Bev Maybury gave a presentation on commissioning to a recent seminar jointly organised between ADASS and SCIE. Her first thought when asked was: if only there was magic formula! And the second? She was reminded of sitting in an old school room with an imposing maths teacher telling me that algebra was not complex. I just needed to understand why ‘X’ had a certain value…
FAST FORWARD TO 2015 and the Care Act is telling us that we need to create a vibrant sustainable market without having all the tools or resources to understand the true investment and value of high quality care. The challenges we all face, whether as directors, commissioners or providers are not new, but are an accumulation of under-investment in social care and a devaluing of the profession over many years.
With our increasingly challenged financial positions; a growing older population; increased regulatory activity and many providers having to make tough decisions whether or not to stay in the market, who’s paying the real price of delivering or not delivering a sustainable high quality social care market?
So if there isn’t a magic formula, or like me you never got to grips with the finer workings of algebra what do we need to do? Step One: we need to understand our market. Do we have enough intelligence about the quality of our provider market that is proactive not reactive? Is our market shaped by supply or demand? And have we a ready supply of labour of the right quality and aptitude?
Are we paying a fair cost of care to ensure vibrant high quality provision? And does the way we work support businesses to grow and respond to demand?
Step Two: We need to ask ourselves whether our approach to the market offer greater choice and control. Do you know the choices that people want to make for their care and support? Or are the choices people make real - or constructed or limited by the availability of what the market wants to offer?
Step Three: We need to ask ourselves: are we really commissioning for outcomes, or are we still commissioning what we always have commissioned? Have we equipped our commissioners with new skills and abilities to commission differently? And have we fundamentally changed our approach to commissioning and procurement or is it still a little like the emperor’s new clothes?
Creating a paradigm shift is never easy and when the going gets tough do we retreat to the tried and tested approaches of contract compliance and performance management, rather than building business relationships with the market that are collaborative, share risk and proactively deliver improvements rather than react to failure or poor quality?
The challenge of the storm we are facing isn’t simple or straight forward, but not getting it right has significant cost to the people who most need care and support. So what is my hypothesis?
Not one organisation or profession holds the key, so we need to tackle these issues together. There is growing attention on the fair price of care, but even if our budgets allowed us to address this fundamentally, this in itself would not completely resolve the perfect storm we are currently facing.
Fees and the fair cost of care are only one part of the equation X. Simply paying more doesn’t not necessarily tackle the other key elements. So, using the algebra analogy, what are the other values that we need deliver? What is our Y?
It has to be our approach to the market. We fundamentally need to ensure we have got our approach to the market and market balance right. We need to be able to assure ourselves that we have got the right providers offering the right services to meet the choices that people want to make so that they have real choice and control.
We need to ensure the way we do business and manage our business relationships with the sector adds value and supports a vibrant market rather than stifles innovation and increases the burden of bureaucracy on our provider partners.
Where we have an oversupply of provision we need an honest conversation with the market to help them either diversify or agree the sustainability of the business model.
Meanwhile, our Z has to be our approach to quality. We need to work collaboratively with providers and CQC to strike the right balance between regulations and improvement. A little like the fair cost of care, regulation and inspection doesn’t in itself raise the quality of care. We need to take a proactive approach to improvement and delivering quality, tackling issues of quality failure early.
We need to develop innovative ways to support the provider market to recruit, retain and equip the workforce to deliver high quality person centred care at a local, regional and national level.
In very specialist areas of provision where we know there are national shortages of certain types of workers – nursing for example - we need to think differently with providers about delivering in each capacity with health partners or a more collaborative approach to the use of agency staff that is impacting significantly on providers’ bottom lines.
Our equation has to be X (fair cost of care) + Y (market shaping and balance) + Z (collaborative approach to quality) = a strong sustainable, high quality, vibrant market that delivers choice and control.
Bev Maybury is ADASS Lead on Commissioning, and Director: adults, health and social care for Calderdale Council