On July 5th CEC Health and Social Care Dept launched its Market Shaping Strategy. Essentially an outline of a commissioning strategy for health and social care services it is the Dept’s response to Self Directed Support legislation and public procurement guidance, in a context of public funding which directs resources away from social care, despite acknowledged demographic pressures and social change.
The following is not a guide to the strategy and assumes some knowledge of it but does not try to cover all the very pertinent issues providers will have. Rather it poses some questions of a general nature as a means to stimulate thinking and contribute to the event EVOC is hosting on August 6th to capture views and comment on the draft strategy.
The document represents a significant shift by CEC. A few years ago a tender for care and support services was recalled in the face of organised action by people affected but not consulted on the changes. From that defining moment many lessons have been learned and we now have an open consultation on how best to organise for SDS options and the provision of services by third parties.
At the same time CEC has been espousing a more open and engaging approach to working with the people of Edinburgh. So we now hear things like ‘we’re all in this together, we need to work together, to cooperate and find joint solutions to common problems’ (to paraphrase). Indeed a Team has been established: Corporate Policy and Strategy Team – Third Sector, which is looking at ways to develop more cooperative approaches with the third sector and communities of the city.
Alongside a more cooperative council there are moves towards co-producing services (a recommendation from the Christie Commission). Co-production appears to mean that all stakeholders will be involved in the commissioning and delivery of care services (in this context). Co-produced services are promulgated as a means to make services more responsive and inclusive (and most likely if not cheaper then demonstrably of better value).
Cooperation, working together and co-production are all ideas and practices the voluntary sector has been familiar with since its inception. Now however the challenge is to uphold these values and principles in a market environment where vulnerable adults become customers and competition pits one company/association against another. An overarching question about the market shaping strategy particularly for voluntary agencies is the extent to which the strategy enables a market accessible and profitable, whilst allowing for development, quality provision and the best outcomes possible.
The strategy outlines new market opportunities:
- Jobs in health and social care provide an attractive choice for workers
- Opportunities for social enterprises in meeting a “growing demand for self funded help with household and garden safety and maintenance tasks” (page 6)
- Voluntary and community groups which “help people better understand the costs of growing old… will benefit from the changes [CEC] is making to its procurement arrangements” (page 6)
and a number of others. The question here might be does this section help providers understand new market opportunities; can a strategy do more to create new opportunities and if so, how? One consideration here might be to think about the range of services open to market players and how demand may be extended. Which is in one sense a question about the structure of the market – which services are in, which out, why and what are the implications of a market skewed towards one provider (who is the most expensive and also the purchaser)?
The strategy goes on to describe the nature of the market and how it may develop over the coming years ie what Health and Social Care Dept thinks may be the nature of need over the short and medium term. The information is detailed and helpful covering geography and the variety of need and demand among different populations. In this the strategy finds its feet and allows providers to consider where they sit now and what else and other may need to be done to respond to demographic and economic change.
The statistical evidence (at population level) gives a picture but cannot offer a comprehensive account of need. Local voluntary agencies have long had a finger on the pulse of the communities they serve and a purchaser would do well to include that intelligence. The risk in this respect comes from a shift in provision which precludes the smaller local provider and so risks losing their intelligence, their histories and the very means for building community resilience. What does the strategy offer in mitigation, and more, how does it actively promote co-produced local provision which elements of the sector have a strong track record in?
Much is made of the need to reduce demand on expensive services which meet higher level needs and a prime means of doing so is to enhance the role of preventive services. The sector has long occupied this market segment and now faces a challenge to grow into an expanded market and maintain its lead role in prevention. To do so requires new approaches one of which would appear to be social media – for many the jury is still out on the role of social media in addressing social care needs; the strategy needs to make a stronger case with a more explicit evidence base for its recommendations in this respect, and more generally across the piece.
One way of looking at the changes sees two markets – one for services that are free at the point of delivery, and another (for people on individual payments) which are not. Given the agenda for integration of health and social care this question assumes a place at the centre of how care provision will look in future, and may be a question more for an audience concerned with integration. However the dual nature of a user experience poses questions not only of presentation but may become a driver for behaviours with the potential to de-stabilise the market and threaten sustainability.
CEC’s market shaping strategy is the first of its kind in Scotland we are told. Just our luck perhaps?! More though the strategy appears as a genuine attempt to get to grips with some thorny issues and the opportunity to make it as good as it can be is very much welcomed.
And if you’re thinking this is all very well but what about procurement, where is procurement in all of this, and how will that part of the commissioning cycle be carried out, the strategy offers nothing. A variety of procurement methodologies are available and it is fair to say that tendering exercises across the piece show a lack of strategic vision and coherence – experience shows that some models are used at some times while different methodologies are employed at other times and little that is clear in determining which is used and when. The strategy may not talk about procurement but the voluntary sector needs answers to these kind of questions of resource allocation.