Strategic Planning and commissioning

Planning service development in health and social care now requires tremendous breadth of knowledge and energy, to keep abreast of the policy initiatives emerging from the Department of Health.

The latest missive comes in the form of an Agreement (Building Capacity and Partnership in Care) (October 2001), concluded between the Department, representatives of the independent sector, local authorities and housing providers.

It signals an injection of cash into the system for getting people out of hospital, and into other settings, so as to free up more NHS beds. The agreement involves health, social care and independent sector providers of these services and housing, and it explicitly recognises that the care home system has become less stable.

To steady the market, it is promised that central government funding will increase by an average of 3.4% pa in real terms over the next 2 years. Local Strategic Partnership Forums are seen as the ideal setting for co-ordinating a strategy locally or regionally for the development of the range of services in current use.

The working principles behind the agreement are close and harmonious working relationships, good communication and constructive co-operation, openness and transparency, equity and trust.

We think that unless Members and Directors of health bodies are invited to read it and inwardly digest, and in turn reflect their commitment to it in proper allocations to social services and health services commissioners, it will not bear the desired fruit. The Agreement expresses the hope that all concerned will manage their business having regard to this Agreement, but of course there is no mechanism to make the independent sector toe this line, even if performance targets are useful in eliciting attempted compliance from public sector officers. This is no doubt why it has been put forward as ‘an Agreement’ – to foster and encourage consensus and co-operation, based on what will ultimately be no more than the mutual self interest of providers to remain solvent, and the commissioners to remain within budget…

As to care home fees negotiation, the Agreement does not mince words:

‘Providers have become increasingly concerned that some commissioners have used their dominant position to drive down or hold down fees to a level that recognises neither the costs of providers nor the inevitable reduction in the quality of service provision that follows. This is short sighted and may put individuals at risk. It is in conflict with the Government’s Best Value policy. And it can destabilise the system, causing unplanned exits from the market. Fee setting must take in to account the legitimate current and future costs faced by providers as well as the factors that affect those costs, and the potential for improved performance and more cost-effective ways of working. Contract prices should not be set mechanistically but should have regard to providers’ costs and efficiencies and planned outcomes for people using services, including patients.’

The agreement recommends that commissioners should produce medium term plans up to three years ahead, describing the services they intend to purchase and in what quantities. Block contracts or investment should be used to reward a provider for establishing a new service, or preserving good quality services.


Other points relevant to planning

There are several legal issues which may impinge upon successful planning which are covered on this site. Examples are duties vs discretionseligibility criteriainformation sharing, consultation, competition law, human rightsTUPE, factors relevant to externalisation and de-commissioning plans, charging law and joint working, including staff swaps and the Health Act flexibilities.

The Building Capacity Agreement makes the point that user satisfaction surveys are an integral part of establishing Best Value, and that those councils which have achieved Beacon Status for supporting independence in older people, demonstrated successful consultative and involvement techniques with the client and provider base.

The Social Care Institute for Excellence is responsible for establishing a knowledge base of what works in social care. Best practice guidance for commissioning is one of its priorities, to which strategic planners will eventually be able to have regard.


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