Thursday, 15 September 2011

Commissioning in Practice – can social care commissioners step up a gear to meet the challenge?

Guest Blog from Doug Forbes, Director, Institute of Commissioning Professionals www.commissioning.org.uk

Commissioning is everywhere in the public sector. New Clinical Commissioning Groups in the NHS, the white paper proposal that a local authority becomes a commissioning organisation and Justice Commissioning. In children’s services, the area of youth services, the inspectorate OFSTED has said, “In the less effective practice, the process of commissioning was poorly understood; confusion between procurement and commissioning impaired planning.” (August, 2011.) The Institute for Commissioning Professionals’ experience suggests that commissioning is poorly understood within local authorities. Apart from in 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 and no doubt, the Winterbourne View and Southern Cross issues in health and social care will herald a clamour for change.

At the IoCP, our goal is to improve commissioning standards, an objective shared by Dame Barbara Hakin, National Managing Director of Commissioning Development at the Department for Health. 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, the 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 small to medium-size businesses; 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 leadership. Currently in Social Care, it is a function for which the Director of Social Services as budget holder is responsible. In the NHS, the National Institute for Health and Clinical Excellence (NICE) is working hard providing evidence based research to determine in care pathways, what should be commissioned. We see no evidence that Social Care Institute for Excellence (SCIE) is performing a 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 in the Winterbourne View situation, where actual harm was caused, it 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 ‘who pays the piper calls the tune’. No one from the commissioning bodies seemed to be listening to the very expensive tune.

The major challenge in social care and health 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 at substantial savings? In social care terms, this already happens in aids and adaptations where the Red Cross, for example, can assess and deliver. What it would mean is to put the purchaser provider split under the Director of Adult Social Services 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? 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 sector-led support challenge or keep it as a low level support service with a focus on procurement. I know which I’d prefer and I think the inspectorates and tax-payers will think the same.

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