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Commissioning Care

There’s a lot bubbling away in relation to children’s social care at the moment; the Department for Education’s independent review, the Education Select Committee’s inquiry on children’s homes, and the Market and Competition Agency’s study into the children’s social care “market” to name just a few. I’m sure the local authority role in the commissioning of services for children in care will be considered in each of these exercises as it has been picked up in previous reviews in this space, including Children’s Residential Care in England (2016) and Foster Care in England (2018).

Commissioning activity has an important role to play in ensuring that local authorities are able to secure the services that children and young people need. Critically, our market shaping and procurement activity must be led by strong needs analysis, supported by flexible systems that can quickly respond to changes in the level and types of presenting needs.

Children in care are not a homogeneous group, and, over time, we have seen an increase in the number of adolescents with complex and overlapping needs coming into care as they can no longer safely live with their families. Our commissioning practices haven’t always been responsive to the needs of this group nor has the offer from providers. Put simply, the system wasn’t designed to provide highly tailored, bespoke placements to meet social, emotional and mental health needs meaning spot purchasing is increasingly common. While better commissioning practices may be the answer to some of the challenges we currently experience, commissioning is not a panacea, we also need child-centred practice and regulation that enables us to respond to these changing needs; we rely on highly individualised placements because registered providers can be unwilling to accept a referral for a young person in severe distress.

Our current system of regulation is prohibitive and doesn’t flex in the ways we need it too. So, we need to continue to strive to think beyond organisational and service boundaries if we are to be truly child-centred. Registering providers rather than physical settings, similar to the approach taken in fostering and adoption services, could offer part of the answer.

Those who are poorly served by the current regulation system require a multi-disciplinary support response. There is a clear expectation running throughout the SEND arena of the need for joint planning and commissioning across local authority and health services. And while there is more to be done in this space, there is also some great learning that we could build on to improve our joint commissioning of other services in children’s social care. To do this, we need to acknowledge and work through the barriers in a health system that is set up to respond to diagnosed clinical needs and the reality of the breadth of emotional health and wellbeing challenges children experience. I look forward to continuing the conversation about how we can best work together to make sure that as a wider system, our commissioning activities ultimately work for children and young people.

This article first appeared in CYP Now magazine

Charlotte Ramsden, ADCS President, 2021/22

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