National, regional, local

I recognise the importance of effective commissioning and am currently the director of children’s services sponsor for a regional commissioning hub. I absolutely agree with the CMA that the residential children’s home market is broken. So, the question I keep asking myself is…why am I not jumping up and down with excitement about regional care co-operatives as outlined in the government’s implementation plan for children’s social care?

• Conflicted over commissioning

I should declare an interest. I am one of those weird (and, in my case, not particularly wonderful) ‘twin hatters’ who is also responsible for both adult services and children’s services. As a result, I have, within my services, a really effective commissioning team who manage the adult residential care home market. The market boasts both sufficiency and quality. Where there are gaps in provision, they stimulate the market to fill them. Where there are quality issues, they work with providers to improve or, if they are unable to do so, to move out of the market.

Why then, can the same people not manage the residential children’s homes market with similar success? The answer is simple. The care home market is a local market. The majority of older people in Warwickshire care homes are Warwickshire residents. The same cannot be said of the children’s home market. Children in Warwickshire care homes are as likely to be from London or the south coast as they are to be from Warwickshire.

In the West Midlands we set up a commissioning hub about four years ago. You might suppose that this would be the obvious place to start from, when considering a care co-operative. However, it was never our intention to use this model to take over the commissioning function of our 14 local authority areas, instead it was to augment it. We recognised then, and still do today, that there are things best done locally, such as fostering, and others which work best regionally, like developing residential frameworks. It is important to recognise though that, even where regional frameworks have been developed, local authorities from other regions spot purchase the beds at a price above the framework price and, naturally enough, providers continue to sell ‘placements’ to the highest bidder. You cannot fix a national problem with a local or regional solution.

The same thing is true of different types of provision. While each local authority will have a need for residential homes, there will not be enough need for some specialist provision, for example for children with complex disabilities, for those with complex social, emotional and mental health needs or those who have been exploited. This could best be provided at regional level. Logical progression, therefore, might be to suggest that there may be merit in some things being done nationally too.

Returning to my excellent team of commissioners who do many things. They assess need and capacity across the area; they develop and manage the market; they quality assure; they focus on developing and managing relationships; they support and challenge providers. What they do not do is place people in care homes. When people move into their new home, they are supported by social care teams who know them and (often) their families well. Practitioners who understand their individual needs and recognise the stresses for anyone, of any age, related to moving home. Our children deserve nothing less. Any care co-operative model needs to separate strategic commissioning from finding a new home for an individual child.

Despite all of my doubts, I believe there is a place for a form of regional care co-operatives; just not on the basis that has been outlined so far. Bringing the commissioning resources of local authorities together, alongside health and youth justice commissioners (who are equally important in this work) to develop bespoke provision to meet children and young people’s needs; sharing quality assurance information (and potentially capacity); and developing regional frameworks through which independent special schools and specialist children’s homes can be accessed must surely be a positive.

Unsurprisingly, in order to make such a system work, there is an ask of government. The proposals put forward from the Department for Education, regarding our workforce challenges, has been promising. A similar set of national rules which required local authorities to commission residential children’s homes through regional frameworks would end the country-wide spot purchasing challenge; turning the national problem into a regional problem - and, of course, regional problems can have regional solutions.

Nigel Minns is director of people services at Warwickshire County Council and chair of the Association of Directors of Children’s Services (ADCS) health, care and policy committee. This blog was first published on the ADCS website.