Overview

Commissioning is at the very heart of providing effective social care for both children and adults. It is the process by which local authorities decide how to spend their money to get the best possible services for local people. Councillors, managers and staff at all levels, service users and carers, statutory agencies and service providers in the independent sector need to contribute to this.

Commissioning is about enhancing the quality of life of service users and their carers by:

• having the vision and commitment to improve services
• connecting with the needs and aspirations of users and carers
• making the best use of all available resources
• understanding demand and supply
• linking financial planning and service planning
• making relationships and working in partnership

It is about getting ahead of the game and anticipating future needs and expectations rather than just reacting to present demand.

This module explains:

• the language used to describe commissioning in Definitions
• the Core Elements and the Must Dos of commissioning
• the Roles to be performed by those contributing to the commissioning process
• the Benefits to be derived from commissioning effectively
• a way of monitoring the Outcomes of commissioning for service users and carers
• a number of the most common Challenges that commissioning has to address
• the various Stages of Commissioning
• a number of practice examples in the Sources
• an Action Plan to help authorities improve their commissioning

Source: Joint Reviews

Acknowledgement

Our thanks go to Bob Welch of Bob Welch Associates for his help and expertise in undertaking this module and to all those authorities who contributed their time most generously.

Definitions

Commissioning: the process of specifying, securing and monitoring services to meet individuals' needs at a strategic level. This applies to all services, whether they are provided by the local authority or by the private or voluntary sectors.

Commissioning is a term that is interpreted in many different ways. For example, the National Health Service commissions services at a high strategic level for example hospitals or prescribing budgets, whereas local authorities apply the term to services at all levels from the individual upwards.

Joint commissioning: two or more agencies pooling their resources to implement a common strategy for providing services.

Collaborative commissioning: two or more agencies co-ordinating their strategies for using their resources.

Decommissioning: the process of planning and managing a reduction in service activity or terminating a contract in line with commissioning objectives.

Purchasing or Procurement: securing or buying services. At a corporate level in local authorities, the term 'procurement' often has an equivalent meaning to strategic commissioning in Social Services.

Contracting: putting the purchasing of services in a legally binding agreement.

Service Level Agreements: written undertakings agreed between purchasing and providing agencies.

Social Care Markets: describe how the purchasers and providers of social care services do business with one another. As in all markets, there are different combinations of purchasers and providers, interacting differently in all the service sectors for each of the service user groups and sometimes differently within the same authority, as, for example, between urban and rural areas in what are termed different market segments.

Stakeholders: all of the relevant parties including councillors, managers and staff of local authorities, other related commissioning bodies, such as Health, service providers in the statutory, private and voluntary sectors and, above all, service users and their carers and their associated advocacy organisations.

Macro-commissioning: the process of meeting needs at a strategic level for whole groups of service users and/or whole populations.

Care Management: the process of meeting needs at an individual level, otherwise known as micro-commissioning.

Core Elements of Commissioning

Commissioning has to be based on:

• a common set of values that respect and encompass the full diversity of individuals' differences
• an understanding of the needs and preferences of present and potential future service users and their carers
• a comprehensive mapping of existing services
• a vision of how local needs may be better met
• a strategic framework for procuring all services within politically determined guidelines
• a bringing together of all relevant data on finance, activity and outcomes - see module on Financial Management
• an ongoing dialogue with service users and carers and service providers in all sectors
• effective systems for implementing service changes, whether of in-house or of independent sector services
• an evidence-based approach which continuously evaluates services with a view to achieving measurably better outcomes for service users and their carers
• an improving alignment with the way that other health and social care services are commissioned - see module on Partnership Working

Source: Joint Reviews

The Practice

• Responsibility for commissioning decisions rests with budget holders but they should be held openly to account by other stakeholders.
• Minimum statutory requirements must be met and, beyond that, resources should be used to support, and not to undermine, the informal caring resources of individuals, families and communities
• The authority must be clear about its own responsibilities and priorities before entering into joint or collaborative commissioning arrangements with another authority or agency
• The process should be equitable and transparent, open to influence from all stakeholders for example users, carers and their advocates, as well as service providers from all sectors.

Source: Worcestershire County Council

Roles of Stakeholders

Commissioning has to be a fully inclusive process, if it is to work effectively. All the various stakeholders need to understand how and when to make their contributions to the commissioning process.

Source: Joint Reviews

Councillors have a number of key roles in commissioning.

Cabinet Members

Councillors who serve in Cabinet and especially those who hold the social services portfolios, provide the political guidelines for commissioning:

• the level of corporate priority to be given to the social care agenda and the contribution of non-social services directorates
• the contribution of social care to the corporate agenda
• the share of the corporate budget to be devoted to social care and, in particular, the organisational capacity to commission
• the relative priority of different user groups
• the needs, over and above the statutory minimum, to be met on a discretionary basis
• the degree of delegated authority devolved to officers
• the role of in-house service provision and the balance with independent sector provision
• the impact of the level of charges on the use of the charging policy to manage demand
• the extent and pace of change, including integration with other services, such as Health
• the scope for joint commissioning with other local authorities

Members of Scrutiny Committees

Councillors, who serve on Scrutiny Committees, also have a key contribution to make in advising the Cabinet and council colleagues in a number of ways:

• keeping the relative priority of social care within the corporate agenda under review
• commenting and making recommendations on the strategic priorities
• checking the organisational capacity to deliver the required scale and pace of change
• monitoring the core set of performance indicators and benchmarking performance against similar authorities
• taking note of other internal and external inspection, audit and review reports
• commissioning investigations into service areas of concern

Other Councillors

Councillors who do not sit on either Cabinet or Scrutiny Committees still have an important role to play in:

• endorsing/challenging the strategic priorities of the authority
• championing the social care interests of constituents and/or of particular user or carer groups
• holding Cabinet to account for the delivery of specified outcomes

Source: Joint Reviews

Corporate Managers

Corporate Managers have to agree a council-wide set of principles and procedures that should govern the commissioning of all services by the local authority.

Lead Commissioning Managers

Lead Commissioning Managers, whether for children's or adults' services, need to:

• adhere to a common set of principles and processes
• define commissioning priorities, matching ambition to capacity
• co-ordinate the inputs from all parts of the authority, bridging operational and support services
• maintain a networked dialogue with users and carers and their representatives as well as with service providers in all sectors
• provide scope for other stakeholders both to influence commissioning priorities and to hold commissioners to account for delivering specified outcomes
• identify opportunities for joint or collaborative commissioning with other commissioning bodies

Chief Officers

Chief Officers of other commissioning bodies, such as Education or Health, will find mutual advantage in identifying where commissioning priorities reinforce or complement each other - see Partnership Working.

Care Managers

Care managers have a responsibility to feed back into the commissioning process:

• eligible needs unable to be met by current services
• outcomes delivered by the various services
• ideas/proposals for new or amended services

Finance Staff

Finance staff have a vital role not only in ensuring that budgets are balanced but in helping operational managers to identify more creative and cost-effective ways of using the available resources:

• providing timely monitoring data on financial commitments
• calculating ever more robust comparative unit costs
• developing predictive financial models based on current trends

Information and Performance Management Staff

Information and Performance Management staff have the challenging tasks of

• identifying and analysing the key monitoring data
• highlighting the strengths and weaknesses of current services
• developing data on outcomes and quality of care to set alongside the data on finance and activity

Commissioning and Contracting Staff

Contracting staff have to support operational managers with the lead responsibility for commissioning services:

• devising comprehensive strategies
• undertaking appraisals of all relevant options
• prioritising services for increase or decrease
• moving from input-based to outcome-based contracting
• driving down the transaction costs of commissioning (for example contracting and invoicing)

Legal Advisers

Legal Advisers have to ensure that all contracting arrangements are within the law but their advice has to give commissioning managers the maximum flexibility to adjust the contracting arrangements to suit local market conditions.

Service Providers

Service Providers, both in-house and in the independent sector, need to be proactive in the commissioning process. They have the most contact with service users and their carers and have the most developed and practical knowledge of what works well in services. This intelligence is vital to the commissioning process. It is of mutual benefit to purchasers and providers of services that, while recognising the constraints of commercially sensitive information, there should be as much sharing as possible of medium-term purchasing intentions, on the one hand, and business development plans on the other. This enables a negotiated sharing of the risks involved in anticipating the future demand for services. Commissioning bodies need to understand from the provider perspective the incentives and deterrents to entering or leaving the local social care market, in order to refine their commissioning and contracting processes accordingly.

Users and Carers and the Advocacy Organisations

Users and Carers and the advocacy organisations representing their interests must have opportunities to influence the commissioning process, both at the political level of determining strategic priorities and resource allocations and at the executive level of how services are best delivered. This means that they should have access at appropriate times to Cabinet and Scrutiny members and to commissioning officers, both to influence the initial policy formulation and to hold them to account for the actual performance of all the services commissioned, whether in-house or in the independent sector.