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From the ‘Modernising commissioning’ Green Paper:

    The cycle of assessing the needs of people in an area, designing and then achieving appropriate outcomes. The service may be delivered by the public, private or civil society sectors.

‘Commissioning for better outcomes’ defines commissioning as:

    A dynamic process to design, specify and procure services to deliver personalised outcomes that build on personal, social and community assets, and enhance capability, independence and promote equality, co-produced with social care users and their carers in a strategic partnership with health and housing organisations and in collaboration with providers.

The NHS define commissioning as:

The process of assessing needs, planning and prioritising, purchasing and monitoring health services, to get the best health outcomes.

The Local Government Association describes commissioning as:

Involving four key activities (understanding, optimising, targeting, choosing) that begin with a review of needs through choosing a delivery model that combines to achieve efficiency and maximise value.

Clearly, we are not short of definitions of what commissioning should be and evidently there has been much debate about the role of commissioning. So, therefore why are the bulk of local authorities making such a poor job of their role in commissioning? And, as far as social care is concerned, the NHS aren’t very good either.

In the eyes of many commissioning teams, their role is simply to extract the lowest price from social care providers with little thought of the real cost of poor quality care, the numbers of unnecessary hospital admissions, the delayed transfers of care, the effect on staff motivation in social care with high staff turnover, poor client survey results and grim CQC inspection reports.

Why do so many domiciliary care providers accept ridiculous fees from local authorities, they cannot add value to their organisation at those levels, they will simply fail as businesses, letting down clients and probably owing money to lenders, HMRC and staff.

With local authorities demanding the use of the Unison Ethical Care Charter and the Living Wage Foundation pay rates, both great initiatives in themselves, how do they expect the provider to survive and thrive on a fee rate of £13.00 per hour? Do local authority or NHS staff work for peanuts on zero hour contracts? No. So why do they expect their suppliers to do this? It would be a help if some local authorities actually paid their bills on time. The statement made by a commissioner, ‘well it doesn’t matter if you’re paid in 14, or 90 days, you know you’ll get paid’, is a clear statement that commissioning does not have the slightest clue, or interest in how an organisation functions.

The UKHCA and the IPC are but two to derive cost models for this area of commissioning all dismissed by local authorities as too expensive and unrealistic. Who knows more of domiciliary and home care support organisations, the UKHCA, or a local authority?  My money is on the UKHCA. Funny that the two models above show a realistic cost pretty close to each other (approx. £18.00 / hr).

We’ve local authorities insisting upon the use of the Living Wage Foundation pay rates, documenting this in their contracts, then awarding their work to providers not paying it and they don’t bother to audit. They simply take the lowest price offer.  Quality, what quality? They also say that they want to contract with providers with a good, or higher CQC rating, yet then award the bulk of their contract work to those on RI. Because they’re cheap. Local authorities also write into contracts the use of specific reporting software, why? If they want this, why are they not funding it, the providers don’t want it, they can get better for less. If the local authority gets the accurate data in the correct format what is their issue?

As Brexit pushes staff retention further over the edge, what will it take for some form of sanity to prevail? Do local authorities want to see clients left without care, or returned to hospitals? The NHS have a hand in this as they see social care as a resource for recruitment with superior remuneration.

A decent hourly rate, sensible tender terms, along with integration with health and proper audit trails would make domiciliary care, a better place to be.  Staff development, staff retention, quality of care and overall quality and satisfaction would improve. Hospital admissions would be lowered as would DToCs. Tender submissions often involve many thousands of words, the expending of hours of time, on a slow, badly structured portal designed for large organisations, for what?  The only line that counts in the hourly rate.

If commissioning is to improve and it must, then CQC must take responsibility for the inspection of Adult Social Care service provision from local authorities. Ofsted inspect their children’s services, for adults’ services? Nothing.

In short, it seems that Local authorities do not commission services, they buy them!

The Rogue Adviser


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