This blog was written by Hannah Gains and Tom Hindmarch
Last month, iNetwork hosted an event, about “Social Value in Social Care Commissioning”. This event explored the complexities and challenges in adult social care as well as how Social Value can be embedded in the sector to improve delivery and commissioning practices.
The event was chaired by CPC Deputy Chair Nichola Cook; she opened the event by outlining the challenges, explaining how austerity has added a lot of pressure to commissioning practices.
Greater Manchester Combined Authority: Implementing the Real Living Wage in Social Care
Ravi Badat, Economic Strategy Programme Lead, from GMCA delivered the first presentation of the session. He was asked to discuss how Greater Manchester is implementing the real living wage in the social care sector. Ravi outlined that GMCA, in partnership with the Living Wage Foundation, aims to ensure that all employers pay the living wage by 2030. Ravi explained that one way GMCA is planning on achieving these ambitious goals is via the Greater Manchester Good Employment Charter, which is a voluntary membership and assessment scheme which works cross-sector.
The Living Wage campaign aims to raise employment standards across the borough and has seven main work streams, one of which is health and social care. The Health and social care sub- group, led by Unison, is committed to bring all local authority and commissioned social care services up to the living wage. Ravi stated that all ten unitary councils within Greater Manchester have agreed in principle to pay the living wage and put pressure on commissioned services to do the same, despite the estimated £25-30 million funding gap.
CLES (Centre for Local Economic Strategies): Considering a Community Wealth Approach to Social Care
Tom Lloyd Goodwin from the think tank, CLES, was invited to share his perspectives from research he has undertaken into social value in social care. CLES were approached by the Association of Directors of Adult Social Services (ADASS) with the aim of exploring what a Community Wealth Building (CWB) Approach could look like in social care commissioning. CWB is a progressive approach that utilises local businesses and communities to retain as much wealth in the local economy as possible. As part of the research CLES worked with the boroughs of Knowsley, Newham and Wigan to apply the concept of CWB to adult social care.
Tom mentioned the process highlighted two important aspects to commissioning, firstly choice and control for service users and secondly minimising the extraction of wealth. There is no one-size-fits-all approach to social care commissioning. Tom posits that local authorities have choice, and that outsourcing care services to multinationals is not the only option; commissioners should explore alternative ownership models including community ownership and insourcing where possible.
Tom went on to talk through three case studies. In the first case study, London Borough of Newham recently insourced elements of the care service. This was coupled with involving the voluntary sector to run memory cafes for dementia patients. Tom noted that Newham are acting as strong market shapers, having tighter controls on who has access to their market by adding additional specifications around local geographical knowledge, equality and diversity and pay to contracts.
Similarly Wigan Council have also undertaken similar market shaping exercise to encourage smaller less extractive providers within the region. Tom mentioned Wigan Council have had a committed approach to developing Community Interest Companies (CIC), ensuring place-based delivery within certain aspects of the care service provision.
The last case study, Knowsley Council, has a long standing history of housing a number of care services in-house. Where services are outsourced, Knowsley Council engages smaller local providers in order to minimise wealth extraction. The local authority is utilising grants to develop suppliers and simulate alternative models of ownership in the sector.
Tom finished his presentation by suggesting ways the sector can scale up this approach, he identified four key points:
– Position adult social care as a key sector within a strategies.
– Support alternative models of ownership.
– Explore opportunities for more insourcing.
– Make greater use of social licensing
STAR Procurement: embedding social value within a shared procurement service
The third presentation came from Peter Walpole, Category Manager at STAR Procurement. STAR Procurement is the shared procurement service for Stockport, Trafford, Rochdale and Tameside councils, and including NHS Trafford CCG and NHS Tameside and Glossop CCG. Peter firstly outlined why social value was important and how it is represented within policy, noting GMCA’s regional social value policy and highlighting how social value was also a corporate priority in many of the local councils they work with.
Peter went on to discuss how STAR Procurement measures and ensures social value is included upfront in contracts to ensure it is not merely an afterthought during the delivery of the contract. Peter explained that they use a Social Value Portal (SVP) on all contracts over £50k to ensure every aspect of the contract measures social value against relevant themes, outcomes and measures that are nationally recognised. The online tool applies an estimated monetary value to the social value metrics on each contract, which allows measurement of Social Value on a ‘like for like’ basis.
In the tendering process STAR Procurement works closely with any potential suppliers to explain the importance of social value and provides advice and documentation to support providers to embed this into their bid. Social Value is then constantly monitored through the course of the contract with suppliers required to update on their progress against specific Social Value KPIs set by STAR Procurement, which are reviewed on a monthly basis.
Academic Research: The Potential of Priceless Procurement
Sandra Hamilton, a PhD researcher at the University of Manchester and procurement advisor, followed up with her presentation and research regarding the concept of priceless procurement. Initially borne from her work in Canada around Social Value, Sandra provided delegates with an overview of her research and encouraged the audience to reflect on existing procurement and commissioning practices within the sector to consider whether changes or adjustments in the way these are undertaken could: improve the wellbeing of the staff; increase staff retention; and improve the services and support offered to those who are receiving care. Sandra advised that the working demographic in Canada is very similar to that of the UK; both countries have a shrinking workforce and a decline in birth rates, leading to an ageing population and workforce. The implication is that there will be an increased need for social care for the existing workforce in the next few years, but with a reduction in the workforce, this is likely to have a significant impact on the ability to provide this support if the continuing trend of decline in the social care workforce continues.
The concept of Human Centred Design has been promoted successfully in both Canada and Australia and focuses on providing a voice to the workers and the community being served, in order to improve services and outcomes. Sandra reported that social norms are changing and we need to consider how we can work together to change the mindset and outcomes of services in order to improve working conditions and promote the fair treatment and retention of staff. By adopting this approach within Social Care, it will encourage staff to have the autonomy to contribute to the improvement of their employment and workplace ethics. Research has shown that there is generally a feeling of “belonging” within the NHS, that isn’t necessarily echoed within the social care sector. There is progress within this area, for example, the Greater Manchester Employment Charter, championed by the Mayor of Greater Manchester, has been a significant driver into improving the working conditions for staff. However it is felt that this is not yet being embedded into social care procurement practices as well as it could be.
Sandra went on to explain that the focus and mindset of procurement is changing; the global pandemic has had a significant impact on this. The focus on cost has now been replaced with value, sustainability and the quality of work and the workers, unlike practices in 1994, which focused on awarding contracts to the lowest priced bidder. The demise of companies like Carillion was a turning point for the Government and embedded the need for more balanced requirements. There is a culture shift within the UK: commissioners are now being awarded more freedom to “do things differently”, however, the existing parameters and cultures within Local Authorities is a significant barrier to enforcing this change.
The Care Act 2014 places a duty on the local economies to shape the care market and to focus on promoting person-centred care for those receiving the services, but there remains the question of who cares for the carers? It has been widely accepted that the historical “time and task” approach to care planning is unsuitable for both carers and the cared for and there has been significant progress in the way that care planning is approached by both local authorities and care agencies, however the issue of staff recruitment and retention remains, therefore impacting on the ability of care agencies to improve outcomes for service users and carers. Presently, evidence suggests that within the independent care sector, approximately 71% of staff are paid less than the Living Wage and there is an average staff turnover of 30%. This is not sustainable and is expensive for providers, it also has an impact on service users as there is a lack of available carers to provide support. Within Greater Manchester, 5 out of the 10 Local Authorities in the borough are either paying, or are on the way to paying, the Living Wage for care staff as part of their procurement and commissioning practices.
Finally, Sandra asked delegates to consider and reflect upon 3 key concepts that may be utilised in promoting the recruitment and retention of the social care workforce:
The provision of electric cars for the domiciliary care workforce
– Currently, care workers are required to provide and use their own vehicles for work and with the rising cost of fuel, this can be a barrier to employment for some.
– By leasing electric vehicles, this could promote engagement of staff who may feel excluded from this line of work due to a lack of reliable transport.
– 45p per mile is currently paid to workers who claim mileage expenses. Some staff travel over 400 miles per month, this would be equitable to the cost of leasing an electric vehicle to the care agency for the staff to use in their roles.
– This would also benefit the climate emergency and would substantially reduce emissions and promote the social value of the care agency
Effective use of the Apprenticeship Levy
– Could this be used to support domiciliary care staff to further their professional development and career path?
– By actively supporting staff to achieve further qualifications, staff are more likely to remain within their employment.
Utilising Priceless Procurement in Social Care
– We need to shift the focus from measuring contracts based on price, instead awarding based on social value.
– This would require Local Authorities to change their commissioning practices to advising the market how much money a contract is worth and basing the award of these on the quality of the care and the overall social value.
– Would this then stimulate more market engagement from care providers and encourage more collaborative procurement?
If you would be interested in discussing any of the key points with Sandra, she is eager to hear any feedback regarding her proposals and research. Please email Sandra for further information.
Social Enterprises – How can they help?
Finally, delegates heard from Nancy Towers at Social Enterprise UK who provided an insight into the characteristics of Social Enterprises and how some of these agencies are paving the way in changing the face and delivery of social care. A Social Enterprise can typically be described as a business with a social or environmental mission; there are five critical factors that make an organisation a social enterprise:
– It’s social or environmental mission is explicitly stated in its governing documents.
– It generates more than 50% of its income through trade.
– It reinvests more than 50% of its profits to further its social or environmental mission.
– It is owned and controlled in the interests of its social or environmental mission.
– It is transparent in how it operates and in how it measures and reports its social impact.
Presently, 2 million people in the UK are employed within Social Enterprises and research shows that they all have a role in addressing social inequalities with 72% of enterprises paying the Real Living Wage with 22% operating within the most deprived areas of the UK.
Within the social care sector, Social Enterprises have been successful in providing space and flexibility for providers to respond quickly to presenting issues. At the start of the Covid-19 pandemic, local anchors were instrumental in the sourcing and distribution of PPE. One agency, Turning Point, was able to rapidly extend its services onto online support which allowed them to continue to provide vital support and to expand their offering to the wider community. Social Enterprises were also able to invest in their staff’s wellbeing during the pandemic and top-up the wages for those who were shielding by re-investing their profits into the workforce. Many of them operate within the employee ownership model of business, which gives employees a say in the direction of the business. Many already have supported career pathways for career progression or are developing academies to train the next generation of care workers, 98% of enterprises who qualified for CQC assessment were rated good or outstanding.
Social enterprises put users at the centre of their care. For example at Thurrock Lifestyle Solutions, people with learning disabilities sit on and even chair their board of directors, the decisions and input they provide filters down to services that they offer in order to improve the service on a more person centred level and promotes the strengths of its members. The service has changed significantly with this input and they have moved away from the place based model of day services, instead providing activities that the service users are interested in, such as DJ nights. They also have the ability to closely work with and understand the local community in which they are based; this input promotes the social value within the supply chain by investing back into the community and supporting the provision of establishing local services to promote the community wealth building model.
Despite the rising popularity and proven benefits of Social Enterprises, commissioners are still facing barriers when considering the social care contracts within the Local Authority. Due to current commissioning practices, these organisations can often be overlooked in favour of existing, larger providers. Nancy encouraged procurement and commissioning professionals to challenge the “agreed” views and to promote thinking outside the box when it comes to commissioning services. The primary action she encouraged Commissioners to contemplate is to re-think what needs to be commissioned, based on outcomes you’d like to achieve.
For more information
This event was delivered to iNetwork members as part of the Connected Procurement and Commissioning (CPC) and the Transforming and Innovating Public Services (TIPS) Programmes. For more information, please contact: