Zoë Garbett is Commissioning Manager for Procurement and Market Development for the London Borough of Barking and Dagenham’s adult social care commissioning team. The role consists of researching and scoping services to develop the social care market. Zoë is currently working on a review of information, advice and advocacy services, looking at developing social enterprises, and on a number of community development projects including support for carers and befriending networks. Here she writes about how the shift to personal budgets is affecting relationships between commissioners, providers and service-users.
The move away from block contracts to new, creative ways of commissioning (Payment by Results, spot contracts and personal budgets) has affected stakeholders and the relationships between them. With the introduction of personal budgets, service users have become their own commissioners of services, meaning that providers have had to adapt their services to become more diverse and personalised.
The transition from block contracts to personalised delivery continues to present challenges. Block contracts need to reduce to make way for personal budgets and to open up the market, however they cannot simply stop. Transition, in this economic climate and with limited intelligence of how personal budgets are being used, has become very difficult for commissioners, whose role now should only be to stimulate the market (through spot contracting) where there are gaps in provision.
Change needs to be seen as an opportunity to improve. Surely this change to service users holding the budget, and therefore the power, is a positive move and the way it should be? Change has led to a shift in, not a loss of, control. The agenda has meant that service users have become central in discussions about their lives.
Personal stories from service users in our borough show that personal budgets, with real choice and flexibility, have allowed people to create and design their own care packages that have enabled independence and improved quality of life. Positive impacts have extended wider than the service user to their support networks, with informal carers feeling more supported and able to take breaks and the service user being able to employ friends and family to provide care.
With the move to personal budgets the relationship between commissioners and providers has altered. This relationship was previously contract driven; providers now have to market their services to individuals with budgets (personal and self funders) instead of relying on block contracts from statutory bodies. Therefore, a more equal relationship between commissioners and providers should be able to develop.
Commissioners have been trying to work more closely with providers in order for outcomes to be met and service gaps avoided, proving the best for the service user. Our commissioning processes have reflected these changes for a while, with specifications becoming less prescriptive and allowing providers more flexibility.
Providers are developing partnerships with other organisations, merging and forming consortia. Subcontracting between providers is becoming more common. These new methods of public service delivery are emerging to ensure that the sector is more sustainable; through tackling competition, meeting specification criteria and protecting smaller, specialised services. Local authorities and other agencies are in full support of these delivery models and welcome guidance around how best to support these developments.
The personalisation agenda is well on its way and it is already impacting services, the market and service user choice. To engage with the agenda charities and other providers are advised to diversify their funding streams as well as review business models, service offers and service evaluation.
Commissioning for social value and specifying the importance of local knowledge and experience throughout the tender process are areas where charities and other voluntary sector providers can usually excel. Barking and Dagenham’s commitment to quality services and providing a level playing field when opening up the market is evident in our tender evaluation criteria which favours quality over price. Engaging with providers through events and discussions during our scoping phase of service review allows potential and current providers to influence service specifications and outcomes.
The traditional segregation and distinctions between the sectors (public, private and voluntary and community) have become blurred. All sectors are facing the same financial challenges and are all impacted by the same agendas, including localism, personalisation and the Health and Social Care Act. Therefore, we need to embrace the strengths of these sectors and see change and challenge as an opportunity to work together to deliver our common goal: providing a thriving health and social care market, full of choice to allow service users and residents to access services that will meet their needs and wants.
Download When the going gets tough for free from NPC’s website. This is the fourth in a series of blogs focusing on the changing world of commissioning which run throughout this week.