Adult Services Commissioning Strategy - Consultation Document May 2010


There are a number of national drivers for changing the way in which adult social care services are commissioned. These include:

  • Forecast demand for services running ahead of the money to pay for them
  • A new emphasis on prevention and avoiding unnecessary dependency
  • The need to provide advice and support to those who fund their own care
  • The need to commission in a way sensitive to choice and self directed support

Merton has a diverse population in terms of affluence and ethnicity. It is becoming more ethnically diverse. At present its population has a higher weighting towards middle age than average, but there is a rapid growth in older people over 80 and in children and young people. This presents a challenge to the whole council and its partners.

Merton’s financial context is very challenging, as a “floor” authority which overall spends the lowest amount per head of population of all London boroughs. Its Medium Term Financial Strategy forecasts the need to reduce spend by up to 30% between 2010 and 2013.

Merton’s adult social care service is a low spender per head of population. Its most recent performance rating is “Good” for all outcomes. Sutton and Merton PCT has a rating of Fair for financial management and Good for quality of commissioning

The aim of this strategy is to facilitate this reform by providing:

  • A framework to deliver better outcomes
  • A framework to shift to preventative and early intervention
  • A framework for allocation of adult social care resources
  • A guide to inform the expectations of those in need of care and support and their families

The strategy’s objectives have been mapped against the “inverse triangle of care”, in line with the aim to maximize effective prevention. Essentially investment in preventive services is being protected for 2010/11 and re-focused while investment elsewhere is being reduced.

The main opportunities for improvement are:

  • Reducing numbers of people of adult working age in care homes, and reducing unit costs
  • Reducing dependence on current block contracts for older people
  • Improving the transitions process between children's and adult services
  • Increasing the number and range of accommodation options
  • Working with the voluntary sector under Compact principles to re- focus the current investment in their services, including an increase in volunteering
  • Streamlining information and advice services to make them easier to find
  • Increasing the use of Telecare
  • Working with the local NHS to bring re-ablement and intermediate care closer together, and having shared teams based on clusters of practices