Commissioning Care in the 21st Century

The new NLGN report, jointly commissioned by the ALDS Forum and the LDC, Commissioning Care in the 21st Century, argues that the only way to ensure that personalised services are affordable is to accelerate radical moves towards a new form of outcome-based commissioning.

The report warns that without these reforms, social care in England risks ending up in the same situation as the Netherlands, where cost inflation and austerity measures have led to the scaling back of the Dutch equivalent of personal budgets.

The think tank’s new analysis of council cost data shows that each additional direct payment issued to someone with a learning disability, between 2002-10 adds between £15-25,000 to a council’s overall expenditure on learning disability services. This may reflect the fact that personal budgets are identifying new and previously unmet needs, and it is possible that the new system will save money for other sectors such as the NHS. The finding should nonetheless ring alarm bells in Whitehall about the pace of change.

This means embedding new measures such as “Social Care Related Quality of Life” (SCRQoL) that assess the quality and impact of social care services. If councils are better able to manage the contribution a service makes to a person’s wellbeing, and use that information to create a vibrant, competitive market that delivers best value for money. With a robust outcomes measurement system in place, emerging commissioning tools such as payment by results and social impact bonds could be developed within social care.

To reconcile the shift in relationships that outcome-based commissioning implies, commissioners will need to play a greater role in developing the market and “place shaping”. This will ensure that people with learning disabilities have a real choice between a wide range of services, so that people are able to access wider public services including employment and leisure as well as residential services and day services.

Report author, Daria Kuznetsova said: “We need to make a decisive shift away from managing outputs and instead develop new metrics and commissioning approaches based on outcomes. This will drive a focus on value for money, rather than simply cost, and it will help commissioners identify effective forms of intervention that help people with learning disabilities to live the lives they want to lead.”

Care for people with learning disabilities accounts for more than 23% of the adult social care budget, and represents the fastest growing part of that budget in last five years.

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