Making social care accountable – a project to use open tendering and open performance

Equal Care is a social care co-operative. Our way of working is very different from that of other social care providers – we’re trying to explode the model of the traditional domiciliary care agency piece by piece.

We are owned by the people receiving support, their family members and the care and support workers themselves. Most social care providers take a 50% cut of the meagre hourly rate that councils pay for care. But by using an online platform to cut costs, we make sure that as much of the council’s payment as possible goes to the care workers themselves. That means that our care workers receive between £15 and £20 an hour gross.

Because we believe in putting power back in the hands of people receiving care, we use a model called Teams, which is a more equitable way of agreeing work than the traditional command-and-control model dominant in social care and the NHS. In our model, the person receiving care can choose who they invite into their support team and what team members can do. The team can include family members, friends, neighbours, health and social care professionals.

Outcomes buried in contract reviews

We have long been keen to challenge the traditional model of tendering, commissioning and procurement by making it as open and transparent as possible. At the moment, published contracting data is very sparse, and it isn’t possible to compare the success of contract models or providers either across or within local authorities. Outcomes are buried in contract reviews – and then lost once new contracts, providers or commissioners take over. This lack of transparency is a major barrier to learning from previous contracts and to developing high-quality services.

As part of the Health Foundation’s social care analytics programme, we planned to demonstrate the impact that open tendering could have on a social care service – for the people receiving support, their family members and frontline workers. We wanted to bring good practice from the open source and open data communities into tendering and commissioning practices, with the aim of creating a shared digital infrastructure for open, accountable, transparent social care.

Our partner on the technology side was Open Data Services (ODS), a co-operative of data scientists. ODS is responsible for the Open Contracting Data Standard (OCDS), a global standard used by governments to publish contracting data in a consistent format so that it can be analysed and compared.

There were three phases to the project:

• Holding four participatory design workshops with stakeholders including care workers, people receiving care, family members, commissioners and social workers.
• Incorporating what we’d learned from the workshops into the OCDS and mapping out a more transparent contracting and procurement route in social care. The aim was to produce a blueprint for making comparisons between service providers and between local authorities.
• Analysing data to test the outcomes design against a live contract.

We ran the four workshops virtually in 2021, with about 40 people in total. There was a real diversity of participants, including commissioners from two different councils, who were very frank about the challenges they faced. We found that everyone involved in the social care system, including people receiving support, social workers and commissioners, felt powerless. A sense of paralysis seems to have gripped the whole sector.

An appetite for transparency

We wrote up a summary of our findings from the workshops, and then ODS developed the digital infrastructure that would make it possible to compare social care contracts and outcomes. The plan was to test this initially using Equal Care’s contracts with Calderdale Council. Unfortunately, we haven’t yet been able to deliver support to Calderdale, so at the time of writing we don’t have the data we need to publish. That should change in a year’s time.

We will, however, publish our total outcomes as a co-operative using the metrics that ODS has built for us and, eventually, our outcomes against specific contracts. Our hope is that in time other, bigger social care providers, including those who deliver support to self-funders, will follow our example. That should provide insight into the types of contracts under which people are receiving support and the quality of outcomes. In talking to other organisations, I’ve found many who are interested in publishing their own outcomes data – there is a definite appetite for greater transparency.

Although it’s disappointing that Covid has impacted our ability to deliver as much of the project as we wanted, it’s still been a useful experience for us, particularly in terms of working with a sympathetic technical partner and hearing the perspectives of people within the care system. We are at the very start of a process that will lead to much more accountability in social care, and empower users of the care system to make informed decisions.