Policy Press
3 Dilemmas in the commissioning of adult social care
Abstract
In broad terms, ‘commissioning’ refers to the process of the planning and strategic purchasing of services. While there are many models available, they all fundamentally break down into four key areas:
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analysis: understanding the value and purpose of the agencies involved, the needs they must address, and the environment in which they operate;
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planning: identifying the gaps between what is needed and what is available, then deciding how these gaps will be addressed;
-
doing: securing services and ensuring they are delivered as planned; and
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reviewing: monitoring the impact of services and ensuring future commissioning activities take review findings into account.
The danger is that these complex activities are, in practice, reduced to a competitive tendering activity, often framed by a rigid set of costed outputs and complex contract conditions. As seen in Chapter 2, local authorities were required to radically shift their role from direct provision to commissioning. In so doing, they stepped into an unfamiliar world, one that is normally found in commercial business, such as sourcing providers, negotiating contracts and monitoring arrangements. The research conducted in the 1990s by Wistow et al (1994, 1996) revealed what a culture shock this was at the time for local councillors, officers and front-line staff, who were more accustomed to a traditional ‘welfare state’ model. It might be expected that since that time, there would be greater familiarity with the task and less resistance to the principle but this is not necessarily the case.
Abstract
In broad terms, ‘commissioning’ refers to the process of the planning and strategic purchasing of services. While there are many models available, they all fundamentally break down into four key areas:
-
analysis: understanding the value and purpose of the agencies involved, the needs they must address, and the environment in which they operate;
-
planning: identifying the gaps between what is needed and what is available, then deciding how these gaps will be addressed;
-
doing: securing services and ensuring they are delivered as planned; and
-
reviewing: monitoring the impact of services and ensuring future commissioning activities take review findings into account.
The danger is that these complex activities are, in practice, reduced to a competitive tendering activity, often framed by a rigid set of costed outputs and complex contract conditions. As seen in Chapter 2, local authorities were required to radically shift their role from direct provision to commissioning. In so doing, they stepped into an unfamiliar world, one that is normally found in commercial business, such as sourcing providers, negotiating contracts and monitoring arrangements. The research conducted in the 1990s by Wistow et al (1994, 1996) revealed what a culture shock this was at the time for local councillors, officers and front-line staff, who were more accustomed to a traditional ‘welfare state’ model. It might be expected that since that time, there would be greater familiarity with the task and less resistance to the principle but this is not necessarily the case.
Kapitel in diesem Buch
- Front Matter i
- Contents iii
- Preface and acknowledgements iv
- Introduction 1
- Before the market 7
- The emergence and consolidation of the market 15
- Dilemmas in the commissioning of adult social care 31
- Dilemmas in the provision of adult social care 47
- State or market? 63
- Context: funding and administration 75
- Looking ahead: an ethical future for adult social care 91
- COVID-19: the stress test of adult social care 117
- Conclusion: making it change – morals, markets and power 133
- References 149
- Index 179
Kapitel in diesem Buch
- Front Matter i
- Contents iii
- Preface and acknowledgements iv
- Introduction 1
- Before the market 7
- The emergence and consolidation of the market 15
- Dilemmas in the commissioning of adult social care 31
- Dilemmas in the provision of adult social care 47
- State or market? 63
- Context: funding and administration 75
- Looking ahead: an ethical future for adult social care 91
- COVID-19: the stress test of adult social care 117
- Conclusion: making it change – morals, markets and power 133
- References 149
- Index 179
