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Effective commissioning stays focused on the needs and preferences of service users and their carers. It concentrates less on the content of services and more on the achievement of demonstrably improved outcomes for users and carers. Authorities need to undertake regular reviews of service users' packages of care to track that outcomes are being achieved. Five 'A's and Five 'E's The aims of social care policy, at central and local level, can be distilled down into ten service outcomes, as experienced by service users and carers. These are the five 'A's and the five 'E's. Services should be:
Each of these service outcomes can be traced back to central government legislation or guidance. Each has implications for the way that authorities allocate their resources. It will not be possible to improve services along all of these dimensions simultaneously, so explicit priorities will need to be set. In Wales there are differences with the Performance Indicators used. Services should be Accessible: Under Fair Access to Care, (In Wales this policy is within "Creating a Unified and Fair System for Assessing and Managing Care.") authorities are required to offer services based on transparent eligibility criteria. Increasing use of electronic access offers opportunities for cutting down on the transaction costs of processing referrals. Accessibility is vital for learning about individuals and families at an early stage in their difficulties when intervention is likely to be most cost-effective.
Services should be Available: The Government is seeking to reduce the waiting times for services in both health and social care, as most recently exemplified by the proposal, in England to introduce cross-charging of local authorities for delayed transfers out of hospital to social care provision. Delays can lead to escalating need that will add to the subsequent costs of service.
Services should be Acceptable: Authorities are expected to publish the standards of service that service users and their carers can reasonably expect and to support users and carers in making complaints where these standards are not met. It is the expectation that services are increasingly customised to individual need and preference. Service providers will expect to be funded to meet those standards.
Services should be Appropriate: Legislation requires that authorities ensure their services are appropriate to the age, gender, sexual orientation, disability, ethnicity and culture of those for whom they are intended. Financial allowance needs to be made to ensure that the necessary features of service are in place, for example recruitment of the ethnic-specific staff.
Services should be Adaptable: It is incumbent upon authorities to adjust services to changing levels of need and/or changes in the objectives of intervention. To that end, authorities are required to review individual care plans at regular intervals. This is a statutory requirement in respect of looked after children and those on the child protection register. Contracting arrangements need to allow for some flexing of funding to cater for contingencies.
Services should be Empowering: Government has confirmed that the primary aims of statutory childcare agencies are to protect vulnerable children and adults from harm and to promote the independence of individuals, whether in enhancing the life chances of children or in minimising the dependency of adults. Furthermore, the ways in which services are provided are meant to be empowering in that service recipients are to be allowed to exercise as much individual choice as possible in the way they conduct their daily lives. The intention to make the Direct Payments option attractive to as many as possible is the latest manifestation of this aim. The extension of choice has significant cost implications as it is dependent on having spare capacity, but developments, such as Direct Payments, have the potential to reduce transaction costs with users themselves assuming many of the contracting responsibilities.
Services should be Efficient: Under the Single Assessment guidance (Unified Assessment process in Wales), authorities are required to develop more integrated ways of assessing health and social care needs to reduce current duplication, and to cut to a minimum the time between referral for assistance and the provision of the relevant services. Such integration means that services are experienced as more 'seamless' by users and carers. More efficient working also cuts costs, and contract arrangements should be ensuring year-on-year efficiency savings.
Services should be Economic: Under the aegis of Best Value (in Wales the Programme for Improvement), authorities have been expected to ensure that the commissioning of all services strikes the most appropriate balance between cost and quality, taking full advantage of the services provided by the statutory, voluntary and private sectors. The application of this principle should extend the range/volume or quality of services that are affordable.
Services should be Equitable: Authorities are expected to ensure that they maintain a consistency of response on the basis of need, irrespective of individual characteristics or of location. Services may be provided in different ways as between the town and country, for example, but all potential service users and carers should have the same basic choice of service options and the same quality of service. The charging for services has to meet the same standard of equity. Equity may have a premium for example additional travelling times in rural areas.
Services should be Effective: Services are required to demonstrate that they are able to identify and manage risks within acceptable limits both to the individual and to the wider community, as well as being required to evidence that they are enhancing the life chances and/or quality of life of all service users, whether they be children or adults. Specifying goals leads to more purposeful, time-limited interventions and promotes the decommissioning of ineffective services.
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