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Summary

Many local authorities are developing social care ‘e-marketplaces’ to give individuals easier access to adult social care services. E-marketplaces allow self-funded adult social care users and holders of personal budgets (including direct payment recipients) to search for and purchase products and services, in line with their personal care plans, on Amazon- or eBay-style digital platforms. In this report we explore the potential for these virtual local marketplaces to become powerful tools for empowering service users and integrating informal care networks with formal care provision. In the context of broad challenges in social care, we examine how local authorities are developing e-marketplaces and the extent to which they are doing so with wider social care goals in mind. We explore the opportunities that e-marketplaces offer to improve the way in which care is arranged and delivered, and consider what more needs to happen to ensure that their development supports personalised care for empowered citizens.1

There has been widespread take-up of e-marketplaces following the Care Act 2014, as local authorities seek to fulfil their new responsibilities to provide information and support to a broader section of the population. Our research suggests that over 25 per cent of local authorities in England have e-marketplaces with purchasing functionality, and many more have plans to implement one.2 We have found many examples of innovative practice, and of local authorities exploring and testing the potential of e-marketplaces. For example, Hertfordshire county council has been exploring how people can manage their ongoing care through e-marketplaces, and in Yorkshire and Humber a multi-authority partnership has been formed to procure a regional e-marketplace.

In the course of our research we identified three major opportunities to improve personalised care that e-marketplaces present.

  • Improving access to the market for new and small providers
    E-marketplaces have the potential to offer smaller and unestablished providers a transparent, easy channel through which they can reach potential users and enter the market. By lowering barriers to entry, they may enable a more diverse market and a smoother journey to market for innovative products and services. Whereas traditional commissioning processes are opaque, inflexible and do not directly respond to users’ needs, an e-marketplace should support and encourage providers to offer more responsive and flexible services. For instance, under traditional commissioning systems care providers would promote domiciliary (non-medical, home) care services to local authority commissioners, but in an e-marketplace providers must advertise and sell their services in ways that are meaningful and appealing to individual users with diverse needs. This means that rather than services being advertised under the technical term ‘domiciliary care’, we see its constituent parts – such as meal preparation, cleaning and maintenance services – listed instead.
    To fully realise this opportunity, local authorities must consider and work with a wide range of providers: proactive engagement can support smaller and less established providers through the process of joining the marketplace. Quality assurance methods – including kitemarking, gatekeeping and feedback, as well as the structure of fees that local authorities charge providers for use of the e-marketplace – should be designed in a way that does not make entering the market prohibitive for new and small providers.
  • Enabling user-commissioning
    Online platforms can make it easier for users to describe the kind of service they want, and for providers to respond with a tailored service and price, which puts the user in the role of commissioner and cuts out the middle-man. Digital services also have the potential to allow users to pool their resources, including personal budgets, to commission services as a group. Local authorities within the Yorkshire and Humber region have recently launched a user-commissioning function on their shared e-marketplace in order to make this possible.
    For user-commissioning to succeed, an intuitive platform is required: one that abandons the language and structure of council commissioning, and is instead designed to be used by people with care needs. It also requires the many agencies that work with care users to create care plans to trust users’ choices and their ability to define what it is they are looking for. Finally, group commissioning works when it is made easy for people to meet on the basis of shared interests rather than narrowly-defined needs; social networking functionality may aid this.
  • Integrating networks of informal and formal care
    E-marketplaces can support a mixed economy of informal and formal care by giving users information about the many kinds of service available that is categorised according to those kinds of service, rather than how the services are structured. If integrated with case management or schedule systems, e-marketplaces may also help to coordinate care around the user.
    However, not all kinds of service that care users might engage with will work well on an e-marketplace. For example, organising ‘services’ that are based on long term relationships, such as interest groups or neighbourhood networks, might be better done on different platforms – such as the ‘Casserole Club’ app that connects people with elderly neighbours. Local authorities should work with service providers to establish which of them do and do not work well on an e-marketplace.

We also found that significant challenges remain in terms of implementing e-marketplaces to support better care. The development of e-marketplaces has been fragmented to date, and the degree of commitment to using them as tools for empowerment, integration and personalised care is not consistent across or even within all local authorities. While some view e-marketplaces as a means of radically transforming care services, others view them primarily as drivers of cost-savings.

External pressure from central government is also important. Many local authorities are implementing e-marketplaces to visibly and efficiently respond to their new responsibilities to provide universal information and guidance, set out in the Care Act 2014. However, although many e-marketplaces are being successfully used as directories, take-up of purchasing and other functionalities has been surprisingly slow. Furthermore, as large, one-off IT systems with high up-front costs, the basic architecture of e-marketplaces is hard to adapt or change after set-up. There is a danger that that poorly designed and managed e-marketplaces will entrench the weaknesses of the current care market – including unresponsiveness to user needs and demands, and competition that is too focussed on price – rather than support transformational change.

Building next-generation social care

Central government, local authorities and coordinating bodies each have a role to play to ensure that e-marketplaces successfully enable personalised and integrated care, and that they avoid entrenching the worst aspects of the current system. Our recommendations for each of them are underpinned by three broad conclusions that emerge from our research.

  • Digital services must be designed around the user experience and journey
    Users will use the channel through which it is easiest to find services. To manage demand effectively and enable personalisation, digital services need to be designed around the user journey, rather than around business needs. This means that users must be involved in the design of the system, either through feedback or iterative design methods. Current IT procurement practices encourage one-off purchases, and do not encourage local authorities to prioritise user involvement in service-design, or to prototype digital products.
  • Proactive offline activity is necessary for an e-marketplace to succeed
    Using a market-based approach to produce relational rather than transactional services requires proactive offline activity, particularly market facilitation. This includes encouraging and supporting small and innovative providers, differentiating requirements by type of service for gatekeeping purposes (so that barriers to entry are lowered for smaller-scale and more informal types of provision), and actively supporting users to come together and jointly commission services. Market-based approaches do not necessarily result in services being run by large, impersonal providers, although without active cultivation this can be the default.
  • Cultural changes, particularly around trusting users and adopting appropriate attitudes to risk, are prerequisites for success
    Simply making services available online will not be enough to facilitate diverse and integrated forms of care. A well-functioning, diverse e-marketplace requires advisors – including social workers and carers – to have trust in users’ decisions while being mindful of the risks of doing so, and to be willing to recommend and signpost services they may be unfamiliar with, such as community-based care. Excessively cautious attitudes to risk can also lead local authorities to set overly stringent requirements upon providers before they can access the e-marketplace, thereby stifling new and innovative providers.
    Most local authority leaders, as well as social workers, support greater personalisation, greater community provision, and greater trust being placed in service users. Yet we also heard from people both inside and outside of local government that this vision is far from being achieved – systemic barriers remain, particularly at the middle-management level but right up to the central government departments that create incentives through policy and guidance. To tackle this culture, we need to make sure that teams are sharing risk appropriately and reconsider where blame lies when things go wrong. Frontline, management and e-marketplace staff must be given the attention and permission they need to exercise their own judgement in pursuit of better outcomes, rather than being cowed by concerns about compliance and liability.

We also question the IT procurement practices behind current e-marketplaces. In particular, local government digital procurement, characterised by large, one-off system purchases like e-marketplaces, contrasts to an increasingly large degree with central government’s ‘digital by default’ strategy, which is characterised by iterative design, the centrality of the user journey, and a shared common platform across government functions. The remit of the Government Digital Service, which has been at the helm of these reforms, was extended to local government in the pre-election 2015 budget. Not only might local authorities achieve better outcomes by rethinking what an ‘e-marketplace’ or digital platform looks like, they may also in future find their current, expensive systems out of sync with the ways in which digital government is evolving.

If local authorities were to adopt truly iterative, design-based digital strategies, they might come up with very different e-marketplace solutions. One alternative solution would be to adapt a platform-based model with a number of integrated ‘apps’ for different services or needs. In practice this might look like Apple’s app store, with different modules for different activities and services – PA services, social networks, and time-banking for example – hosted on a common platform. The advantage of the platform model over an e-marketplace is that multiple, smaller developers can design modules at a lower cost, and each can be designed around the specific user experience rather than trying to make an e-marketplace that does anything and everything.

To make the most of the opportunities that e-marketplaces – and digital platforms more broadly – offer, we make the following specific recommendations.

  • Work across local authority boundaries
    Currently, local authorities across the country are implementing e-marketplaces and grappling with the same challenges. Shared learning is facilitated on the IT side by the professional body Socitm,3 and on the social care side by the Association of Directors of Adult Social Services. While we found that many social service teams did look at other e-marketplaces before procuring their own, deeper collaboration may deliver greater benefits. For example, Yorkshire and Humber have successfully procured one regional e-marketplace covering 13 local authorities, allowing greater coordination and collaboration, as well as opportunities to try innovative functions such as user-commissioning. It has been found that, on average, e-marketplace providers will reduce fees by 33 per cent for 12 or more councils sharing a common implementation team and procuring the same functionalities.4 Further to this, people’s experiences of care are not limited by council boundaries, and regionally procured e-marketplaces reflect this better than individually procured sites.
    Local authorities are independent and will want to develop partnerships that are appropriate to their needs. We recommend that as a practical, immediate step, local authorities prioritise regional collaboration and working groups to explore potential partnerships as well as coordinate across boundaries. Collaboration on shared vision and strategy should be pursued at the local authority and adult social services leadership level, but also at lower levels in order to enable those implementing e-marketplaces to share innovations and best practice. One priority area should be working to common standards on quality assurance, risk management and the gatekeeping of providers on the e-marketplace.
  • Work in close partnership with the Government Digital Service to embed local digital government
    The March 2015 budget extended the remit of the Government Digital Service (GDS) to local government for the first time, bringing digital platforms for social care under its purview. Although details of how this will work in practice have not yet been laid out, it is important that rather than being imposed from above, the GDS works in partnership with – and respects the autonomy of – local authorities. The GDS can contribute its experience of leading transformational change in digital services; the service can also support better coordination across local authorities by developing and providing platforms with shared standards and protocols for multiple authorities. However, great digital services are much more than a website: they fundamentally change how services operate. Success requires support and contribution not only from IT and digital departments, but also the teams that work with services and local authorities as a whole. This is particularly true for care services, which are more complex and less transactional in nature than, for example, applying for a parking permit. The GDS can support major changes in how care is delivered, but social services teams must determine the nature and direction of those changes. In designing platforms for adult social care, the GDS should recognise and draw upon the relative strengths of care and digital teams.
    For such a partnership to succeed, strong leadership in local authorities is required. There is a wealth of digital talent and ambition within local government, and informal collaboration across local authorities is already occurring.5 Yet care and digital teams have not yet become as central to the operations of local government as they need to be, and a hierarchical culture means that local authorities’ digital officers often lack the authority to effect change. Strong leadership can enable these teams to play a central role in determining how public services, including adult social services, evolve.
  • Developing the workforce for next-generation social care
    In the course of our research we repeatedly found evidence that offline activity, and the people who work in adult social care – from teams in procurement to market facilitation to the social workers who help people navigate the care system – are central to making e-marketplaces work. As well as investment in IT infrastructure, e-marketplaces require investment in the people that make them work.
  • Training staff to empower users
    Although most local authority leaders, managers and social workers support greater personalisation and community provision, there are gaps in support – particularly at the middle-management level. Long-term cultural change programmes and training can help achieve two goals. First, they explain the benefits of new models of care and embed the values of those models with staff. Second, they also give frontline workers the confidence and knowledge of their responsibilities that they need to be able to signpost less familiar and community-based services.
  • Develop digital in-house expertise through recruitment and training
    Whether digital platforms are commissioned or built in-house, local authorities shifting to ‘digital by default’ need teams (in both digital and service delivery) who understand what digital services can and should do. This means recruiting more people with strong digital skills across digital and service-delivery teams, but also providing training and support for professional development so that existing staff can fill this gap. This could be provided in collaboration with other, nearby authorities – for instance, by supporting network events such as LocalGovCamp that bring together digital teams from different authorities to learn from each other.
  • Bring providers and frontline workers together to prepare for e-marketplaces
    Frontline teams both within local authorities and outside of them – those in housing associations and advisory services, for example – need to be prepared for new responsibilities, including supporting e-marketplaces, as part of a broader shift from delivery to coordination of care services. At the same time, providers may need support to understand and join e-marketplaces. Events that bring different actors within the system together can be particularly helpful in terms of ensuring that each side understands not only the others but the overall vision of empowered care that underpins e-marketplaces and personalisation.
  • Care coordinators, based in the community, to teach digital skills
    Many care users lack access to e-marketplaces or the skills to navigate them, which limits take-up. While this problem is likely to decline as the younger generations of today, accustomed to using digital services, become the care users of tomorrow, digital exclusion presents an immediate challenge for e-marketplaces. Local authorities can mitigate the impacts of digital exclusion by designing their digital services around the user journey, and to be intuitive, as well as by ensuring that other channels to care remain open. Nevertheless, some users will still struggle to access the services, and this requires a proactive approach.
    IPPR has previously recommended an expansion of the local area coordinator programme that is currently operating in Derby, Cumbria, Middlesborough and many authorities in Scotland (McNeil and Hunter 2014). Local area coordinators (LACs) are recruited from a range of backgrounds, have close links to local neighbourhoods and operate an ‘open door’ policy beyond the point of assessment, providing information, support, advocacy and advice to all, regardless of their support needs or their entitlements to funding.
    As well as recommending that local authorities move from case management to care coordination, we recommend that part of an LAC’s role should be to help care users access e-marketplaces to arrange their care. This would require LACs to receive training, which should be delivered in partnership with digital inclusion teams. Coordinators based in shop-front premises such as in a library could also use in-house computers to provide internet access points.

Government interactions with citizens are becoming increasingly and inevitably digital, and this will include social care. In examining the shift towards e-marketplaces we have sought to explore how this ‘direction of travel’ can be shaped to support more personalised care that empowers people as citizens rather than as service users. Digital platforms, including e-marketplaces, will be most successful where they support fundamental changes to how services are organized and delivered, rather than simply replicating current services online. At the same time, it is clear that digital services are not a panacea in themselves: the people who implement, work with and use them are central to achieving better care. As the Government Digital Service extends its remit to local government, and the Care Act comes into force, the time is ripe for local authorities to work collaboratively to ensure that digital platforms support new and better models of social care.

1 This report is informed both by a literature search and by a set of interviews with expert stakeholders conducted between January and March 2015. Our interviewees included representatives from third-sector organisations, e-marketplace/IT providers, local authorities, the Association of Directors of Adult Social Services (ADASS) and the Department of Health.

2 Based on our interviews with e-marketplace providers, an estimated 40 of the 152 local authorities with social care responsibilities in England have an e-marketplace, with more having a resource directory without purchasing functionality.

3 Socitm is an IT professional body for people involved in the leadership and management of IT and digitally enabled services delivered for public benefit. See http://www.socitm.net