A focus on identifying local needs and defining these as commissioning outcomes, and the duties of 'Social Value' and 'Best Value', require closer involvement of local voluntary and community groups, and local businesses, with the commissioning process as a whole.
Watch our video on the modern approach to commissioning of services.
Developments in commissioning
The diagram above shows the developments that have taken place in commissioning.
Commissioning has moved on from thinking only about who is providing the services. Commissioning 1.0 was about competitive commissioning – what outcomes have we/ have we not achieved? It was about the commissioner’s priorities, not about user value. Commissioning 2.0 is about personalised, meaningful outcomes – what matters in people’s lives. This is the level you should be aiming to achieve.
Many councils are looking at commissioning their adult social care services in a more outcomes focused way.
Sharing a common language
Each organisation in a collaborative working group is likely to have different ways of defining commissioning terms. To avoid confusion, and to ensure everyone is talking about the same thing, it is helpful to define a common language for all partners and stakeholders.
For councils, Social Value and Best Value are familiar concepts and are embedded into policies and procedures. However, as you work more with local groups and businesses it is worth bearing in mind that they may not have such a clear understanding, or be aware of the duties under which councils have to operate.
Guidance – Examples of commissioning definitions
Input – the resources needed to the deliver the outputs and details how the service provider will provide the service
Output – the desired level of service activity from the provider
Outcome – the desired positive result or impact of the commissioned service for the service user or the population as a whole
Procurement – the process of acquiring goods, works and services, including acquisition from third parties and in-house providers
Outsourcing – replacing internally provided services and goods with external providers, which could come from the private or voluntary sector
Privatisation – this specifically means the service being taken on by a private sector organisation
The four worlds of public services
No one person can ever have a view of the whole commissioning experience – each person’s understanding, perception, responses and thinking is determined by their place in the process.
The emphasis on co-design and co-production in outcome-based commissioning, potentially with service users and suppliers, makes it important to be able to see problems and options from the perspectives of everyone involved, especially if you want to find a solution that everybody is happy with.
Business consultants RedQuadrant have developed the Four Worlds service transformation model for public services. It describes public service delivery from the perspectives of the four key areas involved – the four ‘worlds’. Each world is separated by an invisible divide, and for commissioning to work each world must find ways to cross this divide and link with each other. Commissioning is about how we bring these worlds together.
Watch our video on outcome-based commissioning theory and systems, presented by Benjamin Taylor of RedQuadrant.
The 'four worlds' of public services are the:
- customer world
- service world
- management world
- political world.
Customer world
The customer world is where everyone lives their lives. It’s where user demand is created and market research takes place – the people in this world tell us what they need.
Divide – The front line
This is the point of power because if customers are not happy with the service or offerings available they complain, causing more work and complexity in service world.
Service world
The council and its staff form service world. This is where council services are delivered and the people in customer world receive them.
With a modern approach to commissioning it is feasible that the people delivering the services are also customers, and therefore will ‘inhabit’ both worlds.
Divide – Performance information
This is where needs get converted into achieved targets
Management world
This is where business planning takes place: budgets are agreed, targets are set, reorganisations happen and performance is measured.
Divide – Policies and governance
External parameters are set which the council must work within and has limited control over.
Political world
This is where government agendas are applied at a local level and strategic direction is set.
Councillors also sit within this world. They interface directly and frequently with the other worlds, giving them insight and influence.
By using the 'four worlds' model, you can achieve three levels of learning:
- emotional intelligence – an understanding that you are not communicating person to person and that each world has its own perceptions and pressures; and any disagreements are not personal
- try to get inside other worlds by asking: "how can I help them respond to the pressures in their world better and in a way that helps me as well?"
- work out how to work together by asking: "how can we change the conditions of these worlds so that they are better aligned to work together?"
Guidance – The supplier perspective
Commissioning for outcomes presents opportunities for working more with local voluntary and community groups, and local businesses. These are likely to be smaller organisations, and, to enable them to compete with larger organisations, it is important that you consider their perspective in your commissioning and procurement processes.
Jon Harvey Associates is a small leadership consultancy, and they have compiled the following list of considerations to help you do this:
- engage providers early in the process so that they can understand the challenges you face,
- and how they might go about helping you to overcome them
- make sure the time needed to bid is proportionate to the work on offer
- present the specification clearly and concisely, and make it easily accessible – for example, don’t bury it on page 86 of a large document
- ask questions that are easy to understand and relevant to the work
- be clear about exactly what the work includes, and whether there are any parts that won’t be paid for, giving the option to provide this for free
- if it looks like the existing provider has a head start, smaller organisations are less likely to be interested
- similarly, if there are a large number of bidders, smaller organisations are less likely to be interested
- make sure your time scales are realistic to give smaller organisations the chance to prepare a bid
- the requirement specified should match the desired outcome
- the supplier requirements should be proportionate to the outcomes required
- make sure the process provides scope for suppliers to demonstrate their strengths.
Jon Harvey Associates has compiled a list of questions to guide organisations on whether to make a bid for work.
Making the commissioning cycle work
There are several factors that will determine how effective your commissioning is, especially when a number of groups or organisations are involved. The following principles might help you.
Agree a common approach
Each department or local area should have a commissioning cycle which is adopted across all partners and signed up to. As all cycles can be mapped to each other; it does not matter which is used, just that there is an agreed and common approach.
Start the commissioning process with an understanding of the desired outcomes
Any commissioning cycle should start with understanding the outcomes that you and your service users would like to achieve.
Consider a wide range of service options
The ‘do’ part of a commissioning cycle might be something other than a traditional service, so be careful not to constrain your options. Going through a commissioning cycle does not necessarily lead to procurement. It may lead to the decommissioning of a service – that is, stopping it – or it may lead to a solution that does not require formal procurement – setting up a group of volunteers to maintain a local landmark, for example.
Actively seek to involve service users at each commissioning stage
Commissioners should actively seek to involve service users at each commissioning stage so that they become co-designers and co-producers of the positive outcomes which commissioning strives to achieve.
Involve providers at all stages
Providers should also be involved at all stages (except where there are specific commercial considerations). The dangers of using this model are that:
- it can lead you into meeting needs with money, that is, by rushing to renew a contract that is about to expire
- you only get the chance to review at set intervals, rather than on an ongoing basis.
Watch our video on the provider perspective.
Systems thinking commissioning model
The systems thinking commissioning model looks at more than buying services to meet needs. Instead, it takes into account all the resources available and the desired outcomes, after which interventions are designed using those resources to achieve the outcomes.
Resources include:
- public money, including benefit
- buildings and equipment
- internal and external workforces
- what the market can offer
- what innovation and technology can offer
- the people receiving services and living in the area.
Case study – Positive family futures in Portsmouth
Background
Despite being one of the world’s great ports, Portsmouth faces some challenges. Some areas of the city have high unemployment levels, lower-than-average incomes and social problems such as poor health. There are generally lower levels of education and skills in these areas, and barriers to accessing opportunities.
The Public Services Board, which is chaired by the leader of Portsmouth City Council and brings together the chief executives of the main partners in the city, saw the Troubled Families programme as an opportunity to address these challenges.
In particular, the board wanted to understand why families become ‘troubled’ in the first place and developed the hypothesis that a focus on earlier points of intervention could prevent families reaching the Troubled Families threshold. The board, therefore, sponsored a review in 2013 in which a multi-agency team worked with consultants and used the Vanguard Method to look at services from a family perspective.
Commissioning and delivery model
Using a systems thinking model, the journeys of eight families were reviewed over a six-week period to understand how services responded to them and identify any missed opportunities. The exercise found that each family came into contact with a high number of professional and agencies, none of which had all the information about the family. This resulted in high costs through large numbers of intervention, with no discernible improvement for the family.
The services were then redesigned with three elements, to:
- identify and work with families at the earliest point of concern
- determine ‘triggers’ from data and information held to proactively identify families who require help at the earliest opportunity, for example an unexplained absence from school
- assign a ‘navigator’ to act as a single point of contact for a family, ensuring they are offered the right service at the right time.
Outcomes
The new way of working was branded Positive Family Futures and was trialled in the Paulsgrove area in 2014. It has shown benefits to families and improved the cost effectiveness of the system by:
- reducing the number of professionals involved in working with a family
- resolving difficulties earlier
- improving health, wellbeing and financial outcomes for the families involved.
Hints and tips – Further reading on outcomes and efficiency
See chapter two of ‘Outcomes and Efficiency Leadership Handbook’ by Richard Selwyn for an in-depth discussion of the efficiency savings identified by this commissioning model.
Challenge 4 – Knowing your resources
How familiar are you with the resources that are available in your ward and at your council?
Take a moment to consider:
- finances
- internal workforce
- external workforce – can you identify any individuals or groups who could deliver services, or who are already delivering similar services?
- what do local businesses offer?
- how well do you know your local businesses?
- buildings and equipment
- are there any community-owned facilities?
- what technology is available to you?