NDA Consultation on
Commissioning of
Disability Services
Presentation to NDA seminar
on Commissioning - 30th of
September 2011
The National Disability Authority
is the independent state body providing
information and advice on disability policy
and practice to the Minister, and promoting
Universal Design in Ireland
NDA work on disability services
funding
• NDA Review of Disability Service Systems, 2010
o Three basic funding mechanisms identified in
jurisdictions reviewed as part of NDA 6 country review
of disability services, 2010
 Block funding
 Commissioning
 Direct Payments & Personal Budgets
• Ongoing NDA work on disability service system
funding
o Personal budgets & resource allocation
o Commissioning
NDA work on commissioning to date
• “Preliminary view” paper circulated (August)
• Initial analysis of observations completed (September)
• Seminar with UK experts (September)
o Sue Lloyd Selby, Senior Project Manager, Value Wales, Welsh
Assembly
o Alyson Dunn, Director of Development at Praxis Care in Northern
Ireland
o Ian Hood, Coordinator of Learning Disability Alliance Scotland
Responses to “preliminary view”
paper on commissioning
• 20 responses as of the September 29th
• 6 individuals
• 7 service user or disability representative organisations
• 7 provider organisations (including two provider umbrella
bodies and one private provider)
• Some organisations have indicated that they will submit
late responses
Main advantages of commissioning
Service user views
o Ensure service provision reflects the needs & views of service
users
o Provide service users with more choice and control
o Focus on quality, person-centred services & personal outcomes
o Drive personalisation of services & personal budgets
Service Provider Views
o
o
o
o
o
o
o
o
More transparency and accountability
Opportunity to expand / diversify
Greater focus on service quality and more choice for service users
Local service provision more closely linked to local needs
Shift resources from poor performers / inappropriate models
Force providers to examine their provision and “up their game”
Closer relationship between funders & service users
Better control of public expenditure
Main disadvantages of commissioning
Service user views
o Create environment of uncertainty for service users, at least
initially
o Divert resources to application writing and compliance work
o Possible rise in service provision costs
o Fragmentation of responsibility for service provision
Service provider views
o Introduce time-consuming bureaucratic processes
o Create short -term and possibly ongoing anxiety for service users
o Could favour large, low-cost, for-profit providers – or even to more
institutionalised / congregate provision
o Periodic renegotiation of contracts, even for very high-quality
providers, which will threaten providers’ ability to plan for future
o Lead to less skilled, less professionalised workforce
o Could reduce service user choice
Risks associated with commissioning
Service user views
o
o
o
o
o
Focus on price, leading to diminished service quality
Absence of commissioning skills within statutory sector
Become a bureaucratic process that changes nothing
“cherry picking” of certain services which leads to service gaps
Commissioning contracts may not cover “soft” but vital supports
Service provider views
o
o
o
o
o
o
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Contract “cherry picking” leading to service gaps in rural areas
Expertise and independence of commissioners
Failure to align with other initiatives (Standards, CS, ADS, PBs)
Could reduce service user choice by favouring “big battalions”
Commissioner may be too powerful vis-à-vis providers
Absence of national quality assurance system
Industrial Relations and implications of TUPE requirements
Critical issues to get right
Service user views
o System of assessment of service users’ needs
o Role and function of commissioner – should they be in health
sector? should commissioning & procurement be separated?
o Service user involvement in commissioning process
o Balance between specifying service requirements & flexibility
Service provider views
o
o
o
o
o
o
o
o
Transparency and evidence base of commissioning process
Balance between price and quality / innovation / individualisation
Appropriate support / brokerage services for service users
Recognition of holistic nature of support provision
“True” contracting culture (sanctions for breaches by either party)
Appropriate parameters of competition / negotiation processes
Establishing a common understanding of what “quality” means
Quality assurance systems
Open Discussion
Next steps & closing remarks
• All submissions (subject to permission) and
accompanying analysis published to NDA website
(October 2011)
• Report of seminar proceedings published to NDA
website (October 2011)
• This will inform NDA advice to the Minister
Light Lunch