Commissioning Services to meet the Needs of People with learning disabilities in Scotland

1. Commissioning Services to meet the Needs of People with learning disabilities in Scotland View of those who use services

2. Learning Disability Alliance Scotland • Our job is to make sure that • the Scottish Parliament, • the Westminster Parliament • and local statutory organisations like councils • listen to the views of people with learning disabilities and their families and carers • and reflect these in all major policies, laws and changes which may affect them.

3. Commissioning up to 2005 • Early commissioning is characterised by • No Central Strategy from Government • Shared values at all levels • Haphazard growth based on local and personal connections • The Same As You (2000) was a ten year plan to modernise learning disability services • Established 3 yearly “Planning in Practice” agreements as a planning and commissioning tool.

4. What changed • PIPs were never fully embraced nor did they link to procurement. • Continuing local variations in how services were planned. • Local councils became responsible to 75% of spending on learning disability support • Commissioners worked with voluntary sector to deliver broadly what was in these plans and what fitted with the ethos of particular groups. • No agreed basis of quality but large investments in services.

5. Commissioning & Procurement Challenges 2006 on • Rise of public sector efficiency agenda - McLelland Report • Almost all external services had to be justified by “Best Value” and competitive tendering became the procurement tool of choice. • Local authorities seeking to reorganise “high” spending and rationalise “numerous” services • From 2006 – 2008 4 high profile Learning Disability were subject to competitive tendering.

6. Emergence of Competitive Tendering • Poor consultation. • Service Users information and consultation managed by Advocacy agency – a conflicted dual role • Limited involvement in procurement process in some cases. • Most Services Users were not told until one month before change – to avoid worry- and of course were unhappy worried and angry • Lots of anxiety during transition with some short term problems but managed okay. • In the long term – staff and management continuity has helped and service users have adjusted but still some resentment.

7. Competitive Tendering in Edinburgh • Whole service competitive tendering • 700 in Edinburgh • Aim of process was choice, quality, cost reduction and to meet the needs of those without a service. • Limited consultation • People very angry • Better organised in users & carers groups • Major campaign in Edinburgh

8. Why the concern? • Lack of choice of what happened to them • Had a different view of what was quality. • Many been involved in planning and consultation processes but not these plans were not used. • Contrast with public statements about user involvement and participation. • People had “hidden” relationships with support organisations. • People felt there were alternatives such as Direct Payments.

9. Candlelight Vigil

10. Demonstration at Council

11. Letter writing

12. Outcome • Competitive Tendering abandoned in Edinburgh. • Services users very happy. • Still talking about it. • Providers agreed 10% cut in costs. • New commissioning and consultation process drawn up.

13. National Award for Campaigning

14. A new Commissioning Strategy • Growing concern led to new strategy • Positive link between Commissioning and Procurement as part of overall process • Continuity between all stages of Analyse - Plan – Do – Review. • People who use services should be involved at different stages. • Different ways to involve people.

15. A debate on quality • 3 schools of thought • User Defined Quality - Talking Points • Proxy Indicators of Quality – policies, previous experience • Inspected Standards – eg medicine • No single agreed method • Only 2% found poor – given time to improve – not necessarily decommissioned. • National Involvement Network

16. Choice • Most people choose to stay where they are • Choice enters when services are bad or people have a bad experience. • Some reasons • Assessing, planning and delivering complex packages of care involve a lot of work. • Individuals are involved in “unseen” ways with organisations • However for many people there is no need to move house to exercise choice. • Eg service users involved in recruitment but also can refuse particular staff.

17. Self Directed Support • Personalisation seen as service change mechanism. • More control for individuals – can be linked to cost reductions but not necessarily. • Pilot project examples are good quality, slow and well received. • Only 963 people with learning disabilities or their families have such payments. • Most who voluntarily choose this have had bad previous experiences. • A number of local authorities including Glasgow are imposing a form of Individual Budgets.

18. Preventative Services • More Scottish Government investment this budget • Reablement for Older People • For people with learning disabilities • Clear Intended Outcomes • Local Service Coordination - • Accessible Information & Advice. • Emergency Planning - • Short Breaks - • Social And Friendship Support Flexible Support Budgets

19. Procurement in Scotland • PIPs have stopped and no major new plans or commissioning work recently. • No competitive tendering for existing learning disability services since Jan 2010. • Framework agreements more common. • Quality is a condition of contract renewal and service user views are a component of quality.

20. Future Developments • Self Directed Support will becomes default • Individual choice of support type and provider • Regulation continues through Care Inspectorate, Scottish Social Services Commission, OSCR • Local authority commission may limit degree of choice • More investment in preventative services