Social care commissioning reform: why the time is now for a new national framework

Following a tremendously difficult year for health and social care, we have a real opportunity to reflect on lessons from the pandemic that can help us create meaningful change. If we want to allow our colleagues to continue to deliver exceptional care, we must ensure the systems in which they operate are fit for purpose. There is an urgent need for us to replace the current social care commissioning system with a new framework that allows us to consistently offer the highest quality possible care across the UK, placing all regions on an equal footing. The Government’s proposed Health and Care Bill offers a real opportunity to improve integration in the sector, However, as is stands, the current system is resulting in a postcode lottery, leaving room for mistakes and a disjointed approach that can subsequently fail those needing care most.

Under a new commissioning framework of national minimum standards that allows for regional variation we can follow a targeted approach to care that addresses local pressures while meeting robust national standards. As outlined in the Feeley Review of Adult Social Care in Scotland, by establishing a national standard and national accountability, Government can work with Local Authorities to address systemic problems while developing the provision of services available in the region. More frequent consultation with social care providers will be an essential part of improved social care commissioning, as there is a wealth of expertise at the grassroots level that is currently untapped.

Commissioning reform must also place greater emphasis on service user choice. I know of a national provider that recently lost a major contract where user satisfaction was 97 percent. The deciding factor came down to a 10p an hour price difference. I appreciate the desperate need to save money where possible that many Local Authorities are facing, and could understand the logic for a £1 an hour price difference, but is a 10p an hour saving really best value in light of an extremely high user satisfaction rating? This is also potentially going to be more expensive in the long run for the Authority in question, as services with a lower CQC score are likely to require more monitoring. How is this a good example of outcomes focused commissioning?

The bleak reality is that a fifth of all social care providers’ services in the UK are rated as ‘Requires improvement’ or ‘Inadequate’. It is time to look at the concept of best value beyond price, with the potential of linking the awarding of contracts to quality indicators like CQC ratings and customer feedback. Rather than being anti-small provider, this approach would be anti-poor provider, allowing us to level up social care with priority placed on good quality. These are solutions that we must start discussing and debating on a regional basis. Ultimately, the guiding principle behind social care commissioning must be passion for quality rather than price. Social care contracts should not be awarded on lowest cost, but on the provider’s ability to sustainably provide excellent care.

While most social care Commissioners are qualified and do an excellent job under extremely difficult financial budgetary pressures, over the past two decades I have seen instances first-hand of some Commissioners coming from other Local Authority departments such as Leisure or Environmental Services with little or no relevant experience to underpin their decision making. When it comes to social care commissioning, a one size fits all approach simply will not work and an adequately funded, uniform approach to commissioning must be put in place to avoid a dangerous race to the bottom. We don’t need to go far to find examples of best practice – there are already brilliant cases of various agencies working in partnership across the whole of the UK, and I’ve been particularly impressed with the Scottish model of homecare and their willingness to work with providers in delivering high quality care.

A social care commissioning framework of national minimum standards that is led by experts who live and breathe social care will be transformative to our society. We need to start asking big questions of what we want health and social care to look like for our loved ones now and in the future. Speaking from a personal perspective, the pandemic has led to a greater desire from the Government to engage with leaders in the sector, but we need actions not just rhetoric, the proposed Health and Care Bill is a good start and hopefully we will see further significant changes in the long-awaited Social Care White Paper. The time is now for a multi-agency, multi-faceted national approach to commissioning where quality comes first.

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