Oversight of the social care market

How do we ensure that the social care 'market'
responds to people's needs without leaving them
high and dry when things go wrong?

Picture of Preston covered market is
  © Copyright Andrew Gritt and licensed for
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The Department of Health has issued a discussion paper raising issues about who should have oversight of the social care market, and how. It's in response to the recent disruption caused by the financial crisis at Southern Cross, and to reports by the National Audit Office

The paper rightly raises the role of local authorities, the CQC, and the Office of Fair Trading, and their responsibilities to monitor and steer the market in a way that reflects the needs of the population.

It does however seem to lean too much on 'top down' approaches to oversight, missing the key point that much of social care provision is generally coordinated by large organisations that are still weak in the area of listening well to the people that use those services or involving them in their direction.

There's plenty of room for more 'bottom up' and co-productive approaches to market oversight.

For example, giving people much more access to advocacy, directly through their personal budgets would enable more control by individuals. People could use relatively small amounts of money to ensure that they had full choice over who advocates on their behalf, or to employ people to facilitate the formation of circles of support, or to help them create and review their support plans, and ensure that the services they receive match up with their desired outcomes and what's been identified as good support in their person centred plans.

Deconstructing block contracts and their replacement with Individual Service Funds, and personal budgets, along with contracts between the person and the provider, so that the service is at least as accountable to the person themselves as they are to the local authority would also increase the power of individuals in the direction of their own services.

Finally using coproduction processes like 'working together for change' would bring people that use services, their family carers, commissioners and provider services together to think openly and honestly together about what's working and not working about their services in their own area. Using processes that encourage direct communication between different elements of the system would encourage the adaptability, flexibility and responsiveness to economic, cultural and demographic changes that are right at the root of robustness in modern care and support service provision.

My response to this consultation has therefore been to applaud the extra effort being suggested to ensure oversight of the market from above, but to point out that the key to genuine oversight of the social care market is to shift the levers of power into the hands of the people that use it, working in partnership with local authorities and providers to ensure a social care market that can meet the challenges of the twentyfirst century. Co-production of services also means co-oversight of services.