Insights: From micro to macro - turning local customers into purchasing heavyweights

In the first of our articles, we explored the role of commissioning within social care and, in particular, how the commissioning cycle is relevant not just at the ‘macro’ level (regarding local and regional service planning, development and budget setting) but also how the responsibilities and activities at the ‘micro’ level (individual social worker and service user) can impact successful service delivery.


Over the first quarter of 2016, we delivered bespoke workshop sessions with a range of Rutland County Council’s social workers, allied health professionals, commissioning and procurement specialists to help understand what can be done to shape value for money in the market.

We found that investigating these themes gave a much greater insight into:

a) How well needs have been defined from the outset;

b) How providers meet those support needs; and

c) The actual package of care being delivered.


This led us to emphasise the importance of giving frontline social workers the tools needed to critically analyse what providers are actually offering in terms of support, challenging packages to maximise value and identify new opportunities.


“We can’t change the market with a single placement”

This challenge was at the forefront of concerns for most frontline workers.

“Demand is simply too high, we can’t negotiate on costs when providers can choose who they support”

“We’re limited to what the market already provides, we have to look at some placements on the ‘best fit’ for the client”

Despite these frustrations, it was apparent that everyone recognised they acted in the role ‘commissioner’, regardless of whether they had the title or not.

So, if colleagues are in agreement with what commissioning means, and that commissioning (whether ‘micro’ or ‘macro’) is the responsibility of everyone, how do we achieve this?


This directed us to answer some key questions:

1.How do we promote the individual’s ability to shape the market with their own purchasing power?

2.What methods, tools and processes do we need to achieve better value for money, without changing how we commission services wholesale?


The answer: making sure value for money is built from the process for support planning, and that controlling and monitoring that plan with providers is paramount.

What we discovered was that this isn’t simply about putting out a contract, it was about redesigning the process to ensure value for money is built in to the micro-commissioner’s role.

Ensuring that we have the right level of scrutiny from the outset, includes:

  • Confirming the whole provision (social care, health and education) that is ultimately being paid for ties in with the level and type of support needed and requested, by having appropriately detailed support and cost breakdowns;

  • Being clear about these individual costs in line with what others are charging (benchmarking);

  • Focusing on outcomes for the service user, making sure that there is enough flexibility in the support plan so that providers can vary the care and support as needed to achieve those outcomes;

  • Regularly following up to develop a strong on-going relationship with providers, ensuring provision is led by the service users’ needs at all times.

Changing Behaviours

The above outcomes drew parallels with things we already do, but also helped recognise new ways of negotiating with providers to meet service users’ needs in a way that both managed risk and avoided unnecessary cost.

“You can’t change things overnight”

So, we may have gone on to presume nothing really changed… or did it?

Another discovery was that expectations must be managed well in order to change the perception (and delivery) of great value care.