It is important that commissioners work alongside people and families who use services to help drive changes in social care provision – as outlined in “Making it Real” (markers of progress in personalised, community-based support). Commissioners can add impetus particularly with their technical expertise of the funding arrangements.
Work with the partner organisations, and by the National Development Team for Inclusion (NDTi) in other areas has highlighted good practice and some key characteristics of successful commissioning that can help provide good outcomes for individual people. Some of these include:
- Getting top level support to free up commissioning, and avoid the excesses of mechanistic procurement/contracting processes;
- Good collaboration and partnership working between health and social care agencies over time, as exemplified in Ealing, Leeds and Milton Keynes;
- Integrated approaches to and agreements about funding;
- The development of specific joint commissioning strategies to improve work with and outcomes for people with complex needs, co-produced with families; these define individual pathways, and identify how risk is shared between partners.
- Starting with an acceptance that commissioners own the risk, providers manage it, made explicit in Milton Keynes;
- Taking a positive view about providers through efforts to sustain long term relationships with them through provider forums, regular meetings etc; good outcomes come from open, and honest relationships that engender trust. This is demonstrated in all three project sites.
- Using spot purchase or preferred provider arrangements to talk with providers about specific individuals;
- Investment in dedicated care management or care co-ordinator capacity to start and sustain in depth person centred planning for people;
- Prioritising long term relationships with potential housing providers;
- Using robust transition arrangements by building in to planning processes the time it takes for providers to build relationships with new people and their families – see information on project sites;
- Negotiating access to back up specialist support through things like intensive support teams, behavioural advisory teams, or specialist practitioners; these may be provided by health, social care and/or providers themselves.
- Positive and regular monitoring processes that identify problems early on, and can respond quickly to developing issues.
- Facilitating regular multi disciplinary meetings to monitor progress, trouble shoot, sustain the development of good outcomes as demonstrated in Milton Keynes;
- Sustaining the involvement and engagement of families;
- A willingness to challenge bad practice, and if necessary taking the action needed to make changes.
