice of how to manage risk. All with people in the driving seat of their own lives. Safeguarding in place where needed but still respecting how the person wants to live their life.
This way - individual, family, supporter and community assets become the focus of the solutions and things that do require commissioning can then come from a meaningful place. The fact that life flexes and changes and that people develop and grow when given the opportunity, should all be facets woven into the experience and become the cultural norm.
Angie Carter Accredited Independent Support Broker (also an OT)

Posted on by Paul Rackham

Thanks Janet, Nick and Angie.

Observations and suggestions are always helpful, especially when they are from a variety of perspectives.

I think there is a consensus that change is needed, some agreement on what a new system would look like, but very little agreement on how to make the change from one to another.

Personalisation offers a paradigm shift but I'm not sure it will solve the structural issues holding back local authority and NHS commissioning.

How do we move from MEAT to MEAP. From a duty to choose the most economically advantageous tender, to a choice to choose the most ethically aligned partner?

A future blog perhaps........

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