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Care commissioning must improve to meet the challenges of the next five years

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However much the government reinvests in care money saved by deferring phase two of the Care Act, there is going to be a heavy premium on the quality of commissioning during the coming five years.

The demand to improve commissioning skills and scope will come from three drivers.

Deepening integration between services will require a much more savvy approach. The increasing quality expectations from citizens and austerity will also require improved commissioning.

There is a risk that without government reassurance, lenders and investors might freeze activity pending the spending review. Central government must reassure us about its social care funding, making explicit the implications of the national living wage.

Commissioners have key roles in developing a market of sufficient quality and diversity to ensure good outcomes. The regulator has responsibilities for inspection, improvement and enforcement.

The Care Quality Commission has taken the lead by bringing lenders and banks to an event on sustainability of the sector alongside commissioners, providers and government officials.

Improving commissioning isn’t just a political or financial imperative, though. It has profound moral roots and consequences.

I made the point to a recent symposium by stressing the commissioner’s role as bringing people together to co-produce a transparent and shared understanding of the outcomes desired.

We will all increasingly be asked to create the conditions within which citizens make their own purchasing decisions. In that context we need to focus on outcomes, on securing value chains, and encouraging transparent approaches to cost.

We demonstrated the importance we place on this by asking Calderdale MBC’s Bev Maybury to act as our national lead on commissioning, and her initial thoughts can be found on our website at  

Bev will build on the Adass co-sponsored Commissioning for Better Outcomes route map from the Health Services Management Centre at the University of Birmingham. This, as well as the CQC’s and other initiatives, has stressed the importance of sustainability. Bear in mind the 12 key standards the report recommends: they represent current thinking on the issues.

They also describe an ideal. To get there will require all our co-production skills, innovative approaches ready to respond to the new demands and market position statements that provide the basis to shape our markets differently.

We must consider tighter investment in our business relationship capacity to help move us away from reliance on traditional commissioning, procurement and contracting roles, while never forgetting our core principles to prevent, postpone and minimise people’s need for formal care and support.

The concentration and focus on commissioning that we have witnessed over the past couple of years, and the growing interest we can see developing in the next five, should give us all grounds for hope and encouragement.

Ray James, president, Association of Directors of Adult Social Services, and director of health, housing and adult social care, Enfield LBC



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