Government scores ‘own goal’ on care commissioning

In a bizarre sequence of events last week, the government tabled an amendment to its own Care Bill removing the duty for the CQC to make routine checks on the commissioning of adult services.

Jack Lofthouse is a researcher at IPPR

With appalling stories of neglect at care homes and growing public concern over ‘15-minute’ flying care visits, the Coalition has been at pains to beef up the role of the care regulator, the Care Quality Commission (CQC).

But in a bizarre sequence of events last week, the government tabled an amendment to its own Care Bill removing the duty for the CQC to make routine checks on the commissioning of adult services.

If the government is serious about improving the quality of care, this is extremely short-sighted. Commissioning is perhaps the most important lever for improving the quality of care and should be overseen and challenged in the same way as any other aspect of the system.

This should be the case not only to identify failures but also to make sure that some of the brilliant and creative commissioning for care services that  really meets people’s needs and prepare for the demands of an ageing society is replicated in other areas.

As part of IPPR’s Condition of Britain programme, which seeks to understand the pressures and priorities of people in Britain today, we recently visited a Local Links pilot run by the Garforth Neighbourhood Elders Team (NET), a great example of innovative commissioning.

Based in a suburb in Leeds, Garforth NET employs support planners to work in consultation with individuals, their families and carers to develop a package of support based around both voluntary and statutory services. The focus is on helping older people to access resources available to them in their local area, and much of the support is tailored to the individual and delivered by volunteers who are likely to be in receipt of social care themselves.

If staff hear from someone who wants to learn photography, for example, they will try to recruit a volunteer from the local community to help out.

The older person’s personal budget is held on behalf of the individual by the organisation. If the overall package of care delivers savings on what traditional council services would have cost, half the savings are returned to the council and half are retained by the provider to be reinvested in the community.

Combining voluntary and informal care with professional care can drive up quality, generate savings for the community and give many older people the opportunity to share their skills and expertise.

Allowing for greater input from service users, carers and families in the design and delivery of support means that people have far greater ‘buy-in’ to the system, and are more likely to go the extra mile in supporting others.

What’s more, this locally-driven approach could make it easier to involve small-scale care providers who may otherwise struggle to compete for funding from local authorities by nature of their size, which could help to improve the consistency and quality of publically-funded care.

In many ways, what we saw in Leeds was evidence of the ‘Big Society’ in action: the power of volunteers and communities to make a real difference to each other’s lives.

But what is happening is not the result of the retreat of local planning and support, letting communities ‘get on with it’ on their own. Instead, it is an example of well-designed policy that nurtures and extends local networks of support, and offers both the trust and support to allow care workers and volunteers to make the most of the capacities already available to them.

The problem is that while the residents of Leeds and other local authorities with imaginative approaches to commissioning will benefit from this kind of approach, people in other areas may not. This is where we need challenge and oversight from bodies such as the CQC, but also a more fundamental review of how the care market currently operates.

IPPR will be joining others in asking how we can build a more diverse and locally rooted social care system. Being prepared to tackle failures in local authority commissioning as well as celebrating success would be a good place to start.

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