Research highlights ‘uneven landscape’ of social care commissioning and procurement

Two new reports published by CCPS today explores current context and shares ideas for improvement

Two reports published by CCPS today examine the current reality of commissioning and procurement of adult social care (ASC) support and services in Scotland.

The first report, by Professor Stephen Gibb, brings together the results of a scoping literature review of published evidence on ethical commissioning, summarising the context for strategic planning, commissioning and procurement of ASC in Scotland.

Written by Professor Anne Hendry, the accompanying study presents the results of qualitative interviews with a sample of national and local stakeholders involved in commissioning and procurement of ASC support and services.

Together, the research makes clear the complexity and contradictions of adult social care policy, funding, regulation, planning, commissioning, procurement and service delivery.

Drawing on views from a range of interviewees, Professor Hendry’s report shares ideas for improvement, including on the role of Integrated Joint Boards.

Reflecting on what she had heard as part of the study, Professor Hendry said:

“It was a privilege to learn from the experience of people directly involved in commissioning adult social care support and services across Scotland. Commissioners and providers alike called for simpler processes that enable more collaborative commissioning.

“There was a strong sense that this need not, and indeed cannot, wait for new legislation or new structure and it was refreshing to hear what can be achieved now with a strong focus on value and outcomes.

“However, sustainable change requires investment in the social care workforce supported by collaborative leadership, culture and relational practice that respects place and rebalances power.”

Professor Gibb highlighted the distinctive nature of commissioning and procurement in social care and the need to support innovation. He said:

“There are big gaps in the literature, recognising that in principles and practice the commissioning and procurement of social care is distinctive and different from other kinds of purchaser-provider relations.

“Changes like ethical commissioning may bring fresh impetus to better connect and channel the strategic intents of purchasers, local and national government with service providers. Enablers of change need to be identified, for fair funding of collaborations which give the right providers the resources they need for enabling services that matter and their improvement.”

Welcoming publication of the research, CCPS’s CEO Rachel Cackett said:

“At a time of intense debate about reform of social care, these reports provide our members, the wider sector and parliamentarians with valuable insight into the uneven landscape of commissioning and procurement in 2024.

“Having an overview of current guidance and hearing from a spectrum of stakeholders about their experiences helps to strengthen our understanding of the degree of inequity in the system, and what improvement could achieve.”

The research was conducted on behalf of CCPS between March and June 2024, in advance of the publication by the Scottish Government of its draft amendments to Stage 2 of the National Care Service (NCS) Bill.

It builds on previous related publications by CCPS, including a series of interviews with representatives of third sector providers about the viability and future of ethical commissioning and procurement.

Stephen Gibb is Professor of Human Resource and Organisation Development at the University of the West of Scotland.

Anne Hendry is Senior Associate, International Foundation for Integrated Care (IFIC), Director, IFIC Scotland and Honorary Professor, University of the West of Scotland.

Read report 1: ‘From strategic intent to procurement of adult social care and support in Scotland: Literature Review’, by Professor Stephen Gibb.

Read report 2: ‘From strategic intent to procurement of adult social care and support in Scotland: Analysis of current experience and ideas for improvement’, by Professor Anne Hendry.

The reports were produced by CCPS’s Commissioning and Procurement programme through funding from the Scottish Government.

 

 

“A chance to do things differently”

Bryan Davies, Chief Officer – Strategic Commissioning and Performance at Scottish Borders Council, reflects on his experience running a model contract test-of-change as part of our work focused on transforming culture in commissioning and procurement

CCPS has a longstanding commitment to leading culture change in commissioning and procurement, with a focus on embedding rights-based approaches and increasing collaboration, writes Policy Manager Alison Christie. In 2023-24, our work in this area included running a test-of-change of model outcomes-based contract template documents and related terms and conditions. We were pleased to collaborate with Scottish Borders Council and law firm Morton Fraser Macroberts as part of the project.

Background

The aim was to provide local authorities with a set of template documents to use and adapt when contracting for social care support services and to ensure that the contractual process focuses on the person’s outcomes. The Model Contract is three-way agreement between the supported person, the provider and the local authority. It is an Option 3 Self-directed Support (SDS) contract, meaning it can be used for all types of social care services.

The test-of-change was a small-scale project to assess how the Model Contract and Ts & Cs could work in practice and be adapted for use locally. By the end of the project, it was in readiness for use with one individual and support provider contracted through Scottish Borders Council (SBC), with an outcomes-based social work assessment, individual outcomes-based support plan and signed legal agreements all in progress.

In his blog below, Bryan Davies, Chief Officer – Strategic Commissioning and Performance at SBC, reflects on his experience of sharing the work and the learning gained.

“Part of my role at SBC focuses on developing our approach to commissioning, including looking at how we establish new governance arrangements for commissioning decision-making.

Currently in development are an early draft commissioning strategy within which there are 11 commissioning principles we will be committing to upon completion of the engagement process.

The developing approach also includes exercises such as the mapping of all our longstanding commissioning arrangements and the modelling of a capacity versus demand whole system profile across all health and social care settings. This Commissioning Framework will set out a new approach to existing commissioning in the Scottish Borders with a focus on ethical commissioning and collaboration.

One of the first areas of review in the Borders is Care at Home provision. CCPS’s test of change was of particular interest because it allowed us to look at the potential for doing things differently in terms of three-way contracts between the commissioner, the provider and the individual with that focus on the individual’s outcomes.

Trialling ideas

As a small test of change, we felt it was a useful exercise to begin to think through how the model contract might be implemented. However, one of the things that came through clearly was the need for more time. This proved to be a frustration throughout the project in terms of working towards a very imminent deadline.

Very quickly we pulled together legal experts, social work practitioners, partner agencies and other disciplines to look at the detail. But despite an excellent collaborative approach, unfortunately we didn’t have the time to go ‘live’ with a contract and involvement of a service user within the timeframe given.

In scoping a new way of working, lots of questions were raised for us about, for example, distinguishing between self-directed support option two and this specific option three piece of work. This test of change was within the context of option 3 (social work provided care through the means of a framework), and as a result the issue of scale became important.

The real value of any further test of change would be linked to scaling up. However, it was an interesting exercise in terms of the process that stakeholders might go through to get to this new three-way contractual arrangement.

Question time

SBC currently does assess individuals for outcomes but has historically set budgets around time and task provision of care at home rather than outcomes. So there is continued development in this aspect.

The capacity of the provider to deliver on the individuals’ outcomes while also delivering on a large-scale traditional volume of Care at Home provision on a time and task basis also provided a challenge. Questions were raised from the provider’s perspective about how they would manage the capacity to achieve this.

We highlighted other questions around evidencing progress against the achievement of the person’s outcomes.

There was an acknowledgement that there are tools that already exist and are in use by SBC and providers, but questions as to how SBC and stakeholders would agree suitable tools for the evidencing of those outcomes.

SBC also weren’t clear about managing a person’s expectations in terms of how open to be about this being a test of change when getting to testing stage with a service user.

Steps in the right direction

There was also a suggestion to better sequence the steps that needed to be taken. For example, the contract’s function could have been brought in earlier.

There was a significant focus on the legal input, and it was felt that in addition, there was a need for input from the contracts and procurement team to help the group understand where progress needed to be made in practically applying the new contract.

The experience has informed wider working for SBC in developing commissioning approaches, and we feel that it will be important to revisit much of what was experimented with during the project.

Overall, I felt that, despite it being a very small-scale test of change, a great deal of value had been learnt by the project group in a short period of time.

 

Social care commissioning system is ‘out of whack’, new publication finds

Eight sector leaders provide perspectives on the viability of ethical commissioning and procurement, through interviews with journalist Pennie Taylor

A new publication from the Coalition of Care & Support Providers (CCPS) explores the viability of an ethical approach to planning and purchasing social care, with eight sector leaders providing their perspectives on the current landscape through interviews with journalist Pennie Taylor.

The publication, “It’s out of whack!”,  highlights how commissioning and procurement has a significant impact on the delivery of support services, sustainability of providers, the workforce and on people receiving support.

Download the publication (PDF)

Interviewees consider how meaningful partnership, community-level co-production and innovative thinking could address unprecedented service challenges.

As reflected in the publication title, which draws on a comment from C-Change CEO Sam Smith, the consensus view is that the commissioning system as it stands is unbalanced.

CEOs, directors and managers interviewed make clear the risks not implementing reform poses to providers, and the major steps still required to realise the “collaborative, rights-based and participative approach” that was outlined in Derek Feeley’s Independent Review of Adult Scotland Care.

Catherine Garrod, CCPS Programme Manager – Commissioning and Procurement, said: “The expert voices in these interviews demonstrate how Third Sector care and support providers already deliver high quality personalised care and support and work to improve the outcomes of the people they support, in spite of the system.

“These are voices that need to be heard and included in finding the solutions to make the shift we all want – and need – to see for people who require support.

Pennie Taylor said: “The concept of ethical commissioning and procurement has been embedded in the proposals for a National Care Service for Scotland, but a new way of working cannot wait for that. Instead, the people I spoke to for “It’s out of whack!” all want to see action taken to galvanise change, using existing legislation to kickstart widespread reform without delay

“These features spotlight great examples of doing things differently, and describe first-hand experience of current practice that is far from ethical. They eloquently demonstrate the passion, commitment and creativity that keeps the Third Sector going, whatever the odds.”

Interviewees in the publication are Ben Bradbury, Business Development Manager, Capability Scotland; Ian Bruce, CEO, Glasgow Council for the Voluntary Sector; Drew Collier, Director of Development, includem; Dr Ron Culley, Chief Officer, Quarriers; Louise Moth, Contracts & Commissioning Manager, Scottish Autism; Julie Murray, Chief Officer, HSPC; Sam Smith, CEO of C-Change; and Andrew Thomson, Deputy Chief Executive, Carr Gomm.

The publication was commissioned by CCPS’s Commissioning and Procurement Programme, which is funded by the Scottish Government.

Find out more about the Commissioning and Procurement Programme

Family support conference: learning points, links and resources

A summary of our recent event, Whole Family Support: The Power of Prevention – Keeping the Promise for Children and Families Across Scotland   

On 15 May 2023, CCPS, alongside partners The Promise Scotland and Children in Scotland’s Supporting the Third Sector Project, ran a conference exploring how the third sector is innovating, making an impact and driving better outcomes for children and families in Scotland. 

Chaired by Pennie Taylor and supported by CCPS Children’s Committee organisations Children 1st, Action for Children Scotland, Aberlour and Barnardo’s Scotland, the joint event examined: 

  • How the third sector is leading transformational change in partnership
  • What that change looks like and how the Whole Family Wellbeing Fund can support it, and
  • How we can learn from this to achieve our shared goal of accessible whole family support across Scotland for families when they need it. 

On this page you’ll find a series of links to resources covering politics and practice explored at the event, alongside illustrations by Edinburgh College of Art students Rachel Collins, Ola Jackiewicz and Ruby Tait, who attended on the day to provide graphic recording.

Illustration: Rachel Collins 

Workshops: key learning points

Alongside our partner, Children in Scotland’s Supporting the Third Sector Project, our Children’s Committee member organisations Aberlour, Action for Children Scotland, Barnardo’s Scotland and Children 1st have captured highlights, questions and key learning from the workshops they ran at the conference.

Read a summary of the Supporting the Third Sector Project’s workshop (PDF)

Read a summary of Aberlour’s workshop (PDF) 

Read a summary of Action for Children Scotland’s workshop (PDF) 

Read a summary of Barnardo’s Scotland’s workshop (PDF) 

Read a summary of Children 1st’s workshop (PDF) 

Illustration: Ola Jackiewicz 

Family support case studies

We’ve published a series of case studies marking the impact and value of family support, provided by Aberlour, Action for Children Scotland, Barnardo’s Scotland and Children 1st.

Read the case studies

Commissioning & Procurement policy and resources 

CCPS runs a Commissioning and Procurement programme focused on national and local policy and practice change, an area that’s highly relevant to the family support agenda and which was discussed as part of the conference. We recently produced a Commissioning for Outcomes Guide, which explains what outcomes are, why they matter and what outcome-based commissioning means in principle and practice.

Commissioning and Procurement overview

Commissioning for Outcomes Guide (PDF download)

Event overview 

More information on our family support event held on 15 May 2023 

 

Illustration: Ruby Tait