On Homecare Day 2018, I was asked to write about commissioning.
How peculiar I thought, given that the ethos of the day is about celebration yet, commissioning of homecare is continually raised in quite the opposite context.
For many years it seems that there has been little change in the way that homecare is commissioned. At its very worst, it could be described as some updating of statistics based upon a limited dataset pulled together to inform a competitive tender perhaps with the involvement of those who access care and support in the final selection of providers.
Providers, who find themselves torn between continuing to provide a service at a rate which is significantly lower than they require (9 out of 10 home care providers say they do not know if their business will be sustainable beyond the year end), or to leave the market carrying with them the knowledge and emotion of; disrupting the care and support of some of our most vulnerable citizens and, the impact on their workforce.
Of course, this does not apply everywhere, but it is certainly leaning towards the norm rather than the exception.
Indeed, in some areas, the commissioning part has been by-passed completely in the hope of a new national solution, going straight to an extension of existing contracts which may on the face of it seem like a positive outcome in terms of continuity, does not take into account the increased challenges that providers face with a rising cost of living, increased qualification requirements, significant staff vacancies and turnover rate of around a quarter.
I also find that I am writing this in the same week as the strikes in Glasgow highlight the risk of having a majority provider, in addition to the limits placed on a right to choice as intentioned by the Self Directed Support Act.
So what needs to change? How can commission in a way that is worth celebrating?
Remember first of all that commissioning is a whole cycle and not simply procurement.
We need to know who is likely to access home care now and in the future, and what homecare actually means to them. If we are planning for the future now, perhaps you may also wish to ask yourself what it means to you?
Partly this means better data, and better use of data, but it also highlights a need for systems and processes to facilitate future thinking, just as Scottish Care is currently undertaking with the Glasgow School of Art Innovation School on the future of care.
This work is enabling us to couch future thinking in the context of economical, technological and sociological changes amongst others, to develop tangible recommendations for the sector.
Above all, commission in partnership, with planners, providers and people. There needs to be cradle to grave thinking and a person-led approach which supports grassroots involvement in development. There needs to be the establishment and support of a collaborative rather than competitive market, where outcomes focussed and relationship based care takes the place of the inflexible and inhumane time and task model.
And please, don’t unintentionally patronise those involved by shielding them from the economics and the cost. We all know about rising demand in a tightened economy, but knowing exactly what that means locally lends quite a different understanding, which can led to quite different solutions. I have previously spoken at length on how by involving those who access care and support in commissioning amidst the context of careful market stimulation with providers, resource was freed up which led to the local authority that I was a commissioner in at the time lowering the eligibility criteria, thus increasing the numbers of people accessing care and support by 110% at no additional cost.
Incidentally, last week I heard of a pilot on outcomes based commissioning in Wales that led to a reduction in cost because people were able to access what they needed when they needed it, and often this meant better use of and access to existing facilities in the community. It was described to me in terms of an all inclusive holiday. The first two or three days are often about over-indulging on heaped plate loads accompanied by rivers of the local tipple, but by the end of the week we’re reaching for the salad and water.
We find a pattern of knowing what we need and when.
Which brings me to the most important aspects of commissioning – trust. On all levels, if we can trust, then we can foster the transparency and respect required to think innovatively about what the future of care means for the future of commissioning care.
Despite the gloomy start to this blog, I will finish with something worth celebrating. A focus on and a nod to the areas in Scotland where this conversation is beginning to happen and I hope to be able to share some of this in the next few months. As we progress we need to work together to evidence and measure the impact that such changes to commissioning can have, both locally and nationally. We need to share both learning and success when a test of change becomes the norm, let’s make my blog on commissioning for Homecare Day 2019 a celebration from start to finish.
Karen Hedge
National Director, Scottish Care
