National Care Service: Ethical procurement co-design report

What we learned

Our findings from this research fit broadly into 3 themes. These are: People, Quality and Ethics.

People theme: lack of trust and equality in decision making

People told us there is a lack of trust in how decisions are made and how care contracts are awarded. They felt left out of discussions and did not trust that their input is valued in the same way as the paid workforce. They told us people who access services should be involved so that services are right for people. They also said that it can be intimidating. It is important that everyone involved in decision making has the same power and value.

We were also told that:

• people feel there is a power imbalance between people with lived experience and council staff. This needs to be addressed to allow for better engagement
• speaking to civil servants can be intimidating and they do not feel welcome when they visit government buildings
• training should be given to procurement staff so that they are trauma informed when working with supported people
• the word “procurement” was seen as intimidating. “Help finding the best service” was suggested as a better phrase by one group
• it is important the procurement process gives everyone an equal opportunity to be involved

During the discussion people said:

• there is a “lack of public trust in how decisions are made” Participant from Glasgow Disability Alliance
• “people should be treated fairly [so] there isn’t any discrimination, and they should make an extra effort to include people with additional support needs”. Participant from Action for Children
• “trauma-informed approaches were seen as vital to ensure the process is supportive and inclusive.” Participant from SACRO
• “hybrid should be the default. This is particularly for people in the islands who may be unable to attend mainland conversations without an impact on cost and quality of life”. For example, the energy used to join conversation. Participant from Glasgow Disability Alliance
• It is “important everybody gets the same quality of participation”. Participant from Glasgow Disability Alliance

People theme: people should be involved throughout the whole process

All groups said they want to be involved in procurement. They told us disabled people should be involved in the checking quality and contract management. How people want to be involved changed depending on the person. But most people agreed involvement should be meaningful.

We were also told:

• the All in for Glasgow project was a good experience. People were involved in developing a specification, evaluating tenders and training sessions were given
• having different options to participate would be best. It would mean people can chose to be involved at a level that is right and valuable for them
• involvement in procurement is not just at the start, it should be throughout
• using trusted organisations to get your voice heard is a good option

During the discussion people said:

• “if you don’t include people then you’d just end up with a rubbish service, people would go to it for a bit, realise it’s no good and leave.” Participant from Action for Children
• “we don't need to hear about how the government works … we need to hear about and be involved in discussions about how this will impact our care.” Participant from SACRO
• “good examples to be shared; learning from each other is important. When something works, be open about it and share”. Participant from Homelessness Network Scotland
• [we] “need help and support from a trusted advocacy group such as MECOPP for gypsy traveller communities” and there is an “important role for advocacy.” Participant from MECOPP

People theme: training and support is needed for meaningful participation

People felt that they should be given enough time and resources to participate. They also want training and support so they can participate well.

We were told that:

• people want significant training in procurement to allow them to participate meaningfully as equals
• if people give up their time to assist with a procurement process, they should be paid for their involvement
• young people should be reimbursed for their time as well as receive quality vocational training and experiences
• having taster sessions so that people can find out more about procurement and understand what the participation will look and feel like was suggested

Here are some of the things people said during our discussions:

“Good procurement means that people involved are open to change; open to discussion, open to accept they’re wrong and open to ‘bend’ and adapt ideas and processes.” Participant from Homelessness Network Scotland

“Participants expressed a need for training that covers the totality of procurement, including its purpose, terminology, and processes.” Participant from SACRO

“I feel like I’d want to meet someone and they’d explain to me what would happen and that I could ask them questions before I actually became fully involved. As it would be all new people and a new thing, so that would help me.” Participant from Action for Children

Quality theme: high quality services are person led and flexible

People told us procurement can have an impact on the quality and flexibility of services they receive. People told us social care services need to be flexible enough to meet their needs and outcomes, be person-led and of a high quality. People also want a stronger focus on services that work together to provide ongoing support to meet all a person’s needs. For example, services that address issues like:

• mental health
• substance misuse
• housing situation
• unemployment
• prison social care

Care should come together so that the whole person is supported. Procurement should support all of this.

They told us:

• if people can choose their service package, they are more likely to identify services that meet their needs best and have healthier lives because of this
• care should focus on achieving outcomes and not tasks from set lists
• it is important people can give their honest opinion of the quality of services
• one idea was that people should be able to review the services like TripAdvisor to test quality and hold the service providers to account

During the discussion they said:

“High quality support services are incredibly important for people experiencing homelessness.” Participant from Homelessness Network Scotland

"As carers assisted with the surveys, service users felt unable to give honest feedback." Participant from Glasgow Disability Alliance

We “need staff to be confident and empowered to make decisions and provide flexible support not just from a restrictive list of tasks.” Participant from MECOPP

Quality theme: human rights is at the centre of quality

Taking a human rights-based approach is very important. It helps stop stigma. Putting human rights at the centre of procurement should provide a better quality of life for people who use the services and a better use of resources for the health and social system. It is also needed for financial transparency and fair work.

They told us:

• social care support staff need to be trained in the culture as well as conditions that the people they are supporting need help with. This should be a part of fair work.
• when trying to improve support services, there is a need for equality and fairness with other communities. This means supported people are not mistreated because of the community they belong to
• it is really important for people to know their rights

During the discussion they said:

“People should be treated fairly and there isn’t any discrimination and they should make an extra effort to include people with additional support needs.” Participant for Action for Children

“Handwashing is often done outside, and it is disrespectful to wash hands in the kitchen sink…[This] impacts on gypsy travellers quality of service due to relationships with care workers.” Participant from MECOPP

Quality theme: consistency of care, and the workforce is important

People suggested good procurement involves longer commissioning cycles where workers have stability and long-term contracts.

They also told us:

• fair work can have an impact on the quality of service people receive
• the stability of support services is important as changes can impact the quality of support and relationships
• for people accessing support for domestic abuse, services that are split up, are less safe. This increases stress and make accessing support more difficult.

Here are some of the things that people said during our discussions:

“Looking for the best and the right people for jobs; people-driven and looking for the best in the community and in the hearts of the people that they’re working with and for.” Participant from Homelessness Network Scotland

“same worker attending each week so that trust and relationships can be built.” Participant from MECOPP

“Poor procurement was described as contributing to fragmented services that fail to work cohesively, particularly in a domestic abuse context” “lack of integration can compromise safety, exacerbate stress, and make accessing support more difficult.”

Participant from SACRO

Ethical theme: getting the ethical principles right

We asked for feedback on:

• what ethical means
• the draft ethical commissioning and procurement principles.

Some people felt the principles were unclear. People talked about how:

• important their involvement in procurement was
• how human rights should be at the centre
• workers should be treated fairly

Other feedback included:

• people expressed support for an additional ethical principle on the ‘importance of local’
• people felt it was important the principles are a “must do” rather than a “should do”
• one group proposed an additional ethical principle “we should listen, learn and adapt to what is people are telling us they need”
• ethical should mean that people get the same level of care and support and quality no matter their circumstances
• one young person felt ethical principles should do more to prioritise equality, diversity and inclusion
• young people felt that the principles were quite confusing and not easy to understand

Here are some things people said during the discussion:

“Local workers and local companies deliver the services to boost the local economy.” Participant from Glasgow Disability Alliance

“Language is important - we need commitment to build trust.” Participant from Glasgow Disability Alliance

“Human rights at the centre of the work. People need to know their rights.” Participant from Homelessness Network Scotland

“Ethical means accessible language, no jargon, it needs to be understandable to everyday people” Participant from MECOPP

Ethical theme: the environment

People told us they are unsure about the climate and circular economy being one of the ethical principles. They are worried that measuring carbon footprint could negatively impact on people’s experience of services. They are also worried it could lead to councils buying services that are not person-led but have a better environmental impact. They told us it needs to be clear that human rights and person-led social care support comes first.

• one group noted if you do not get the right support, it can have an environmental impact. For example: more use and disposal of incontinence pads
• relying on ready-made meals with more plastic

This should be included in the guidance on the principle of the environment.

Here are some of the things people said during our discussions:

“Environment it's too broad a term. Need to understand does this mean carbon footprint or social environment, general living environment [or something else].” Participant from Glasgow Disability Alliance

“Service users may end up being required to utilise a bus to cut down on carbon footprint, but this might not meet their needs or help them achieve their goal.”

Participant from Glasgow Disability Alliance

How we will use this

We will:

• use findings to help improve the ethical commissioning and procurement principles
• consider how we can make improvements that will with these challenges
• consider how procurement evaluates the quality of services so that it supports what people have told us is important to them
• do more research on these examples and share them with our procurement working group
• include the findings in our development guidance for the principle of full involvement of people with lived experience