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Social care services and the provision of care for adults is coming under increasing focus, much to the delight of the Commission for Social Care and Inspection which is determined to see excellent, personalised care become a reality. Commissioning is at the heart of effective social care, according to the CSCI, and it is through effective commissioning that people's lives can be transformed with tailor-made services for each individual. With 70 years old being described as the new 50, and 60 as the new 40, there is an overwhelming need to address the problem of lumping older members of the population into the same group with the same services. As Dame Denise Platt, chair of CSCI tells The MJ: ‘One would not provide the same services for a 12-month-old and a 30-year-old, so why provide the same services for those aged 50 to 80?' There are many issues to address when looking at commissioning services. According to CSCI, one of the main questions regarding long-term care is, who is going to be responsible for funding it, and where will the line be drawn between the state and families? In the past, there has been a lot of concentration on contracting out services, and the main focus has been on price. And this has led to some concerns over quality. ‘The view that we must keep the costs down is part of the old agenda,' says Dame Denise. ‘Now, services need to be more tailor-made, and councils must be more in touch with the services people want. And choice is a major factor. People must be able to choose what they want.' Addressing a national commissioning and contracting conference last month, Dame Denise made it clear current ways of commissioning services had to change. ‘While some councils are beginning to show they understand this – that they must change – too many are still commissioning and contracting the same traditional profile of services for those whose care they expect to manage, with an over emphasis still on residential care. ‘The Wanless review of social care funding made clear that "additional money should not be forthcoming without a commitment to reconfigure services". And Wanless didn't mean "restructuring". He meant doing things differently.' Indeed, the ever-rising eligibility crisis from councils, due to funding pressures, means greater numbers of people are funding their care services, and they have very clear views on what they want to ‘purchase'. ‘Council have to bear this in mind when commissioning for services', she adds. Dame Denise also believe councils have a greater responsibility to engage with people at all stages when commissioning for services. ‘Councils shouldn't just approach people and say, "This is what we're planning, what do you think?" They should involve people at all stages, from conception through to delivery.' There is no demand for councils to learn new skills to achieve this, according to Dame Denise. They already have the skills and techniques in place to do so, and should look elsewhere within their organisations where they have effectively consulted. An increase in demand for services and an increase in costs above the price of inflation results in a difficulty to see the relations between quality and price. Councils and the NHS have also been struggling with budgets, which has provided an added financial burden. Next year, CSCI will introduce quality ratings, but until then, will provide councils with tools to assess their quality of services, and find ways to improve them. Clarity is another issue which must be dealt with, says Dame Denise. ‘People want inform-ation, but they also want an explanation,' she tells The MJ. ‘They want a proper health and social care assessment, which current legislation entitles everyone to, but this is not widely known. They then want to sit down and discuss what they need, which is when independent social workers could be employed. ‘At present, we deal with people in terms of services and not in terms of looking at the impact this has on the individual. ‘It's too easy just to say we have an ageing population. We have to see the differences between ages 60 and 90. People in their early 60s may want to continue working and contributing. Indeed, many do. If everyone in their 60s just gave everything up, we'd have major social problems. We must help people to remain engaged for as long as possible.' The new agenda for councils is definitely one of a personal focus. Councils have to rethink some of the traditional ways in which they have operated. They need to help adults remain engaged, but when they need services, they have to be available. If this revolution takes place and a step change can be realised in the way services are commissioned, provided and used, and a greater focus on keeping older citizens, a vital part of caring can be achieved. And it may not be long before we call 90 the new 60.

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Window of opportunity for care

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