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

1. User Involvement in Commissioning – Speech to Community Care Live
Rich Watts, Director of Policy & Development, ECDP (www.ecdp.co.uk)
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
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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.
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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
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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
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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
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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.
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