One care provider told the Independent Review of Adult Social Care in Scotland “competitive tendering destroys the very relationships that are crucial to success in social care”.

Derek Feeley’s review went on to recommend a shift from competitive to collaborative commissioning, with “alternatives to competitive tendering developed and implemented at pace across Scotland”.

“Commissioning and procurement decisions must focus on the person’s needs not solely be driven by budget limitations”, it added.

The organisation that creates and manages Scotland’s national social care frameworks – a list of providers from which local authorities can commission social care services – was set up on the principle that centrally supported procurement can be a force for good.

Scotland Excel was created in 2008 to support Scotland’s councils and then, in 2016, its health and social care partnerships.

Jennifer McKerrall is Scotland Excel’s Strategic Programme Manager for Social Care, overseeing frameworks for services such as fostering, residential care for children, care homes for adults with learning disabilities including autism, care agency workers and care and support services provided at home.

She told healthandcare.scot the most immediate benefit of the frameworks is to make things easier for frontline staff deciding which service best matches their client’s needs:

“At the most basic level what we do is help councils and health and social care partnerships (HSCPs) reduce inefficiency by avoiding multiple organisations conducting the same exercise over and over again.

“When you are talking about 32 local authorities, 31 HSCPs, it means we are freeing up time for social care practitioners by dealing with the contractual issues for them – once, and on a national basis.”

Scotland Excel says the frameworks are open to all provider organisations, regardless of size, so long as they meet required standards around grades, financial stability and business probity. Scotland Excel undertakes the checks for each organisation and sets the same requirements for reporting by all organisations on the frameworks which, in turn, allows it to gather the same information from across Scotland to develop a national and local picture or activity, trends and variation.

Although not a regulator, by using the benchmarks and grades of the Care Inspectorate and Healthcare Improvement Scotland, it does offer reassurance to those commissioning services on the ground that standards are being met by those included on the frameworks. And, if a provider on a framework sees their grades drop below the threshold, a process is triggered where this is flagged, and conversations take place with the provider to work out how they can get those flags removed.

“What all this means,” says Jennifer, “is that a social worker can look at the list of providers who have already undertaken that exercise to join our framework and, when sitting down with a person to choose a provider, can say to them ‘here are the ones on the framework: there’s already been a degree of due diligence done, they’ve already met our standard, they’re all here and ready to use’.”

Scotland Excel says its major national care frameworks reopen regularly to admit new applicants and the numbers of providers who can be included is not capped.  Securing a place on these frameworks is made as straightforward as possible and successful providers remain on the frameworks for up to four years. The aim is to offer as much choice of local providers as possible.

The hope, says Jennifer, is that a further level of competitive tendering by the HSCPs shouldn’t then be required:

“The bulk of what happens under our frameworks sees local authorities directly award work to the providers on the basis of the information that we provide them in the framework.

“We are quite clear and set out what is included in the base service, what is not included and what they need pay extra for – what a provider’s specialisms are and a breakdown of the costs. Generally, that is the information people use to make decisions rather than have a further exercise below the national framework.

“I think the issue is about understanding what aspects of the competitive process are problematic. And that is looking at cost as the primary factor.

“I think there can be some consideration of cost so long as it is balanced well with other factors. We have to be realistic about how difficult it is for people not to consider cost when they are looking at contracts given how difficult the financial pressure is. But it is understanding what parts of that process are problematic and taking steps to avoid it.

“There is a lot of criticism of competitive tendering and procurement in social care more generally and I think that doesn’t necessarily give the full picture. There are some problematic practices where you’re talking about competitive processes based primarily on cost – particularly where there is some negative impact on the workforce – and indeed the person receiving the care.

“So, in Scotland Excel, for example, one of the frameworks where we did consider cost as part of the process was for our Agency Workers Framework. We didn’t want any considerations of cost to negatively impact the workforce, so we broke down the costs into two different aspects: the hourly rate that is paid to the worker and the fees retained by the agency. And our commercial assessment was only based on the level of fees retained by the agency so that there was no incentive in that framework for an agency to keep the cost low in terms of what is due to the worker, we know that if the worker receives a fair rate, then the service is good.”

In the report of the Independent Review of Adult Social Care in Scotland, the authors called for a more collaborative rather than competitive approach to commissioning.

“I think our approach is collaborative,” says Jennifer. “It has to be. It is driven by a whole range of stakeholders. Scotland Excel is not in a position to make decisions in isolation, we work closely with a whole range of partners involved in the delivery of care such as care practitioners from councils and HSCPs, and the representative bodies for care providers.

“I think that’s what collaborative commissioning is about, making decisions that are informed by an appropriate range of stakeholders.”

Jennifer points to other forms of collaboration that she believes allow Scotland Excel to create better frameworks, such as asking care-experienced young people and adults with learning disabilities to set the questions – and be involved in aspects of the assessment of providers – for services that they know all about having been service users.

“The direction of travel in both the Feeley review and The Promise in children’s services following the Independent Care Review is quite clear – the expectation is around greater collaboration and less competition.

“I think we will see less ‘bog standard’ open tenders and more people moving towards the approaches the Review talked about like public social partnerships and alliance contracting.

“Already there’s work going on looking at the social care workforce and I think a key role for Scotland Excel going forward will be ensuring that our frameworks, and our work more generally, supports and drives the agreed outcomes of these workstreams.”

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