Commissioning care and support in Wales: new code of practice

The Welsh Government has published a new Code of Practice which came into effect on 1 September and applies principles and standards to the commissioning of care and support services by local authorities, local health boards and NHS trusts in Wales. Emma Watt looks at the details.

The National framework for commissioning care and support: code of practice (the Code) is underpinned by seven principles of effective and ethical commissioning which commissioners must embed within their commissioning practices and proactively encourage providers to embed them into service delivery:

1. Relationships matter: Caring, compassionate, and equitable relationships come from inclusive co-production, between care and support providers, citizens, commissioners, people in need of care and support and carers in need of support and representative bodies as appropriate.
2. Effective leadership is inclusive, transparent and honest: Decisions should be evidence-informed and leaders should seek to continuously improve and develop digital, technological and human learning systems required to collect, share and understand evidence including impact and any unintended consequences (positive, negative and neutral), including data; with the aim of minimising data duplication (collect once, use many times).
3. Collaboration: share risks, resources and assets: Leaders and commissioners must foster a shared understanding of risk, and positive risk enablement, involving communities and all available assets in mitigating risks to population well-being.
4. Value is what matters: Value is more than cost; it is good quality, safe, care and support that delivers outcomes that matter to people and enhances social value. Public value is derived from meeting all legal, procurement and regulatory responsibilities including, equalities, human rights, fair work principles, and economic, social, technical and environmental considerations.
5. Sustainable care and support is built on fair work and fair pricing: Commissioning practices must support employers to improve the status, well-being and working conditions of health and social care workers with the aim of parity of esteem and terms and conditions across (statutory, private and third) sectors.
6. Plan for current needs and future generations: Commissioning for better outcomes is a medium to long-term activity; planning requires forecasting, and delivery should focus on prevention and sustainability (including carbon commitments).
7. Evidence what works through stories and numbers: Commissioners should collect evidence from people in need of care and support and carers in need of support about what matters to them and what helps them to achieve a good life and use this to inform service outcomes. The performance of services should be measured by experience and outcomes and commissioners should promote a culture of continuous learning and improvement, building on and embedding good practice.

Aside from seeing improvements to the commissioning lifecycle, social care providers operating in Wales will be pleased to know commissioners are also required to:

• demonstrate that they understand the full costs of directly provided and contracted care in their area;
• implement a consistent and transparent approach to fee-setting processes; and
• confirm their fee rates to providers in a timely manner before the start of each financial year.

Additionally, contractual uplift mechanisms must include appropriate inflation mechanisms to keep pace with rising costs.

Social care providers will want to bear the Code in mind when reviewing tender opportunities published by local authorities, local health boards and NHS trusts in Wales. 

The Code should also prove helpful when negotiating annual uplifts or facing threats triggered by a service redesign or decommissioning. Importantly, providers can point to the Code when evidencing that their services are cost-effective and that they deliver well-being outcomes for people based on ‘what matters’ to them.

Emma Watt is a Senior Associate at Anthony Collins.