Is your basic process letting down your systems design? Your relationships holding you back from a user and outcome focus? Or are you sticking to ‘we buy the services we are told to buy’?
A new tool from the Public Service Transformation Academy with RedQuadrant might help you get insight into what’s holding your commissioning back. Commissioned by the Local Government Association’s Care and Health Improvement Programme, jointly run with DHSC and ADASS, we are producing a strategic options appraisal tool for adult social care commissioners.
Commissioners can assess how it’s going in their council, particularly focusing on the extent to which they have ‘room for manoeuvre’ – room to actually be commissioners, shaping the health and care outcomes for their place. We think it will be handy for all commissioners – and that all procurement people should take a look too.
To learn more and find out how you can get involved, contact us! Find out more by contacting Benjamin Taylor at Benjamin.Taylor@publicservicetransformation.org and 07931 317230
How does the Strategic Commissioning Options Appraisal work?
A strategic options appraisal for commissioning has three key documents which will guide you through the process. These are
- Implementation Guide: This is our hands-on guide on how to carry out the options appraisal. It contains guidance on producing and commissioning a development plan, guidance on implementing each of the commissioning approaches, and a strategic risk framework for implementing new commissioning approaches.
- Self-Assessment: This provides the worksheets and resources required for you to carry out the options appraisal
- Commissioning Aspects and Approaches: This is a more detailed handbook to explain and give context on terminology.
Carrying out the assessment involves three stages:
- Assess yourself against the eight aspects of commissioning
Answer our questionnaire to assess yourself and your team against the core aspects of commissioning. This will help you to identify which factors most enable and constrain you and what shapes your context and room for manoeuvre as a commissioner.
The core aspects are:
- System design – are we actually able to work as one place and shape a whole health and care system – or, even better, a wellbeing system?
Procurement folks might like to apply this ‘whole system’ lens to whatever they get involved in – are we just working in our box, or thinking about real world outcomes?
- Relationships – how do the critical relationships work at present and what could change to help outcomes improve?
This is always critical in procurement as it is in commissioning – are you empowered to actually bring your best professional judgement and challenge, or do relationships with service, legal, finance, and politicians limit what you can offer?
- Capacity and capability development – are we helping to build the provision that helps needs to be met and people to achieve their purposes in life (includes market, social procurement, VCFSE, asset-based work, workforce etc)?
For procurement, we might thing about whether we are ‘just spending money’ or looking at all the ways the desired outcomes of the procurement can be met.
- User and outcome focus – are we working with the citizens in our area to check and measure that they are actually getting the benefits from our work?
This is core to procurement – it’s one thing to execute to specification, it’s another thing entirely to actually make sure the benefits were achieved, and were worthwhile…
- Insight and inspiration – the role of innovation, disruption and experimentation in changing the system – and the respect and role of commissioners or procurement professionals.
- Policy – are we actively shaping and influencing the core enablers and constraints of the legal and policy framework that we have to operate within, as well as interpreting them?
- Process – so much attention is usually paid here, yet there’s still room for improvement! Is our commissioning process and practice well developed as a mechanism for commissioning – competition, collaboration, commercials, clarity of contracting? Are we using this for incremental improvement?
For procurement this is obviously critical too – is our procurement slick, effective, professional?
- Models and tactics – are we paying attention to the way in which the things we buy get delivered? Service design, workforce, technology, innovation, aggregation, joining up, reducing waste, and improving user journey?
As you can see this is going to be a fairly holistic way for commissioners to look at their situation and work out how to work to create better outcomes.
- Create a Commissioning Development Plan
Building on your learning from the questionnaire, you need to create a commissioning development plan.
For each aspect:
1. Which factors currently most hold you back?
2. Which most support you?
3. Which of the supporting factors could you boost?
4. Which of the inhibiting factors are:
a) in your control?
c) out of your control?
d) require innovation if they are to be changed?
5. Create an action plan to address the inhibiting factors and boost the supporting factors.
- Identify potential models to fit the context
Using your questionnaire and worksheet, you can then assess the fit between your context and several core models of commissioning.
Our identified core models include:
- Prevention and early intervention
Strong focus on keeping people ‘out of care’ and maximising conditions for people to be able to look after themselves.
- Leadership of a system in a place
Acting as a convening body to shape the whole system of health, care, wellbeing, and need in place.
- Community development focused
Creating the capability within the community to meet care needs
- Developing VCFSE capacity
Meeting care needs through the voluntary, community, faith, and social enterprise sector.
- Political economy approach
Maximising spend and re-spend locally where it will have maximum impact, minimising extraction of funding for external profit.
- Individual focused
Creating conditions for individuals to manage, select, fund, and direct their own care needs.
- Values-based commissioning
An approach that aims to challenge the status quo based on citizen perspectives and equity.
- Disruptive commissioning
Focus on innovation, creativity, novel approaches and technology
- Strategic procurement of services against needs
Procedural focus on good service provision and management
- Contestability to drive down costs
Focus on squeezing providers
- Market management
Focus on mixed and healthy economy of providers
- Small government
Reducing the involvement of democratic decision-makers in delivery through a focus on contracting for provider expertise and user empowerment
- In-house delivery, mutualisation etc
Focus on reducing or removing market dynamics from the provision of care