Analysis of commissioning and procurement of adult social care in Scotland

Background: Strategic planning and commissioning of adult social care (ASC) involves forecasting population needs across a defined area, together with availability of services or resources to meet those needs then commissioning to best meet these needs through in-house provision, shared services or procurement of independent or voluntary sector services.  This paper reports qualitative research conducted on behalf of the Coalition of Care and Support Providers in Scotland (CCPS) between March and June 2024.  It analyses current ASC commissioning and procurement practice across Scotland’s integrated health and social care partnerships (HSCPs) and considers the actions required to shift away from procurement largely based on price and competition.  Approach: An introductory email, information sheet and consent form were e-mailed to key contacts in seven national policy, delivery, advocacy, audit and improvement organisations working on ASC commissioning and procurement issues.  Eleven people working at a national level agreed to participate. These conversations informed selection of a purposive sample of commissioning and procurement officers from local HSCPs.  An introductory email, information and consent form were sent to key contacts in 13 of Scotland’s 31 HSCPs. Twenty-two professionals working in strategic planning, quality, finance, commissioning or procurement roles in 11 HSCPs agreed to participate. A further five interviews were conducted with social care provider organisations to triangulate issues raised by local HSCPs. Interviews, averaging 40 minutes, were conducted via Microsoft Teams by two researchers using three appreciative inquiry questions to frame the discussion.  Data from the interview notes was analysed independently by the two researchers using Braun and Clarke’s   six steps of reflexive thematic analysis. Results: Analysis of 38 interviews resulted in six themes and related sub-themes: Resolve Ambiguity; Reduce Complexity; Refresh Practice; Rebalance Power and Relationships; Respect Place; and Realise Value. Participants spoke of multiple disconnects between adult social care policy, funding, regulation, planning, commissioning, procurement and service delivery levels. They voiced frustration with the current complex commissioning and procurement system and called for greater empowerment to commission collaboratively with local people who have lived experience and to build trusting relationships with providers. National bodies are slowly engaging with local commissioning realities but are not keeping pace with the need for local transformation or the nuances of place, particularly in remote and rural settings where interdependencies require highly integrated workforce models and commissioning practices.  Implications: There is evidence of local innovation in commissioning and procurement practice, but these innovations are not yet being shared well. Coordinated action to enable the desired change in commissioning and procurement practice requires education and support for implementation, underpinned by ASC data that includes personal and reablement outcomes and the voices of people with lived experience.  This paper offers transferable learning for policy makers, national and local health and care organisations, and ASC providers. It will help them understand what can be done to enable more ethical commissioning through a stronger focus on  collaborative leadership, culture and relational practice aligned with outcomes that matter to people and communities.