Current care commissioning and procurement practices are confounding the best of our collective intentions to do our best for children.
In these theses we are asserting that:
- The current paradigm places no weight or reward on child-centredness, creates no space for children’s wishes and feelings to meaningfully influence commissioning and placement decisions
- Monetising and commodifying caring relationships has impacts and implications that modern commissioning has not thought through
- Price, cost and value are importantly different from each other, but current commissioning conflates and blurs them. This hides and distorts the creation of true value, the determination of true costs and the setting of fair prices
- The current commissioning paradigm is ideological, while pretending not to be. The level playing field is not level, or neutral. A new paradigm must be founded on clearly articulated and agreed common values
- This system cannot be improved by tweaking – the current system is irreparably flawed
We call on our friends and colleagues across children’s social care to help us to stop doing the wrong thing better, and chart a path that will lead us to doing the right thing, together
Signed: Jonathan Stanley, Principal Partner NCERCC Kathy Evans, Chief Executive Children England
We have drafted a set of ‘theses’ about current commissioning and future directions, which follow on the next pages.
We readily acknowledge that at this stage the theses are not fully developed – they are intended to act as a starting point for dialogue, and designed to be challenging, in the hope of them stimulating a wider shared dialogue and declaration of the need for fundamental change, and the foundations upon which future practice should be built.
We want to be challenged if you think our assertions are wrong; inspired by your ideas and commitments to better ways forward; and galvanised by finding common ground across our varied roles and perspectives within the current system. The way forward needs to be forged together, through dialogue – and the shape and form of our theses will need to be shaped and changed by dialogue with you too.
How can you be involved?
- Read and reflect on the theses, and join the discussion about improving them
- Respond – this is a discussion document. Please send your comments and thoughts to email@example.com We are looking towards forming a dedicated discussion group.
- Commissioning currently lacks any overt ethical framework – concerned only with adequacy, sufficiency, capacity, price and [inspected] quality. Neither commissioning nor service delivery are currently being held to the established public ethics framework for ensuring selflessness, integrity, objectivity, openness, accountability, honesty and leadership – but they should https://www.gov.uk/government/publications/the-7-principles-of-public-life
- Procuring and commissioning are verbs not nouns, they describe activity not roles or status. As verbs, or activities, they require the active involvement of providers as much as they do of local authorities.
- Councils hold the duty to ensure ‘good enough’ care for each child, but they depend upon other people and places to provide it. There is a mutual dependence to be acknowledged. That should create a need for dialogue and collaboration and on-going relationships through which to establish how best to arrange and share responsibilities between all the people and organisations who are essential if duties to children are to be upheld
- Caring well for a child cannot be reduced to an algorithm or a formula, nor can the value of a care setting or organisation be evidenced by a balanced account sheet of income vs expenditure
- Commissioning/procurement must encourage critical thinking rather than an unreflective rush to implementation. An essential task is to compare, contrast, and combine theories and practices.
- Children who come to need care are not a homogenous group, therefore the needs and responses to each will vary in length, intensity and cost. A system that is meeting each unique child’s needs will be characterised by its unequal spending and investment on each of them too. Standardised and benchmarked pricing will fail the majority of children, whose needs (and costs in meeting them) are infinitely varied
- Humans have raised children for millennia. To care well is not ‘innovation’ or a ‘unique selling point’ – it is something rooted in wisdom we have long known and shared freely
- Co-production requires that all parties are involved right from the start, from setting Terms of Reference onwards (co-creation/co-thinking). There is a mutual weight of responsibility for all parties. Anything less is not co-production but consultation, characterised by increasing limitations and separation of the parties perhaps resulting in adversarial interaction.
- Meeting all the personal needs of the many thousands of children and young people who need care requires an appreciation that this is a complex matter.
Systemic problems in current commissioning and procurement
- There is no evidence that competitive market approaches have reduced overall public spending on social care – the figures show quite the opposite
- The procurement paradigm treats ‘placement units’ as the traded product, and renders children the raw material in providers’ model of production and local authorities model of consumption.
- Any potential for genuine innovation is marginalised / excluded by having to meet benchmarks defined by what already is, and by standardised prices and processes
- We don’t have commissioning for social care, we have retrofitted commissioning for health services to social care without asking whether it’s fit for purpose
- Current commissioning is a monoculture dominated by repetitive standardised processes, rather than by variety, diversity or flexibility
- Current commissioning is costly, makes inefficient use of human and financial capacities, and is ineffective in matching needs to the right resources
- Commissioning has become solely about ‘shopping’ (procurement) with no strategy for investment
- The current commissioning paradigm applies one single universal methodology to meeting care needs, whereas child-centredness should lead to a plurality of methods available to meet the diversity of unique needs. Spot purchasing has emerged in the marketplace as a dysfunctional attempt to make procurement individually responsive to idiosyncrasy and individuality.
- The wealth of research evidence from recent decades and many countries, on the dangers and costs of ‘outcome-based performance management’, has been wilfully ignored in modern social care commissioning
- Service specifications are usually management models and financial term-setting, in which ‘frontline staff’ are predominantly viewed as a business costs to be controlled and cut, rather than being valued as the heart of good practice
- Current commissioning has made affordability its primary focus, without looking at what that does to the sustainability and quality of services
- In current commissioning tokenistic consultation masquerades as co-production, and competition trumps collaboration at every turn (on both sides!)
- The current obsession with ‘outcomes’ is irreparably tainted by managerialism (e.g. PbR) and simplistic measurement, rather than reflecting a genuine concern for children’s actual lived experience and welfare
- Too often we assume we are operating with all the facts when we are not.
- Procurement/commissioning needs a clear understanding of costs, price and value. These are different but currently and confusingly often used interchangeably.
- The current level and range of care provision is significantly (and increasingly) reliant on private ownership, private equity finance and commercial debt levels that aren’t recognised, managed or mitigated as a potential risk to the sustainability of care provision in the medium to long term.
- The effects of the separation between sufficiency analysis and statements and critical business management decisions made by providers e.g. mergers and acquisitions, re-financing, geographical location and property investments, need to be understood.
- The lives and needs of children are more complex than commissioning models could ever account for – current commissioning only adds more conflicting complexity to the task of meeting them
[Re]Discovering and [re]Defining shared philosophy and values in care for children
- Markets don’t care for children, people do. Commissioning should therefore be characterised by its humanity, and the collaborative relationships it builds, not by abstract impersonal transactions and procedures.
- Investing in the people who care for children day in, day out (whether for love, expenses or salaries) is the primary determinant of the real quality of any ‘care system’. Care commissioners and provider organisations must share the responsibility to invest well in all carers – from kinship and friendship care to the most high intensity specialist needs settings (investing in carers means personal and professional recognition enables child-centred terms and conditions, training, support and supervision)
- The fundamental objective of a new paradigm must be to ensure that each unique individual child gets the right care (for them) first time
- Innovation is not something that can be created or imposed by specification, and is not reliant upon a programme for its origin or working. Creativity is an essential ethic of all good social care practice and good future commissioning will need to move away from rigid specification and compliance, to nurture practice environments that can be constantly evolving in response to the needs and views of children and young people.
- There must be a plurality of tools and guidance offered for the operation of procurement/commissioning. Those with responsibility must be aware of the plurality and adept at using the arrangements that best meet the needs of the young people.
- Children have been cared for by people other than their own parents throughout human history, in all cultures and all societies, long before commissioning came along. We must remember that it can be done without the function of ‘commissioning’ and if it does have a role in future arrangements that role must be clearly stated, re-justified and re-defined.
- The behaviours and priorities in commissioning and procurement bear no relation to the kind of behaviours and priorities expected of a good parent – nor indeed of the council as a corporate parent. [Parental duty = you move heaven and earth to get your child what they need, for however long they need it, whatever it costs].
- The needs of one whole child cannot be met by their placement alone – care procurement obscures whole-child approaches and the necessary integration of all services active in the life of the child, and tries to hold care providers accountable for ‘whole child’ life outcomes that are beyond their control on their own
- The focus on ‘placements’ as meeting the needs of a child in care leaves the wider impact of wider services and commissioning unaddressed – the future of social care and the achievement of the best life experiences for children in care, rely on ‘whole systems’ working together in localities, across early years and education, health, housing and social care.
- Good commissioning today must not only meet children’s needs today, but build and preserve the social infrastructure needed to care well for new needs that arise tomorrow, next year and for the next generation
- There must be growth of supply to fulfil the demand for placements of all types. This future growth must answer the questions, ‘Growth of what, why, for whom, for how long, and how much is enough?’ All must be answered explicitly with the rationales, data and discussion, shared with everyone.
- The control of the theory and practice of commissioning/procurement has been ‘commandeered’ as being a discipline defined by, and concerned with public finance, bargaining transactions and accountancy. Commissioning/ procurement is more than this, and needs its sociology, psychology, economics.
- Qualitative research, interviewing, fieldwork and theoretical argumentation need to be supported and included in the roles and costings. Commissioning/ procurement needs to explore other disciplines’ insights into its operations
- There must be critical evaluation of in-depth studies of the effects of commissioning/procurement beyond financial spreadsheets.