Are you proud to be a commissioner?

30 March 2015

I hope so. Because being a commissioner is to play an absolutely indispensable part in caring for people at a time when they really need your help.

A good commissioner of health and social care is just as important to the wellbeing and happiness of people we love as a good nurse or a good care worker. They answer the question “What did you do today at work Mummy?” in exactly the same way. “I made sure that people, who needed support today, got what they needed.” I hope that each and every commissioner is proud of the important work they do.

I start there because every day we see the enormous pressures that commissioners face. Every day it seems that a politician is on the airwaves saying that resources are limited. And equally often frontline care workers and the people they support talk vividly about the gaps and shortcomings in the care that is available. And the place where these pressures collide is in the person of the commissioner. This must – and I think does – put them under enormous personal pressure.

To give just one example, at Leonard Cheshire we no longer bid for homecare contracts containing visits of less than 30 minutes, unless they are a matter of personal choice or for medication checks. We welcome recent guidance from government that councils should not commission 15 minute visits for personal care, however we remain concerned that inadequate funding for social care means flying care visits will remain a reality for too many people.

I could go on. And I’m sure that we could all go on to give examples where health and social care is today less than we would all wish it to be. Whether that is in terms of the esteem in which we hold those who provide the care, or the increasing number of people who receive less care than they need. But the answer is not to blame commissioners. Integration is certainly part of the answer. It will certainly make the money go further. To ensure a fair and sustainable system it is important that people can access care and support solely on the basis of need and not, as is currently the case, be restricted by whether these needs are defined as a “health” or “social care” need.

But an equally important part of the answer is for us to support commissioners. We cannot leave them alone to reconcile the irreconcilable twin pressures of insufficient funding and increasing numbers of people who need support. They must not go home at the end of every day feeling like all that they have done is make the best of a bad situation. They must be proud of what they have done. Because if they – who know most about
the standard and suitability of the health and social care they commission – do not feel proud of it, then nor can we, as taxpayers, citizens and friends and family of those who receive it.

So how can we best support commissioners? I think it is a question that we should all put to ourselves. One important way, I suggest, is for those who provide care to find better ways to be good and supportive partners to commissioners. We all want the same thing – high quality person-centred care. We know that personalised care and support helps people achieve the things that are important to them and that commissioning for people’s individual outcomes is the best way to ensure providers are directly focussed on things that matter to people. This ensures that providers can support people in a way that builds on their strengths – increasing their wellbeing and independence and, in many cases, decreasing their need for support in the long term.

Sometimes it seems to me that the only thing that is holding us back from building more trusting partnerships with commissioners is ourselves. So, perhaps we might begin a small but vital cultural change today. Let’s assume that everybody is trying to do a good job, to provide care that is great for people who need it. A job that we’re proud to do.

We know that commissioners know that care for people isn’t a widget that you buy by the dozen or by the minute. We all want great outcomes. So, let’s trust each other a little more and aim to provide those outcomes together as partners. Let’s have a commissioning process where the partnership and the trust and the transparency between providers and commissioners are the themes.

We would love this at Leonard Cheshire, because we know that great care comes from teamwork. And commissioners are part on the team.

Clare Pelham, Chief Executive, Leonard Cheshire Disability



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