A people-centred approach to commissioning in Wales

Published in Features on 10 May 2022

When we think of what’s needed to support independent living and change the way care and support is provided, is a more person-centred approach required? And if so, what does this look like and how can we make it happen?

We’ve been exploring person-centred approaches to commissioning care and support – and learning in particular from what’s happening in Wales. 

Meilys Heulfryn-Smith, the Programme Lead for Community Transformation at Gwynedd Council; and Alison Hughes, the Manager at Gofal Seibiant, told us about their journey to achieve a more person-centred approach to commissioning. They talk of co-commissioning with people, and moving away from a time and task model. They also detail what is required for successful change: clear vision and purpose; good leadership; and the importance of valuing staff, not just through better pay, conditions and flexible working, but with career opportunities and progression.

Listen to Meilys and Alison speak about their journey to a person-centred model of commissioning. The audio and accompanying transcript provide detail of the practices they put in place and the tools they used to make change happen.

What can support this approach?

There was a lot of interesting discussion and sharing at our event on 9 February 2022. It echoed some of the points made in our initial event in this series back in November. These included the proposal for meaningful involvement that is relationship- or people-centred; better investment in the workforce; and how a rights-based approach needs to underpin actions.

Other supports suggested: 

Have a clear purpose

In Gwynedd the team was clear on the purpose – to help people live their lives as they wanted to. And this was key to getting buy-in from the team, keeping people focused, and to persist when things got tough. 

Keep it simple 

Consider what the person needs – what would make a difference to their lives – rather than overspecifying support contracts that create rigidity and bureaucracy, and are focused on cost savings rather than improving lives. 

Listen more and better

Ask what matters to people rather than what’s the matter with them, and find creative ways to hear people’s stories. Decision-makers need to know more about how it feels for people who need care and support to live the lives they want to – to be on the receiving end of 'commissioned services'. It feels very easy to focus on what care and support people need - and for the focus to be on services, rather than how the need is being created in the first place. 

Overhaul the system

Decision-makers need to recognise that getting support for people right involves community development, workforce development and empowerment of supported people – issues that require a complete system overhaul; it’s not just a commissioning and procurement challenge.

Improve the links between 'health' and 'social care'

In Gwynedd, health and care services in the locality now co-commission rather than create unnecessary competition in the support sector – health professionals, social work, care provider organisations and others, wrap services around the individual in a way that supports them when they need it, and encourage independence as much as possible.

Change the goal and the measures of success

Do we have the right goals and measures? If we focus on trying to help people have a better life rather than using planning and lagging measures, such as how much is being spent, how many hours people need etc, then the whole system improves as there is a focus on doing the right thing.

Invest in resource and capacity to make long-term change

An investment of time is required to: build trust; influence senior leaders; establish new relationships and keep relationships going when things get tough; test out new ideas and ways of working; and to start to influence national conversations. 

Listen to Meilys and Alison’s story.

If you missed our first event, be sure and catch-up –  read our short article and listen to Kiana Kalantar-Hormozi, an activist, artist and filmmaker, share her views from her own personal experiences of how we can get independent living support right for everyone.