Should the Care Quality Commission inspect the commissioning of social care by councils?
There is a growing convergence of opinion from health and social care secretary Jeremy Hunt and provider associations that this may now be needed. Their motives may differ, but they both want an independent view on how councils are addressing outcomes, quality and value for money.
The commission has already dipped its toes into this water with the area reviews looking at places with the highest numbers of delayed discharges. The brief from Mr Hunt was to find out how services are working together to support and care for people aged 65 and older.
The CQC’s approach has been well received. It fielded large teams, including external expertise, for a long period, taking the views of system leaders, service providers, patient representatives and frontline staff. But scaling this up from 20 to 150 areas and extending the brief to all adult services would be a substantial undertaking.
Commissioning is not a regulated activity and the supporting data are indicative rather than definitive. The approach would need to be a review with recommendations for action, rather than a simple judgment or generating a league table.
Those conducting the review would expect to see evidence that a council understands the needs of its population, not just those eligible for care. They would have to test the expectations of the Care Act that everyone can access good information and advice and help to plan their support.
They would also consider the state of the care market, how the council ensures sufficiency of supply and encourages good quality, irrespective of whether they are purchasing care from providers. And they would need to explore how well the council works with its key partners – particularly the NHS and the housing and planning functions – and how it relates to current and future providers working on for their population.
At an operational level, any review would need to consider how the council behaves as a commissioner in designing and purchasing services for those it is funding. Personalisation should be the default operating model.
Reviewers must ask whether councils are seeking to improve outcomes or just drawing up a menu of services. Do they draw on the National Institute for Health & Care Excellence (Nice) guidance, encourage innovation and entice new entrants to the market?
Any review will also need to address whether the council is making the best use of its resources. Is social care a political priority? Can it demonstrate good outcomes, good decisions about who gets priority, and whether a fair price is paid for the care commissioned?
If the government presses ahead with this, it will not just smoke out bad practice. It will demonstrate that even were it working optimally the system is at breaking point.
Andrew Cozens is an independent social care and health specialist