The need for a new agenda between Commissioners and Providers

A personal Perspective by Mark LLoyd, Managing Director of Avante Care & Support

As a Kent based NCF member we have needed to successfully tender for the new dynamic purchasing model as commissioned by Kent County Council. Judging by the media coverage of the last few days another 11 Councils including Birmingham, Devon, and Southend have gone down the same route with many more likely to follow as Councils face the continued extreme financial restrictions on their annual budgets and meeting their statutory obligations for an aging population in need of social care.

Both at a national (BBC Radio 5 Live and Daily Mail) and local level (Kent on line) emotive headlines are starting to appear regarding the ‘auctioning’ of older people to the cheapest bidder with potentially little regard to the quality of provision.

The purpose of this blog is not to criticise the introduction of systems designed to control the market and price in preparation of the Care Act changes to be seen in 2016 but rather to raise a dialogue regarding a new approach to commissioning and provision of registered care and domiciliary care services.

My only comment on dynamic purchasing would be to question the ethics and values we want to see in providing care and the model leaves me concerned not only as a professional but a son who might have to use such a system one day for my mother. Surely there is a better way to offer registered care to the public which enables an open discussion on quality and cost.

For me commissioning strategies across the country appear broken and are increasingly failing through impersonal procurement processes which are pre-dominantly price driven and allowing little or no dialogue. For domiciliary care many Providers are aware of the key Burstow Commission recommendation on minimum hourly local authority pricing to be no lower than £15.74 (including mileage) which is well above current commissioning intentions of most local authorities. No doubt what is an extremely well written report will end up in the political long grass.

However, the fact of the matter is in my opinion we are at the edge of perhaps the worst ‘melt down’ in health and social care delivery seen in our lives which any in-coming Government will inherit.

Expectations arising from CQC are well documented but the arrival of dynamic purchasing will not only force the registered care price down to the lowest level but see many providers exit the local authority market. I suspect pricing in registered and domiciliary care is yet to settle.

What most local authorities do not realise is that the historical market of providers is not necessarily there (particularly with the profiled exit of a number of the larger commercial providers to focus on private funders) and as fewer providers are prepared to offer ‘cheap’ placements I suspect pricing will have to rise.

‘A problem shared’ has to be central to future dialogue between health and social care commissioners and providers. Returning to the Burstow Commission the summary is simple ‘lack of money, lack of staffing, increased service user complexity’.

NCF members many of whom have long standing associations as local providers are well placed to push an agenda and dialogue with local Commissioners to find common solutions which override current faceless procurement processes and enables established providers to be part of the problem sharing and solutions over assessment criteria, pathways, and use and rationing of scarce resources. I call this an intelligent approach to the current problems faced in the sector.

Central to all of this is the ability of providers to pay a living wage which would do more than any other action to raise quality standards across our sector in providing specialist services for those people most in need having the obvious positive knock-on effect on quality and standards.

I am of an age to remember good solution based management used to occur in most local authorities in the 1990s with the advent of Community Care with intelligent dialogue between commissioners and providers (many of whom were in-house). A new intelligent agenda and dialogue is desperately needed before we reach a point of no return and we as providers are part of the solution in helping our local commissioners to find innovative solutions.

Mark LLoydMark is Managing Director of Avante Care & Support and former Managing Director of Ashley Homes (now part of Sanctuary Care) and Essex Cares.

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