3. Wider context
'Strategic commissioning is about challenging historical spending patterns in light of what we know about population need. While that will be different for each partnership because of varying populations of need locally, it is likely that all partnerships will have to deal with the two major trends of our time - our ageing population and an increase in co-morbidity.
'These changes to our population require a different type of health and social care system, one that is modelled on supporting people to live independently in the community. Therefore the real added value of strategic commissioning will be in our ability to shift resources from the old model to the new model. It is not a panacea, but it is a crucial element of reform.
'To optimise the effectiveness of strategic commissioning, we now need to redistribute power from the centre to partnerships and localities.'
Ron Culley, Chief Officer, Health & Wellbeing at CoSLA
3.1 The Commission on the Future of Public Services, 'the Christie Commission', identified, as a priority, "maximising scarce resources by utilising all available resources from the public, private and third sector, individuals, groups and communities", while adding "implementing better long-term strategic planning, including greater transparency around major budget decisions like universal entitlements".
3.2 The Scottish Government response to the Christie Commission set out four pillars of public service reform that should be kept in mind when developing plans for public services:
- A decisive shift towards prevention;
- Greater integration of public services at a local level driven by better partnerships, collaboration and effective local delivery;
- Greater investment in the people who deliver services through enhanced workforce development and effective leadership; and
- A sharp focus on improving performance through greater transparency, innovation and use of digital technology.
3.3 In 2012, Audit Scotland reviewed how effectively the public sector commissions social care services, examining how well Local Authorities and their partners plan, and either procure or deliver, effective social care services. The report contained a number of key messages and recommendations. In summary, the key messages were:
- Councils and their NHS partners need to do much more to improve how social care services are planned, procured and delivered, through better engagement with users and providers and better analysis and use of information.
- People who need small amounts of support are not being offered the preventative services that might help or delay them needing more costly intensive support.
- More needs to be done to manage the risks to users when a provider goes out of business or closes, including contingency plans and financial monitoring of voluntary and private providers.
- Users and carers need to be more involved in decisions about social care services, with better evidence of what differences the services make to people's quality of life. Councils may need a significant amount of support to effectively implement self-directed support.
3.4 Strategic commissioning plans should be developed to take account of the Scottish Government's 2020 Vision for Health and Social Care, of which integration is, of course, one of 12 priorities.
Our '2020 Vision' for health and social care
Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.
We will have a care system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.