The development and sustainability of a diverse supply of small scale providers of social care – a local micro market – has been an ambition of many local authorities as part of their quest to offer choice and more personalised care.
As you might expect, some councils have been more successful than others. Generally, the task has proved challenging and slow to mainstream, ending up being stored away in the “Too Difficult” box. I wonder, is it now time to re-open and re-package the box as “Difficult – but Worth It”?
My recent discussions with councils suggest a trend towards this. One of the key drivers is seemingly the fact that a raft of strategies across different departments – and not just social care – is also reliant on micro markets. A new perspective is urgently needed on how to address the wider determinants of health and wellbeing, sharing a common purpose to enhance the resilience of local communities.
A London Borough has described to me how they want to turn the spotlight back on developing small, local providers to help achieve their overarching ambition to put prevention at the heart of all their strategies. The innovation and flexibility they seek resides in their small, local providers who are attuned to the needs of communities and able to identify and engage with the strengths and assets already present. This brings local economic benefit through employment and training opportunities, particularly if coupled with the supply needs of NHS partners too.
Might this wider lens on micro-markets offer new scope and scale of opportunity to develop a healthy and sustainable supply of local providers?
As we know, alongside opportunity often sits challenge. Take definition, for example; often a first hurdle for anything! What exactly is a “micro-provider”? Is it defined by the size of staffing? Or revenue? Does it only include the third sector? What about social enterprises? Small businesses? And what about the individual sole trader who has something different and valuable to offer their community?
How’s this for an example? A young opera singer has been so successful helping her grandmother with breathing exercises to relieve her respiratory condition that she wants to offer this to other elderly people. There’s even the added benefit of a live sound track not normally heard in outpatient clinics! Can she be part of a local micro-market?
Although providers in a micro market may share a common set of values, they are likely to represent different legal entities and business models. This will impact the initial engagement, support and ongoing relationship with the commissioners and gatekeepers of this local market. In fact – how can the component parts of the commissioning cycle translate across to the development and management of this market? How is the principle of proportionality best framed for small providers? How does seed and grant investment sit alongside contractual relationships? How is safety and quality managed across this market?
These are difficult questions certainly, but strike me as a good place to start in order to frame the solution. They represent a set of activities familiar to all commissioners and where experience and learning can be shared to get the contents of the ‘Too Difficult’ box out on the table.
I hope you’ve enjoyed my first Adass blog. This time I’ve posed a lot of questions, and in my next blog I’m going to talk through some potential answers! What might, for example, “procurement” mean, and look like, for small providers who sit outside existing current norms but appear to have so much to offer the future of public service provision?
Thanks for reading!
Anne Jarrett is Strategic Director, Health and Social Care Integration, at Local Partnerships, a not-for-profit organisation jointly owned by the LGA, HM Treasury and Welsh Government.