Commissioning for Health & Social Care

 

When discussing health and social care, the importance of commissioning is often mentioned. Nobody doubts the commissioning  of services is essential to ensure a good market that enables personalisation to flourish and allows people to have independence, choice and control.

 

Unfortunately, though the intention is there, it is often complicated by the processes employed by government organisations, which stops good commissioning to occur and people to have real choice.

 

From my experience as a person who has watched many services get commissioned, I have, believe it or not (though coproduction is talked about), really not had the opportunity to be involved, all bar on one occasion, when I slipped/pushed myself in through curiosity. I have also applied for commissions whilst running our local disability user led organisation and again found the whole process quite daunting.  I've also in the past  just gone out and commissioned and developed a service, whilst working for the local authority and by working with local groups, came up with a much cheaper, more effective option.

 

From experience, it's quite a strange concept. Rather than going shopping and seeing the market, researching, and talking to businesses, commissioning works the other way around. A statement or intent is put out saying we've got this much money to spend on this project and you let the sellers come to you.

 

My first bit was whilst working for an authority. I was asked to look at our language translation services, which had been running for a while. We had at the time (10 years ago) been paying over £2 a minute for phone translation services and over £50 per hour for professional face to face translation services. The cost was huge. On looking around, I met with a few of these businesses and managed to knock one of their prices down to 89p a minute on phone calls, saving an immediate 50%. In the past, people had just carried on with the services we had before, without checking whether the market had changed. As times moved on, new companies came on to the market, offering better support and deals; however, without active management of the contract, nobody had checked to see what had happened or what was now available.

 

With relation to face-to-face translation services, I again examined what was needed. Looking at where and when, such services were required. The majority of cases where meet and greet or help with form filling. Only occasionally where professional translators required. Sometimes, if it's for a  legal, medical or technical  reason, you do need professionals. However, in 80% of cases, this was not the situation. At that time, I was working in the field of Equalities and being a firm believer in knowing your local communities, I contacted members from these different language speaking  communities. We offered a weeks training on the organisation and how it works along with other essential background training including  equalities, health and safety, and other things our council was responsible for. We checked DBS and interviewed individually to check comprehension of English and the ability to get on with people. These people were then offered £10 an hour for day to day translation services covering most of the local languages used. The bonus was that these people acted as our gateways into the communities and enabled two way sharing  of information and conversations. This not only saved substantial  amounts  of money, but allowed us to better develop our community engagement.

 

 

My second bit of  involvement showed that unless you have a good bid writer, it's a nightmare. Which small organisations who are running for free can't compete with. They want small business to flourish; the Care Act is clear on ensuring a robust market with different levels of support. However, in reality, you need financial backing and a team. So, for people on personal budgets, say who want to work together to self develop services, will get little chance or support which is often the reason why such enterprises don't exist.

 

 

My most recent involvement actually meant I managed to talk myself onto the panel for commissioning. There are strict criteria to allow fairness; everybody's bids are taken as gospel. I was astounded by this; I could see no checks being made for large amounts  of money. Unless I missed it, there didn't even seem to be basic companies' house checks on companies or directors. Something that can be done freely and easily . Anything they say is just taken as given. I queried this and was told that's the process. In the one that I managed to get involved locally, I'd taken an interest  as from what I was hearing  the  service provision was failing the people who needed it. The authorities seemed to be ignorant of these facts. Their annual visit was usually, “How's it going? Fine OK, see you next year then. “  The data I had collected and passed on to the authorities said very differently. What a surprise when I was looking through the bids to see that the same company had rebid for the service and had in fact stated that they where working with our user led organisation and myself in particular to deal with the issues. They'd never even contacted me. Once I had declared the fact that I had been used in the commissioning bid, I was no longer able to assist quite rightly. However, I did query if any checks had been carried out on these organisations, even checking their websites, or customer complaints, etc. I was told that's not done.

 

So, what did I learn? Working regularly  with local communities is essential not only to get know what's happening and what's needed but also to share resources and information.  A lot is talked about in relation to commissioning and coproducing, but I've seen very little of it. It is essential to improve our services that organisations allow proper vetting of companies and allow people from local communities, to be involved and fully utilised in developing the services they need. After all who knows what they need better than them.