Latest Scottish Care blog: National Director, Karen Hedge
Putting human rights into the commissioning cycle
This has been a period of uncertainty and deadlines. It seems every other headline covers Brexit, but for the care sector there is a real and significant effect of negotiation at various levels.
When 19 care homes closed last year, and 9 out of 10 of our care at home providers told us that they may not survive until the end of the financial year, it confirmed that we are in worrying times indeed.
The Freedom of Information request by Robert Kilgour on the cost of statutory care home provision highlighted that the cost for the Local Authority to run a care home is double that of what they pay the independent sector. We know that for care at home providers the proportionality is similar. But it is not simply about cost.
The care sector is exactly that, a sector which cares. Choice and control is critical to the Self Directed Support Act and the independent care sector is sufficiently diverse to meet that; made up of charitable, voluntary and private providers; and they range from small, single, family-owned businesses through to large corporates. It is a vibrant sector, grounded in Human Rights and the National Health and Social Care Standards which enable person-led care and support in a flexible way. We know this from our conferences and awards ceremonies; held to facilitate innovation at the forefront of the sector, and to celebrate the dedicated but often overlooked staff with whom it is an honour to work.
I am fortunate to have had a varied career in health and social care and have experienced the sector from many different perspectives. The intent of the system is to have the person at the centre, yet, there are glaring gaps and confusion.
All too often commissioning (the delicate balance of facilitation and planning to ensure the right services are provided at the right time) is confused with procurement (the purchasing of services). With only one major purchaser – integrated authorities, the concept of competition in the sector is a false one, and the push to drive down costs has led to a focus on the wrong things. We measure the amount of time that we spend with a person, not what difference we made for that person during that time. This competition also limits opportunity for the collaboration needed to maximise the full potential of the sector and is worsened by the tendency to consider only one part of the system and not the totality as intended by the Public Bodies (Joint Working) Act on integration.
Back when I was a Local Authority commissioner, the Commissioning Cycle was my guide as remains true for commissioners today; Plan, Do, Analyse, Review (repeat). But I came into that role with the experience of having been a carer, social worker, researcher and citizen. I knew that bringing those components and more to the table would change the nature of the process. So we changed the make up of the Board. It was, I now realise ‘integrated’; it consisted of 50% citizens and 50% professionals comprising of health, social care, commissioners, providers and procurement managers. This was over 10 years ago now and at the time it was not considered revolutionary, it was merely a step on the road to getting it right.
Together, we could map a realistic picture of a complicated landscape, and create the conditions to share resources, maximising the potential of the totality of our assets, but most importantly, we could sense check this approach with those who matter. It took time and courage, but we created a safe space to try out new ideas, quickly focussing on successes, continually improving as we went, always coming back to the person.
It is this realistic and person focussed embracement of the commissioning process which meant that the changes we made were meaningful and had impact; increasing the number of people who could access care and support by 110% at no extra cost, and with every one of them saying that the service had made a positive difference to them.
The current frustrating focus on measuring outputs limits our possibilities, as do the invisible and enduring barriers of silo-working. But change takes bravery. We had to put in systems to support those involved in decision making to enable them to equally and fully participate in the process. At Scottish Care we do something similar for the independent sector through our Branch structure and Partners for Integration Team, representing our members, creating trusting relationships with our partners to enable collaboration.
We have some great examples where working together has led to people getting the right support in the right place at the right time; implementing an enablement approach, supporting people to move back into the community, reducing falls and pressure ulcers to prevent admission to hospital, and targeting medicine waste to make tens of thousands of pounds worth of savings per month in just one area of Scotland.
For all of these to work, they had to be approached with courage, and from the perspective of the person accessing care and support. Without this they would have failed. Planning and Review is all good and well, but what is clear in the current landscape of diminished budgets and increased need is that that we need to change our approach across Scotland.
It is time to put human rights into the Commissioning Cycle.
National Director, Scottish Care