Introduction
This step is about everyone involved in a local housing partnership understanding how, and in what way, the housing strategy for autistic adults and adults with a learning disability fits with the commissioning of NHS services by Integrated Care Boards (ICBs) and adult social care services by local authorities. It is likely that health commissioners from ICBs will only be involved in commissioning for those autistic adults and adults with a learning disability with high needs, and adult social care commissioners will be responsible for commissioning for those with high or moderate, and moderate or low needs.
It involves working with health and adult social care commissioners to understand the current commissioning landscape, including what is currently commissioned, and future commissioning priorities, with respect to housing for autistic adults and adults with a learning disability. It also involves working with potential providers and developers to understand what information about commissioning they would find helpful and would support them in making investment decisions.
Aside from the importance of commissioning in relation to the housing strategy, those involved in developing a housing plan may not have a good understanding of commissioning. It will help with conversations and planning if everyone has some understanding of the local commissioning systems and priorities.
This isn’t necessarily a sequential step, but something that can happen in conjunction with all steps, to best ensure that the health and adult social care landscape is a ‘data point’ that feeds into the provision and development outlined in the housing strategy. One way to achieve this is to have an ICB health commissioner and an adult social care commissioner be part of the housing partnership team developing the business case.
This is important to your housing strategy because health and adult social care commissioning is one part of the longer-term financial stability of housing provision for autistic adults and adults with a learning disability. Providers and developers need to be reassured that the housing strategy doesn’t sit in isolation from the wider commissioning landscape.
How to?
Talk to commissioners of health and adult social care to understand:
- The statutory duties of ICBs in the planning, funding and commissioning of NHS services as set out in the Health and Care Act 2022, for example commissioning for Continuing Healthcare (CHC) as well as NHS funded aftercare under section 117 of the Mental Health Act. Equally important is understanding the role of Integrated Care Partnerships – statutory committees that bring together a broad set of system partners to develop a health and care strategy for the area.
- The strategic objectives of adult social care, the legal requirements under the Care Act, the national and local context, for example, demographic challenges, reduced funding and the pressures on the social care workforce and market.
- How health and adult social care commissioning works in their local area, for example, which public bodies are involved, the funding sources, the populations served, the services provided, and process of procurement and contracting.
- Trends in demand for, and spend on, different health and adult social care services and any projections of demand for different types of services.
- The aims and priorities for health and adult social care, in particular any commitments to developing/expanding different types of housing options and timescales associated with these priorities.
- Sense checking steps 1-4 and discussing how the housing strategy can support the work of commissioners.
Talk to potential providers and developers to understand:
- Their current understanding of health and adult social care commissioning and what further information would be helpful in informing their investment decision-making process.
- Their views on how health and adult social care commissioning can help support the development of, and investment in, housing options for autistic adults with a learning disability.
Sources of information and resources
- Kings Fund, What is commissioning and how is it changing?
- Kings Fund, Social care in a nutshell.
- NHS England, What are integrated care systems?
- Kings Fund, Integrated care systems explained.
- Rethink Mental Illness, Section 117 aftercare - Under the Mental Health Act 1983.
- SCIE, Joint commissioning for integrated care.
- Access group, Commissioning cycle in social care.
- NHS England, NHS continuing healthcare.
- Health and Care Act 2022: Integrated Care Boards – functions.
- The Care Act 2014: Responsibilities of local authorities.
- SCIE, Care act, assessment and eligibility.
Partners to involve
- Health and adult social care commissioners, ICB, investors, providers and developers.
Co-production
The ‘I’ and ‘We’ statements below are illustrative examples of co-production outcomes associated with this step. We encourage housing partnerships to adapt them as they see fit to best reflect their local context.
For individuals:
- I understand what commissioning is, how local organisations work together to deliver housing, and how it affects my access to services and housing.
- I help define the key messages that need to be communicated when describing the commissioning landscape based on how it affects my housing options and access to services.
For the partnership:
- We facilitate individuals’ understanding of the objectives and process of commissioning, local organisations and partnerships involved, and how these affect individuals’ access to services and the local market for housing for older people, ensuring that information is provided in a range of accessible formats.
- We have conversations, providing any support needed, and take on board individuals’ views on the key messages that need to be communicated when describing the local commissioning landscape.
Insight: The King’s Fund – changes to the health and adult social care commissioning landscape
The King’s Fund have published commentary on changes to the health and adult social care commissioning landscape, including the structure of the commissioning system after July 2022, when ICBs become the statutory commissioners of the majority of NHS care.
Commissioning arrangements have evolved since their introduction, including through numerous changes to the structure and remit of the organisations that commission care. The underlying philosophy of commissioning has also changed over time with a move away from transactional models and towards greater partnership working.
These changes are all part of enabling a shift towards strategic commissioning and a more collaborative approach to planning and improving services. This means that, instead of focusing on procurement and contract management, the role of commissioners is to work closely with key partners across the system (including providers) to understand population needs, determine key priorities and design, plan and resource services to meet those needs.