In a time of growing demand and diminishing resources, it is time to widen the lens in order to better understand and manage demand.
A recent media story (‘Councils not held to account for commissioning social care, claims MP’) reported the debate in Parliament’s Public Accounts Committee as to whether commissioners of adult social care within councils were held as accountable as their peers in the NHS. Some people take the view that healthcare providers are subjected to much more rigour than providers of social care, which clearly has an impact on expected outcomes.
While the focus of the discussion was on adult social care, local councils’ spend on Looked After Children is also substantial – some £4 billion annually – so we should shine a light on these resources and outcomes too.
Children’s services commissioners are buying ‘placements’ or ‘accommodation’ but these terms do not adequately describe what the investment is really meant to deliver. They are not just buying bed and board; they should be making investments in children’s futures. Current commissioning processes rarely reflect the importance of these outcomes or make it easy to get it right.
As the Parliamentary discussion showed, the role of regulation is a hot topic – as there are valid questions on whether spending decisions are examined with sufficient rigour. My view is that they are not, as iMPOWER’s analysis has shown that there is no correlation between need, spend and outcomes. In addition, the flaws within the market for children’s placements are not limited to regulation and contract management.
Councils should take an entirely new approach – one that widens the lens to consider the whole commissioning cycle, and that starts with a genuine and evidenced understanding of individual children’s needs.
There are two parallel processes at play: one between those holding the purse strings; and another between those determining what the child in question needs. More needs to be done at the interface to make the whole system work in the best interests of the child.
I have seen first-hand that while a local authority’s commissioner and placement officer do talk to a provider’s placement officer, there is often no connection to the design of individual packages of support and the impact on the life of the child or young person in question. That part of the conversation is often entirely separate, and is played out between carers, social workers, and hopefully the child or young person themselves. There needs to be a single conversation for this system to work effectively.
There is a danger that talk of ‘rigour’ and ‘holding to account’ could be misinterpreted. A real issue within the market for children’s placements is that (all too often) there is no constructive engagement between commissioners and providers. Too much of a “them and us” narrative risks reinforcing this. There clearly need to be assurances over quality, and we need to be confident that needs are being met. But we also need a more joined-up and coherent conversation that engages providers, commissioners, social workers and young people – and we need to reframe the problem and actively develop the right solutions.