Mick shares his thoughts on the world of commissioning care and support services in Adult Social Care, why we need it and what we’re doing to make sure we’re getting it right.
What are your thoughts on Good Care Week Mick?
Good care week is a chance to celebrate all the positive work that goes on in the caring profession. There are negative views sometimes about social work, home and residential care but this week rightly celebrates the committed social care people putting huge efforts in to try make a real difference to the people they work with.
Obviously it’s not about one week in the year, it’s about raising awareness. Hopefully people might remember when they are thinking about getting support services, when they are thinking about moving in to the job, thinking about becoming a care worker, that there are good practices and we can and should share these.
As the Head of Commissioning for Adult Social Care, how do you describe what commissioning is?
Commissioning in Adult Social Care (ASC) is the process whereby local authorities decide how to spend their budget with services delivered by other organisations on behalf of the council. But I’m one of the big champions who say it’s not just about that, it’s much bigger. It is following a commissioning cycle – what are the needs of the people? What can we do that is going to be different, that is going to make a difference? How do we get that set up? How do you monitor it, how do you evaluate it, and how do you use that evaluation to inform what you do next. I think that cycle explains it well.
Yes we commission services, we have commissioning in our job title and we go through the many processes needed but increasingly we’re not the only commissioning around, crucially there are three new groups now.
One of course, and has been for some time, are people like social workers, people who work with individuals and help them plan their care, working with somebody who might want home care or moving to a care home. Organising that includes helping that decision about where money is spent.
Secondly, people themselves are commissioning now, getting direct payments to commission a service either for yourself, for your family or for the person you care for.
Thirdly, and what I think what you will see more of in the next couple of years, are community organisations being the commissioners; being more enterprising and being able to influence more. This aspect fits very well within commissioning – the potential to be a ‘group of influence’ with regards to what we purchase, what we buy, where we spend our commissioning. A good commissioner is somebody who is good at influencing.
Why do we have commissioning?
It’s about having that overview. Allowing for the shifts in the way commissioning is provided and the role providers play within the local authority, whether that’s the independent sector or the third sector or their own in-house services.
The most important thing to remember about commissioning however is that we make very little difference unless the people who provide services make a difference – it’s what somebody does in a care home or hospital for example. In the section ‘I have a better life because…’ on our Better Lives blog, Susie is one of many who have experienced the difference our services can make. The role of commissioning is to allow that to happen really effectively, if we don’t do that, we’re not adding any value at all.
What is the process to ensure that we are getting value for money and excellent standards?
When you start a new commissioning process you’ve looked at what’s needed and what sort of services you have to deliver that need. Critically, we have ‘co-production’ in place – talking to the people directly affected by the service, which we do right at the start. If you involve people at the beginning and throughout the process, you are more likely to get it right.
The second is articulating the sort of service that you want and more crucially the outcomes – what is it you wanted from the service? Then you get into the process of judging which organisation is going to be the best, again in co-production with the person receiving the care and support as you’re more likely to make a good decision.
Leeds is very strong on quality being a significant factor. Yes we have to look at price and I would be naïve to pretend otherwise, but this is one area we’re are very strong on – quality and excellent standards. Once this is established, it’s about having very good monitoring systems and very good evaluation. This process is a mixture of using our own monitoring staff and the Care Quality Commission to ensure we get to hear the voices of the people who use that service. We encourage people to complain where relevant too as we really want to know when it goes wrong.
Constant dialogue is also key when you set the service up. You don’t just forget about it, you want to and need to work with social care providers all the time. I often argue that yes, you need a contract, yes, you need terms and conditions but it’s also about your relationships with the provider and the service users.
How do you ensure that the services we commission are safe?
Safety is the core bit of quality and we use the formal safeguarding policies and procedures that are nailed into any sort of contract. We ensure our providers and independent third sector organisastions undertake safeguarding training and that staff are appropriately checked. Safeguarding element is a very strong factor within that monitoring regime.
How do you manage the needs for services with reduced budget?
It’s not an easy time, and despite the huge financial difficulty of the council, I have been very impressed how well Adult Social Care has been supported. We’ve not had to make huge cuts as in other cities.
What we have done is be more sensible with the money we’ve got, but it’s difficult and we still need to do things differently. That varies between holding the price on a lot of things which is challenging for some organisations and some staff; staff working in home care and the independent sector.
Where we have had to make cuts, like a couple of years ago, we sat down and worked with each organisation individually about how they spend the money that they’ve already got, what can they do differently, what can we do differently and working with them rather than just having a simple let’s cut this money off!
It’s this idea of the ‘Leeds pound’, so it’s not just what ASC spends, it’s about what the council spends, what the NHS spends, and between us, can we spend the money we have in a better way and more innovatively.
The NHS have put significant funding into Adult Social Care because they see the benefits for health. Take effective homecare. We did a pilot last year connecting home care with pharmacist and medication support which proved very successful. By taking that step back and looking at the entire picture really helps us to spend the money that we have got more sensibly.
Leeds is also investing more money in neighbourhood networks and, in the longer term we save money because we slow people down from going into more expensive services. We recognise that investing in good quality ASC services will save us money in other areas.
What are the main challenges you face in your role as Head of Commissioning?
The best things about my job are the same things that are the most challenging. It’s looking at the complexity of having care contracts, contracts with small independent sector organisations and then receiving complaints around home care. What can I do to make a difference? What can the team do to make a difference?
How did you come to be the Head of Commissioning?
I’ve worked in social care forever and ever! In past roles, I was working around partnerships, service transformation and better engagement which became the currency of commissioning so I was sort of doing that when the word commissioning was just beginning to be formed!
I’ve been around a long time and I’ve got the big picture – not a bad thing to have really. The fact that I was a care assistant; worked in a care home and managed a day service for a long time, is phenomenally important as that day-to-day practice massively informs what I do in commissioning.
It also means I’ve got incredible respect for people who do the actual work that matters. Crucially, I have spent lots of time face-to-face with service users, stressful situations, emotional things – all very intensive personal care. That has a massive impact on you and should never go away.
What interests you outside your day-to-day job?
I like films, I like art, I like cooking and cook every night from scratch. About the art, what is worth noting is I have no ability or the faculty to be an informed critic – I just like the idea of it!
I’m a Leeds United ticket holder too and recently saw them win which is always a great joy.
I do a tiny bit of volunteering for an organisation called Inkwell, a mental health arts charity. I partly did it because I do a bit of work on promoting volunteering social capital and the benefits of volunteering to people. I really enjoy it though – it goes back to, yes I have that history of being a care assistant (I often refer to that as ‘when I had a proper job’!) and doing face to face volunteering with clients is a good thing. In my job nowadays apart from a bit of consultation, I rarely meet social workers so it’s a good way to connect back into that.
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