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User Involvement in Commissioning


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The text of a talk I gave at Community Care Live 2010 about user involvement in commissioning.

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User Involvement in Commissioning

  1. 1. User Involvement in Commissioning – Speech to Community Care Live Rich Watts, Director of Policy & Development, ECDP ( 19 May 2010, Business Design Centre, Islington Introduction Thanks to Alex [Alex O’Neil – Joseph Rowntree Foundation] for inviting ECDP to contribute to this session today. I’m always reminded of that scene from Monty Python when talking to local authority colleagues. It’s the one where some instruction or other is passed to someone at the head of a line. They then turn around and pass the instruction on to the person behind them. And so the instructions pass down the line until the person at the end is left with no one to pass it to. That person at the end is local government. Alex has highlighted some of the challenges we all have when involving users in commissioning. I want to build on what he’s said and focus on the positives – on the ways in which user engagement has made a real difference on the ground, not just in terms of the outcomes for service users, but also for commissioners and the many – often conflicting – demands they face. Our experiences at ECDP Our experience at Essex Coalition of Disabled People is that service users have had a real influence over service commissioning. This has been through a combination of, if I may modestly suggest, a good user-led organisation and Page 1 of 6
  2. 2. through a local authority in Essex County Council which is fully engaged, and the mutual benefits which arise from this. Some of the best examples come from our support planning work. As part of the transformation of adult social care, the need for some independent support planning was key. ECC trusted ECDP to shape and inform the approach to support planning work. We brought together people who had either been through the process or were likely to go through it. We asked them what good looks and feels like to them. We also asked them about the process they went through – what was typically difficult about it, where the unnecessary elements kept cropping up and, importantly, what was good about it. With that, we were able to develop a series of quality measures, based fundamentally on what disabled and older people in the locality told us, that we could use as part of the specification and KPIs. And service users remain involved in the monitoring of those KPIs and quality measures. Fundamentally, what we were doing was using the everyday lived experiences of our users and members to understand what the support planning should look like if it was going to be effective. Fast forwarding to now, ECDP’s support planning service (won, I hasten to add, through a competitive tendering process) is delivering up to 330 support plans per annum. That is, the local authority has commissioned a ULO to deliver a key component of its care process. Page 2 of 6
  3. 3. The real difference this makes is the following: for those service users with support plans done without independent advice just under 16% end up with some form of cash payment. For those service users with support plans done with independent advice, 100% end up with some form of cash payment. Thus, through service users shaping and informing the support planning work from the very start and throughout the process – built on a quality relationship between the ULO and local authority – a significant difference in outcome achieved has become clear. Using this experience to meet other challenges I think we can extend this approach to meet many of the challenges that face us in the transformation of social care today. There are 3 I’d like to briefly talk about today. Workforce development The first is workforce development. We strongly believe that the Personal Budget holder of today is the support planner of tomorrow. What better person to provide information, advice and support than someone who has been through the process, learnt some of the tips and tricks and can apply that knowledge to help someone else? The benefits are clear: to the person who has to create the support plan, they benefit from peer support and the knowledge of someone who has already navigated the social care system. To the person who is supporting the creation of the plan, there is the sense of using their lived experience and the knowledge they have developed for some wider good than just themselves, perhaps even in a formal employment setting. And for the commissioner there is the chance to tap Page 3 of 6
  4. 4. into a wealth of unused knowledge and experience through less formal routes than may currently exist. Probably my favourite example of this approach in action is my colleague Robin. He wanted an oven door that opened sideways instead of up and down. The only place he could find who supplied such ovens was in Holland, so he used his Personal Budget to pay for this new oven and its shipping. So delighted was he with it when it was arrived and installed that he promptly told everyone he spoke to in his capacity as an SDS Adviser. I’m told orders from Essex for sideways- opening oven door from this particularly company jumped 4-fold. Regulating Personal Assistants? The second challenge is Personal Assistants. The issue here is around safeguarding and risk: should the PA workforce be fully registered, with all the possible things that will fall to local authorities to do to put that into practice? Here’s the thing: in a Community Care survey last year, 93% of social workers thought that a CRB check for PAs should be compulsory. But just 2.5% of our clients at ECDP take up a CRB check for their PA, despite the service essentially being free. Both views are valid. But it’s this difference in perspective that user involvement can bring to commissioners who may otherwise go down a path that ultimately many users don’t or won’t want to be lead down. Developing the market Finally, there’s the challenge of developing the market. Through Personal Budgets, service users become micro-commissioners of the care and support Page 4 of 6
  5. 5. they want to meet their care outcomes. But how do they find services they can commission and who do they actually commission those services from? We’ve just completed the first phase of a study of 46 Personal Budget holders, part of which looks at precisely these questions relating to the market. Our findings so far suggest that, in the first place, service users are having a real problem finding services that could offer what they want. Although many people had been given a list of providers by the Council the vast majority said the list was unhelpful, usually because it was too generic and didn’t have the right type of providers on it. Instead, over a quarter of the sample had relied on professional or personal contacts to provide informal recommendations about which service providers they should use. While many found this advice invaluable, they also tended to feel that they were particularly lucky to have such people to ask. Only one person had identified a service through direct advertising by a provider – a company had given a presentation in the building where an older person lived and had provided them with information on their company. And in terms of the service providers themselves, their response to the personalisation agenda was split almost exactly along attitudinal lines. Personal Budgets were considered wholly appropriate for people with physical or sensory impairments. But views were much more mixed when people with learning disabilities or older people came into view, with some providers typically falling back on paternalistic views on ‘looking after’ people. And so it was those providers who were proactive in listening to service users and involving them in how the service may develop and adapt who were far Page 5 of 6
  6. 6. ahead of their less engaged competitors in responding to the opportunities arising from personalisation. Over time, we will see how this position changes. But this perspective from users is clearly vital if both commissioners and service providers are to better understand the interventions they need to make if a fully-functioning market is to meet the demand of users as micro-commissioners through their Personal Budgets. Conclusion I hope I’ve given a positive view of how involving users in commissioning can make a difference. As the people at the end of the Monty Python queue, local authorities – and in particular the commissioners – are left with a thankless task. At ECDP, we embrace the view that user-led organisations straddle the supply side of social care (i.e. providing support services) and the demand side (i.e. representing the voice of disabled and older people). We think of it as balancing business with voice, with the benefits that accrue (for example, sustainability beyond a core grant). And we equally take the view that responsibility for user involvement should lie not just with commissioners, but with ULOs and the voluntary sector more widely to make a positive contribution to the transformation of adult social care. This is a role that clearly could be of value to commissioners. Thus, and to finally finish the Monty Python line of thought, neither ULOs nor commissioners should be the Knights that say Ni. Instead, we can and should work together to ensure users have the opportunity to have their voices heard in commissioning. Page 6 of 6