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, Think Local Act Personal 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.
