Doug Forbes ponders the future of adult social care delivery in a GP commissioning environment, and suggests emulating the Royal Air Force model.
The structure of the market for social care services has followed clear demarcation lines for some years between professional social workers and care providers. The provider end is based upon inputs, hourly rates and prescriptive contracting. Nominal movement towards outcomes is being introduced and large scale transformation programmes are focusing upon personalisation. This will help to improve the service culture but will it deliver enough?
Perhaps it is time to consider how any council will deliver the most appropriate market structure and the cost savings required in the next few years?
The worry about personalisation is how will competent suppliers be able to channel their offerings to customers, particularly when they use Direct Payments? Current approaches on confidentiality will make it expensive for providers to market directly to customers. In addition, public sector bureaucracy can stifle change and innovation. Is there a way of freeing up the culture as we have seen in many other parts of the public sector?
The Royal Air Force tendered for supply of its social care service and we have information regarding that process and provider responses. The provider market is now starting to offer integrated professional assessment and care management and delivery in the same way that other suppliers have in other services. This brings with it capital and delivery expertise when provided by the third and private sectors.
In other sectors, this type of contracting arrangement has yielded savings of up to 10 per cent of total budget with no change in quality. The provider will have to follow regulated standards and the council will retain its statutory functions. The test of competition will be at a higher level so encompass assessment and care management as well as care provision. Cost savings would come from the operator’s greater efficiency, more targeted care packages using innovation and technology, housing benefit contributions, flexibility and reduced legal constraints. The consultation and user arrangements will become more focused.
Such integrated organisations would potentially fit into the GP Commissioning Consortia as local service providers having the advantage of allowing the local authority role to be strategically focused and not clouded by local delivery issues.
The issue is what would such an arrangement look like for your council? Is it politically, administratively, technically and financially deliverable? How are you going to research and investigate this emerging market?
Doug Forbes is director of the Institute of Commissioning Professionals
