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User-driven commissioning: Building on the ‘lived experience’ of disabled people – the most under-used resource in social care

18 December 2012

This report sets out the background to and learning from an informal national programme on user-driven commissioning which culminated in a roundtable event in London in December 2011 and has been further developed since. The aim of this event was to bring together the key stakeholders involved in six pioneering local initiatives that have been taking forward this approach since at least March 2011. This publication reports the background and findings as a resource to help roll out this approach in social care and health, which can turn the rhetoric about user-centred and user-driven support into reality with numerous positive by-products. The report draws on the development paths taken on the six sites as well as on the discussion between a wide range of co-productive service users, disabled people, commissioners and friends and supporters. The Appendix contains some case studies on the valuable commissioning support from disabled people's user-led organisations.  

What supports this programme most is the current shift from commissioning services towards outcomes-based commissioning which puts users of services at the centre - possibly more so than personalisation and integration agendas could achieve by themselves. To take this one step further, people should be seen and encouraged to pursue their own care and support pathways –which commissioning systems and providers have to pick up on to benefit everyone.  

We are aware that we are on a continuous journey, being concerned with undertaking more robust and co-produced evaluations on ‘what works’ in strengthening the impact of lived experience on more positive outcomes in health, independent living and quality of life (alongside whole systems improvement, integration and productivity gains). Locally, a range of pooling projects (where personal budget holders put together their budgets) already begin to shift economies of scale towards themselves, quality has been put on a more equal footing with price in negotiations of service level agreements, and peer support has become a defined element to assess, specify and co-deliver improved access and discharge pathways in mental health – quite an achievement if one thinks of the distinct cultures, timescales and objectives (eg rights-based approach versus efficiency targets) both stakeholders commonly operate. These improvements in social care are reflected in the recent evaluation of personal health budgets which showed - amongst other positive outcomes - that personal health budget holders had fewer referrals for unplanned care. This is also one of the reasons why 'integration' should be user-driven if it is to be effective.

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