Commissioning Physical Disability Services: What Councils and ICBs Look For

Physical disability services are commissioned differently from generic adult social care because commissioners are managing long-term need, fluctuating risk and cost pressure at scale. Strong providers understand that commissioners are not simply buying hours — they are buying assurance that people will remain safe, independent and stable without avoidable escalation. This article builds on service model design and pathways explored in the Working With Commissioners and Governance & Leadership sections of the Knowledge Hub.

How commissioners frame physical disability provision

Local authorities and ICBs typically commission physical disability services to achieve four system objectives:

  • Maintain independence and reduce long-term dependency.
  • Prevent avoidable hospital admissions and delayed discharges.
  • Manage safeguarding and risk proportionately.
  • Deliver sustainable packages that represent value for money.

Your service model is assessed against how effectively it contributes to these outcomes — not how compassionate your language sounds.

Expectation 1: Clear eligibility and pathway logic

Commissioners expect providers to articulate exactly who their physical disability service is for and where it sits in the wider system. High-scoring bids clearly distinguish between:

  • Short-term reablement following discharge or deterioration.
  • Long-term domiciliary care for stable needs.
  • Supported living for people requiring structured environments.
  • Outreach or enablement services to reduce isolation and dependency.

Vague “one-size-fits-all” models are routinely marked down because they do not support commissioning decision-making.

Expectation 2: Risk-managed independence, not risk avoidance

Commissioners are acutely aware of the cost impact of overly restrictive care. They therefore expect providers to demonstrate positive risk-taking within physical disability services, including:

  • Documented risk enablement plans linked to outcomes.
  • Time-limited restrictions with clear review points.
  • Evidence that staff are trained and supervised to support autonomy safely.

Providers who default to double-handed care, constant supervision or blanket restrictions without review are seen as financially and ethically high-risk.

Expectation 3: Workforce competence and continuity

Commissioners look beyond headcount to assess whether the workforce can safely deliver physical disability support. This includes:

  • Competency frameworks for moving and handling and personal care.
  • Clear delegation arrangements for health-related tasks.
  • Continuity planning to reduce unsafe handovers.

Inspection history shows that inconsistent staffing is a common contributor to falls, skin breakdown and missed deterioration.

Expectation 4: Outcome measurement that reflects real life

Physical disability outcomes are not limited to “care delivered as planned”. Commissioners expect evidence of:

  • Improved independence or maintained function.
  • Reduced falls, pressure damage or hospital admissions.
  • Improved access to community, work or education.
  • Stability of packages over time.

High-performing providers translate these outcomes into measurable indicators that can be reported and reviewed.

Operational example 1: Preventing escalation through early review

A provider identifies increased fatigue and missed transfers during routine reviews. Instead of waiting for an incident, they:

  • Trigger an early review with OT input.
  • Adjust visit timing and equipment.
  • Reduce falls risk and avoid hospital admission.

This is exactly the type of preventative action commissioners expect to see evidenced.

Operational example 2: Managing cost pressure transparently

When a package increases due to deterioration, a strong provider:

  • Documents the clinical or functional rationale.
  • Sets review dates to test whether support can reduce again.
  • Communicates clearly with commissioners.

This builds trust and avoids adversarial cost challenges.

Operational example 3: Supporting independence without safeguarding drift

A person wishes to manage personal care independently despite occasional falls. The provider:

  • Completes a risk enablement plan with the person.
  • Introduces low-level mitigations.
  • Monitors and reviews incidents transparently.

This balances autonomy and safeguarding — a core commissioning priority.

How to evidence this in tenders

High-scoring physical disability tenders typically include:

  • A clear service model diagram.
  • Defined outcomes and review processes.
  • Real operational examples.
  • Clear escalation and governance routes.

Bottom line

Commissioners fund physical disability services that reduce system pressure, not those that simply deliver hours. Providers who evidence risk-managed independence, workforce competence and outcome delivery consistently outperform competitors.

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Written by Impact Guru, editorial oversight by Mike Harrison, Founder of Impact Guru Ltd — bringing extensive experience in health and social care tenders, commissioning and strategy.

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