Shifting the social care dial: improved commissioning approaches

As flagged in our recent blogpost there are nearly 300,000 people awaiting social care assessments, care and support, or reviews, an increase of 26% over the last three months. Responding to the Chancellor’s Budget and spending review, vice-president of the Association of Directors of Adult Social Services (ADASS), Sarah McClinton said:

“It is deeply disappointing that the Chancellor failed to recognise the crisis in social care that is already upon us and will now only deepen this winter.  We are facing a perfect storm, with care staff quitting, family carers reaching breaking point, care agencies going out of business, and people with support needs waiting longer and receiving less care and support.”

Based on our experience, simply providing (limited) additional funding won’t shift the dial or help better marry demand with supply. So, what could?

As much as 80% of social care is delivered by non-public providers and that care secured through commissioning – or procurement. This presents a massive issue. Building on our earlier blogposts, another key way to shift the dial is therefore improved commissioning approaches – which impacts so much on social care outcomes and costs.

Our experience of working with local authorities and health organisations is that commissioning is too often seen as a variant of procurement – it is too transactional, commissioner-driven and focused on procuring and incentivising inputs and activities, rather than securing outcomes that matter.

The below diagram represents the variance in procurement approaches:

• Horizon 1 reflects traditional procurement approaches
• Horizon 2 builds on this, reflecting improved approaches to both procurement and commissioning – but still adopting traditional approaches
• Horizon 3 represents more impactful commissioning that is focused on securing outcomes that matter, drawing upon more collaborative and joint/multidisciplinary approaches and adopting more of a people and place-based perspective

Drawing upon our earlier blog that explored more collaborative approaches between commissioners and providers, our focus is on supporting organisations to migrate to Horizon 3.

More innovative approaches to commissioning should adopt and secure:

• A greater focus on outcomes that matter to both providers and care recipients
• Co-designed outcomes and interventions that would better support independence and living at home and in communities
• New commissioning approaches including a more hybrid-based approach, rather than extending what is very traditional procurement approaches
• Genuine adoption of people and place-based multidisciplinary team approaches, not universal service delivery
• Collaboration between markets and providers to understand and co-produce solutions that work for both them and commissioners, are innovative and more outcomes focused
• Improved data and insight sharing
• Payment mechanisms, monitoring and incentivisation arrangements that encourage outcomes rather than just more inputs and activity
• Strengths-based outcomes that cost less.

IMPOWER has supported local authorities for years in the social care space. We have a passion for delivering sustainable impact that matters – especially for vulnerable people.

Our EDGEWORK approach, enhanced by technology enabled care (TEC), data science and better commissioning, all embedded within our Valuing Home programme, has enabled us to deliver significant impact in the Home First space. We recognise that change management is not a simple thing – but we are very focused on embracing that complexity to secure better outcomes that cost less.