Prioritising quality, not price: Commissioning in Social Care
By Andrew Crawshaw, Chief Executive Officer, Millbrook Healthcare
Across health and social care, we face a persistent tension: the need to deliver better outcomes for people while operating within increasingly constrained financial envelopes and growing demand.
A hasty commissioning response to this conundrum could be “let’s go cheap”.
But if we are honest about the realities of our system, this approach is not sustainable.
Care providers can fail (painfully evidenced by NRS last year) and, more importantly, bare bones, poor quality service increases costs for the public sector elsewhere in the care system.
The question is not whether we can afford to prioritise quality. It is whether the commissioning process can recognise that better service quality leads to overall cost savings in the healthcare system.
The limits of price-led commissioning
In a system under financial pressure, it is entirely understandable that commissioners seek to extract maximum value from every pound. However, there is a clear distinction between value and lowest cost.
When procurement decisions are driven by price, a number of predictable consequences follow:
- Providers reduce investment in workforce, systems, and innovation
- Service delivery becomes transactional rather than outcome-led
- Long-term costs increase through avoidable demand, delayed discharges, and reactive care
Across the UK, demand for care is structurally outstripping supply, driven by ageing populations and increasing complexity of need. In this context, short-term cost minimisation often leads to long-term inefficiency.
Put simply: the public purse ends up paying more for worse outcomes.
What “quality” actually means in practice
Quality in social care is sometimes treated as an abstract concept – difficult to define and even harder to measure. In reality, the characteristics of high-quality provision are well understood.
At its core, quality means:
- Consistency – reliable delivery at scale, every time
- Responsiveness – the ability to meet needs quickly and flexibly
- Integration – working seamlessly across health, social care and local communities
- Partnership working – listening and co-producing solutions with customers
- Human impact – preserving independence, dignity, and safety for service users
In our own work, enabling hospital discharges into the community and supporting people to remain safely in their own homes, rather than in a care facility, is central to improving health outcomes, quality of life and reducing health system pressures. This aligns directly with the broader direction of travel across UK health policy, which is shifting care away from hospitals and into communities.
Quality is not a “nice to have”. It is the mechanism through which the system becomes more efficient and therefore sustainable.
Why quality drives financial value
There is a misconception that prioritising quality inevitably increases cost. In reality, the opposite is often true – service costs may be higher but the benefits and savings realised elsewhere in the healthcare system, are far greater.
High-quality services:
- Reduce downstream demand by preventing deterioration and crises
- Improve flow by supporting timely hospital discharges and avoiding admission
- Enable prevention through better use of technology and early intervention
Our same-day service for healthcare equipment delivery and installation into people’s homes is a great example. A quality, dependable service installing the right equipment (such as a bed and pressure care mattress) within hours of ordering, enables quick hospital discharges, freeing up vital hospital beds.
If commissioning frameworks reward only lowest price, providers are actively disincentivised from investing in precisely the things that would deliver better value overall.
The role of providers: raising the bar
It would be wrong to suggest that the responsibility sits solely with commissioners. Providers must also take a long-term view.
This means:
- Investing in systems, data, and operational performance
- Building a culture where accountability, innovation and continuous improvement are expected
- Being willing to walk away from opportunities that cannot be delivered to the required standard
Winning on quality requires discipline. It also requires confidence – confidence that the market will increasingly recognise and reward outcomes rather than inputs.
Our own strategic approach reflects this. We prioritise opportunities where we can deliver the highest quality services and create meaningful impact, rather than simply competing on price.
A shift in how we define “value”
If we are serious about improving outcomes in health and social care, we need to move beyond narrow definitions of value.
A more mature approach would consider:
- Whole-system cost, not just contract price
- Outcomes achieved, not just activities delivered
- Long-term sustainability, not short-term savings
- Social value, including workforce wellbeing and community impact
There is already momentum in this direction. Integrated Care Systems are increasingly focused on population health, prevention, and care closer to home. The challenge now is to ensure that commissioning frameworks fully align with these ambitions.
Looking ahead
The pressures facing health and social care are not temporary. Demand will continue to rise, expectations will continue to increase, and financial constraints will remain a defining feature of the system.
Against this backdrop, we need to make deliberate choices about how we allocate limited resources.
Choosing quality over price is not about spending more. It is about spending better.
It is about recognising that sustainable services are built on strong foundations – skilled people, effective systems, and a relentless focus on outcomes.
And ultimately, it is about delivering what matters most: safe, dignified, and independent lives for the people we serve.
