Last Thursday, the Public Service Transformation Academy (PSTA) and the Local Government Association (LGA) gathered together 90 commissioners and providers of social care to explore with each other how best to develop the social care market. It was a surprisingly upbeat session given the scale of the challenges ahead.
There was widespread agreement that there are strong systemic pressures encouraging a race to the bottom with care prices being held down and quality suffering. One speaker went further: ‘as a director I spend a lot of time and money dealing with market failure.’ This is despite the 2014 Care Act requiring local authorities to develop markets that are sustainable, diverse and high quality.
And this not a new problem. By some estimates, since the late 90s there have been 12 white papers, green papers and reviews on developing a sustainable care model – few of us have faith in the upcoming one sorting out the social care challenge.
So we’d better get on with it ourselves. There was pretty broad agreement that, whatever the national funding and policy configuration, commissioners and providers need to reinvent their relationship. This needs to include more healthy challenge of each other, better use of evidence, taking a braver, longer-term view and sharing the risks of this approach too. The providers in the room were really clear that longer-term contracts with close working relationship with commissioners can transform social care delivery.
There are, however, some big system challenges to overcome to make this relationship work better. Focusing on outcomes was seen by many as the way forward, but how do you ensure good outcomes for individuals translate into good outcomes for the health and care systems? And, if it is true, as one participant said, that there is no correlation between local authority spend and any identifiable external factor (such as age or poverty) what does this tell us about the coherence of the current system?
One participant observed that the current approach does not encourage innovation: ‘Where is the iPhone of social care going to come from?’. However, this was countered by others who argued we know what works already, so the focus should be on delivering that better
Perhaps some of the answers lie overseas. We are big fans of stealing with pride so the New York example of outcomes-based commissioning was interesting. There, almost 90% of health and social care integrated commissioning will be outcomes-based by 2020. This has required negotiation between providers and commissioners to make it more financially sustainable for providers – something that would have to be addressed in England too.
Closer to home, we examined the Stockport case study, which underlines how long it takes to truly integrate services (with a long previous history of working together) and the importance of full financial disclosure to work out the best outcome for each pound spent. I regularly hear how tricky this is when local authorities and health are working together.
Overall, we were however left more optimistic than pessimistic about the future. There are some huge challenges to overcome but there are models out there that work and there is willingness among providers, commissioners and procurement staff to deliver such new models locally.
Frank Curran is director of adult social care and criminal justice at RedQuadrant and Catherine Taylor is head of member value at the Whitehall and Industry Group. Both organisations are partners of the Public Service Transformation Academy
