Commissioning: Care placements and sufficiency
Toni Badnall-Neill
Wednesday, January 2, 2019
A recent report warns of a crisis in care commissioning. Long-term planning is the only solution, says Toni Badnall-Neill.
The Independent Children's Homes Association's (ICHA) discussion paper, Onside on One Side, published last November, highlights the fundamental contradiction pushing care commissioning towards a crisis: where growth of placement supply cannot occur without expansion of providers' current profitability, yet local authorities need to manage or reduce spending within a financial climate of austerity.
In this paper, ICHA addresses a volatility of market conditions resulting from a culture of spot-purchasing individual placements. This causes uncertainty of funding in residential care, with demand outstripping supply but providers unable to respond and develop more provision due to instability within the sector and diminishing financial reserves. The paper advocates for a shift in the financial, emotional and professional environment that promotes "everyone working in a focused, child-led way".
This call for action from the residential market echoes recent messages from independent fostering agencies (IFAs). Although most local authorities operate framework arrangements to purchase fostering placements, an increasing volume of business now comes from spot-purchasing, with many agencies reporting half or more of placements spot-purchased solely by London boroughs. IFAs also identify the contradictory pressures of cost inflation and procurement cost pressures as barriers to sufficiency, along with the increasingly complex needs of children and young people now entering care.
ICHA and the Nationwide Association of Fostering Providers (NAFP) express frustration at the often-conflicting financial priorities of commissioning organisations and providers. NAFP stated earlier this year that there was too much of a focus in local authorities in making savings, with a risk that commissioners did not understand the cost benefits of making child-led placements, and the Onside paper emphasises the impact on sufficiency of such procurement-focused commissioning practices. It states: "The failure of local authority purchasers to recognise the impact on providers is self-defeating as it inhibits anything but cautious investment in the new capacity that the high demand and referral activity indicates is needed."
I would argue that these issues and their impact are recognised all too well by commissioners, who are often forced by budgetary pressures to make short-term efficiencies that can contradict good practice, storing up costs in placement breakdowns - and the human and social costs of poor longer-term outcomes - for further down the line. The dual constraints of increasing care costs and decreasing budgets are further exacerbated by rising numbers of looked-after children, creating a perfect storm for authorities with a statutory duty to ensure a sufficiency of accommodation for these children.
The one resource which can and should be shared more freely is intelligence. One key message from providers is that greater strategic commissioning activity is needed - not just purchasing packages of care on a placement-by-placement basis but establishing a clear picture of future need for volumes, types and outcomes of placements. A number of local authorities such as Essex and Suffolk are now making use of predictive analytics to forecast where children may be in need of early intervention, and this method can be equally well-applied to project and map demand for care placements.
Making better use of intelligence in commissioning strategies would enable both local authorities and providers to respond more proactively to demand. If we as commissioners know that over the next five years we will require, for example, 300 IFA placements, an average for how long these placements will last, and the levels of need carers must cater for, then we can make a business case for a longer-term commitment of resources or more stable contract. Even under a framework or dynamic purchasing system, clear and open communication of needs to the market offers security to providers wishing to develop their business to meet demand - and may provide the much-needed stability to avoid a crisis.
STEPS TO SUFFICIENCY: THE RIGHT PLACEMENT AT THE RIGHT TIME
- Framework agreements often have cost-capped pricing bands, which may deter providers from joining the arrangement and be a barrier to matching. Needs-led referral processes allow suppliers to offer more realistic quotes which may then be used as a basis for dialogue and negotiation.
- Both brokerage and strategic commissioning need to capture the voice of children and young people - many looked-after children report that they are not consulted in these processes, which can negatively impact the potential for making a good match.
- While ICHA's report calls for a moratorium on imposing outcomes in commissioning exercises, some providers welcome outcome-based specifications. These can be needs-led for individual young people or cohort-level, using individual outcomes to build up a picture across the care population and implementing contract performance indicators to measure progress.
- It is likely that some mixed economy of in-house, block-contracted and spot-purchased placements will always be needed to meet demand. However, better identification of what needs should be met by which placement is key to making them work.
Toni Badnall-Neill is strategic commissioning officer for children's services at Central Bedfordshire Council
FURTHER READING
Onside on One Side: A New Future for Children's Care Procurement and Commissioning, Independent Children's Homes Association, November 2018
Are We Valuing Care? Children's Services Essay Collection, iMPOWER, October 2018
A Review of Commissioning Arrangements for Looked After Children in London: Final Report, Institute of Public Care, July 2018
How Well Are Our Services Commissioned? Early Messages From the 2018 Survey, Nationwide Association of Fostering Providers, February 2018