NDA Consultation on Commissioning of Disability Services

Presentation to NDA seminar on Commissioning - 30th of September 2011

The National Disability Authority

is the independent state body providing information and advice on disability policy and practice to the Minister, and promoting Universal Design in Ireland

NDA work on disability services funding

• NDA Review of Disability Service Systems, 2010o Three basic funding mechanisms identified in

jurisdictions reviewed as part of NDA 6 country review of disability services, 2010 Block funding Commissioning Direct Payments & Personal Budgets

• Ongoing NDA work on disability service system funding o Personal budgets & resource allocationo Commissioning

NDA work on commissioning to date

• “Preliminary view” paper circulated (August)

• Initial analysis of observations completed (September)

• Seminar with UK experts (September)o Sue Lloyd Selby, Senior Project Manager, Value Wales, Welsh

Assembly

o Alyson Dunn, Director of Development at Praxis Care in Northern Ireland

o Ian Hood, Coordinator of Learning Disability Alliance Scotland

Responses to “preliminary view” paper on commissioning • 20 responses as of the September 29th

• 6 individuals

• 7 service user or disability representative organisations

• 7 provider organisations (including two provider umbrella bodies and one private provider)

• Some organisations have indicated that they will submit late responses

Main advantages of commissioning

Service user views o Ensure service provision reflects the needs & views of service

userso Provide service users with more choice and controlo Focus on quality, person-centred services & personal outcomeso Drive personalisation of services & personal budgets

Service Provider Views o More transparency and accountabilityo Opportunity to expand / diversify o Greater focus on service quality and more choice for service

users o Local service provision more closely linked to local needs o Shift resources from poor performers / inappropriate modelso Force providers to examine their provision and “up their game”o Closer relationship between funders & service userso Better control of public expenditure

Main disadvantages of commissioning

Service user views o Create environment of uncertainty for service users, at least

initially o Divert resources to application writing and compliance worko Possible rise in service provision costso Fragmentation of responsibility for service provision

Service provider views

o Introduce time-consuming bureaucratic processes o Create short -term and possibly ongoing anxiety for service users o Could favour large, low-cost, for-profit providers – or even to more

institutionalised / congregate provision o Periodic renegotiation of contracts, even for very high-quality

providers, which will threaten providers’ ability to plan for futureo Lead to less skilled, less professionalised workforce o Could reduce service user choice

Risks associated with commissioning

Service user views o Focus on price, leading to diminished service qualityo Absence of commissioning skills within statutory sectoro Become a bureaucratic process that changes nothingo “cherry picking” of certain services which leads to service gapso Commissioning contracts may not cover “soft” but vital supports

Service provider views o Contract “cherry picking” leading to service gaps in rural areaso Expertise and independence of commissioners o Failure to align with other initiatives (Standards, CS, ADS, PBs)o Could reduce service user choice by favouring “big battalions”o Commissioner may be too powerful vis-à-vis providers o Absence of national quality assurance systemo Industrial Relations and implications of TUPE requirements

Critical issues to get rightService user views

o System of assessment of service users’ needso Role and function of commissioner – should they be in health

sector? should commissioning & procurement be separated?o Service user involvement in commissioning processo Balance between specifying service requirements & flexibility

Service provider views o Transparency and evidence base of commissioning process o Balance between price and quality / innovation / individualisation o Appropriate support / brokerage services for service users o Recognition of holistic nature of support provisiono “True” contracting culture (sanctions for breaches by either party)o Appropriate parameters of competition / negotiation processeso Establishing a common understanding of what “quality” meanso Quality assurance systems

Open Discussion

Next steps & closing remarks

• All submissions (subject to permission) and accompanying analysis published to NDA website (October 2011)

• Report of seminar proceedings published to NDA website (October 2011)

• This will inform NDA advice to the Minister

Light Lunch