The impact of the Health and Social Care Standards on commissioning 

Published on 30 Mar 2020

Introduction

April 2020 marks two years since the new Health and Social Care Standards were introduced. Iriss invited commissioners of adult social care to join us in roundtable discussions to explore perspectives on the impact of the Health and Social Care Standards on the commissioning process. 
 
We were interested to understand more about how the Standards have been impacting across the broad spectrum of adult social care providers and commissioners from statutory bodies, third sector and independent organisations. Through these discussions we aimed to provide a space to take stock and put down a place marker on the current landscape of commissioning of adult social care by identifying what supports good practice in commissioning and opportunities to take this further.
 
The first discussion took place on 27 February 2020 with another scheduled for 30 March. Due to Covid-19 this second event has been postponed.  31 people had signed up to the two events, representing a spread across local government, independant and third sectors, with more interest registered from people in non commissioning roles.  In response to this, but to keep the events grounded in the perspectives of commissioners, we have offered a feedback session with discussion to those interested who are not commissioners. This will be scheduled in due course to follow on from the second re-scheduled commissioners event.

This short report summarises the first event discussion points, covering the evolving landscape of commissioning, what enables and slows down good practice in commissioning, and how commissioning can be best supported in the future. 

Impact of the Standards on commissioning so far - an evolving landscape

  • Standards are not necessarily the catalyst but they complement other changes such as Integration. They are a bright thread within the ‘messy spaghetti’. 
     
  • There is a different approach to monitoring now, it is less ‘clipboard’ and more strategic. When this works it leads to an improved relationship with providers.
     
  • The standards reflect a growing joint approach between commissioners and providers to improve outcomes for people.  
     
  • These standards are more aspirational and people focused than the previous ones. They are also aspirational for future users of services, as they can support future thinking by providing a framework.
     
  • The standards require, and also support, increased engagement with people who access services.
     
  • They are helpful for working with people in a less siloed way. Along with the integration agenda this is showing a shift away from procurement to operational services.

Challenges to address

  • It takes time and support for people to conceptualise what HSCS mean and how they apply.  
     
  • The standards haven’t had the same impact in some spheres such as Health. There are questions about how the Standards, Social Care and Social Work are assimilated into the Health model and approach. This is having an impact on the extent to which they have embedded so far.
     
  • Health and Social Care Integration legislation doesn’t include all the independent sectors (as it only relates the standards to voluntary organisations). However the standards can act as a useful bridge over this, as people have the right and permission  to request appropriate care for them. Standards therefore, support the Independent sector to enter this space and engage in more complex conversations.

Looking to the future

What will enable future good practice in commissioning?

  • Policy and legislation
  • Ongoing examination by Scottish Government of the conflict between self-directed support legislation and procurement legislation
  • Adult social care reform
  • SXL care and support framework has potential to be a tool for change
  • Improved articulation of social work and social care

Data

  • Open data sets
  • Data-driven decision making
  • Clean data sets - citizen owned and shared access to data

Leadership and workforce

  • Collaborative and compassionate leadership > coproduction >shifting resources around > investment in relationships
  • Investment in an integrated workforce
  • Future proofed skillsets - access to qualifications and training
  • Health sector engaging more with the Standards

Service delivery

  • Shift the focus away from delayed discharge
  • User centred service design that breaks down barriers and silos
  • Technology as part of everyday support plans
  • Multi and inter-disciplinary working
  • New models of care and support
  • Locality working and generic social work: Why do we try to separate people?
  • Compassion and support for people and families - not MH, Justice, Substances
  • Full implementation of SDS and human rights in services

Commissioning practice

  • PANEL principles applied to commissioning decisions - all the way up to IJB level
  • Recognise care is a complex system
  • Reciprocity in contractual arrangements - what can we (commissioners and providers) offer each other?

What will boost future commissioning of adult social care?

Culture

  • Increased public understanding of their rights and of the Standards.
  • Moving away from silo mentality. True integration will require a major cultural shift.

Commissioning practice

  • Open and honest communications with providers - make good provider forums
  • De-commissioning less effective services
  • Prevention and early intervention approaches
  • More investment at the front end

What will continue to slow down positive change to commissioning?

Silos and separation

  • Policy silos e.g. substance/ MH/ Adult Social Care/ Prisons/Community Justice
  • Traditional models based on task/time - the ‘medical’ model
  • Information sharing practices, often it is a bureaucratic issue that prohibits effective sharing e.g. local authorities and NHS (even when integrated).
  • Legislation that is not inclusive of entire independent care sector
  • Power and lack of transparency

Service delivery and workforce

  • Austerity and funding impact on services
  • Workforce shortages

Monitoring

  • Measuring the wrong things e.g. ‘delayed discharge’ instead of a person’s experience of their HSC journey

Evaluation: what did participants take away from the discussion?

  • As a commissioner, I need to work more closely with social work.
  • Really interesting conversations and better insight into how people feel about the standards.
  • Taking the headspace to think this through has made me re-focus on the value of compassionate commissioning and how I can promote this through practice.
  • The standards have been positive. There is still a way to go to fully embed them with health services to fully reach their potential.
  • There’s a shortage of carers.
  • Consensus around the situation from practice, providers, commissioners.  
  • Great conversation and connections.
  • Confirmed complexity and challenges - of ‘transformation’ and a possible direction of travel.

Participants agreed that it had been a helpful and thought-provoking discussion forum and were keen to return in a year’s time to reconnect and continue the conversation.  We look forward to further conversations at rescheduled events later in the year and will share additional learning and reflection points as they emerge.