Millions of disabled people rely on state-funded services and the valuable care workforce in order to lead independent and fulfilling lives. Accessing the support they need, in the way and places they choose, is becoming increasingly problematic as fees for providers fail to keep pace with rising costs, needs and demand.
In our new report, ‘Reframing Commissioning: Provocations for Change’, developed in partnership with VODG (Voluntary Organisations Disability Group) we explore how commissioning practices can better enable disabled people to live the lives they choose. We draw on insights from VODG members, commissioners, people with lived experience, and stakeholders from across the sector.
Whilst the shifts described in this report are central to improving the ways in which third sector support for disabled people is commissioned, they also echo broader conversations about the changes needed in commissioning and across public services in general.
Key Insights from the Report
Current commissioning practices often bundle care into rigid units of time, with broad, generic ‘outcomes’ which don’t reflect the complexities of people’s lives and the systems in which they live. This report proposes something new, where commissioning:
- is shaped by the voices of lived experience.
- emphasises collaboration.
- looks to the long-term.
- encourages bravery from commissioners and providers alike.
In the short term, working towards this vision means commissioning services that meet people’s needs, where and how they choose; co-designing and delivering support wherever possible with disabled people and their families; and utilising the tools available within our current ways of working to maximise choice.
Longer term it means a significant shift of power to disabled people, carers and families. A move away from procuring units of time and the adoption of an agile way of working, which is likely to require a full system reset when it comes to billing, staffing and delivery.
Commissioners, providers and policy makers all have a role to play in putting the principles of the future vision into practice.
The shifts required to establish this vision include:
| From… | To… |
|---|---|
| Tightly defined services and contracts | Outcome-based commissioning which recognise and speak to the complexities of people’s lives, starting with what matters most to them |
| Unit costs and short-term efficiencies | Prioritising long term vision, value and sustainability |
| Poor level of insight about need and demand | Involving disabled people, their families, carers, and a wide range of stakeholders in exploring needs and assets across local systems and the life course. |
| Disabled people as passive recipients of care | Disabled people taking the lead and having choice and agency of the type of care they receive and how it is delivered |
| Risk aversion | Bravery, risk sharing and innovation |
| Top down approaches with rigid and inflexible contracts | Partnership approaches with space for ongoing learning, iteration and adaptation |
| Competitive approaches and siloed working | Collaboration and relational working across local systems and based on a shared vision. |
Importantly, the vision for the future is a shared one. It is one in which commissioners, providers and people accessing services are working together, supported by national policies and funding decisions. It involves not just a shift in relationships, but also a shift of power and a fundamental reset of the systems currently used to procure and deliver support services.
We want this report to serve as a starting point for further discussions and action. It lays the foundation for conversations about how we can collectively reframe commissioning, challenging entrenched approaches while promoting practical shifts towards better collaboration and co-production.
This report invites providers, commissioners, and stakeholders to come together and engage in bold, honest conversations about how they can work collaboratively to make the shifts needed to deliver the future we heard that they collectively want to see.
At Collaborate CIC, we are committed to supporting this shift through our work with commissioners across the country. Our Commissioning with Communities programme is designed for commissioners from a range of backgrounds who want to develop their practice to make resources work better for communities. You can find out more here or contact Amy Hurst for further information.