Susan Lloyd-Selby Senior Project Manager - Value Wales Uwech Rheolwr Prosiectau - Gwerth Cymru National Disability Authority of Ireland September 2011 A commissioner’s view on commissioning

Commissioning is about more than procurement Procurement is not just about competitive tendering Service users are citizens The market is the care sector A word about language

Getting into shape for the future: How do we manage/respond to demand more effectively? How do we shape the market to ensure choice, flexibility & innovation? How can we achieve better outcomes with less? Key Questions

A good approach to strategic commissioning provides: Improvements in care services and better outcomes for service users A framework within which interested parties are able to work together to achieve a shared vision & goals. A transparent process which provides an evidence- based rationale for decision-making - informed by the needs of the population & capacity of providers. Auditable objectives which ensure that value for money services deliver required outcomes Increased choice and control Nothing more important to get right Why is Commissioning important?

A shared vision and common goals Citizen centred approaches and personalisation Focus on outcomes not inputs and outputs Partnership & collaboration rather than competition Key Characteristics

Understand the needs of those using services Consult provider organisations when setting priorities Put outcomes for users at the heart of the process Map the fullest practical range of providers Consider investing in the provider base Ensure contract processes are transparent & fair – long term contracts & shared risk taking Seek feedback to review effectiveness of commissioning process Key Principles

A word of caution from Einstein ‘Not everything that can be counted counts, and not everything that counts can be counted’

Inputs Process & Activity Outputs Measures End user happy and has warm feet Outcomes Example of Inputs, Outputs and Outcomes

Service Example of Inputs, Outputs and Outcomes Isolated/lonely and lacking confidence following a fall Inputs £££££ Equipment Staff Training Process & Activity Assessment Personal Care OT programme Physio Day activities Other Outputs Outcomes I am more confident, mobile and independent

Focus on choice and control through funding mechanisms Personal budgets/ Direct Payments Co-production - sharing responsibility & control of the full range of commissioning & procurement activities Ensuring quality & access for hard to reach groups Market shaping - key function (seeing over the horizon) Intentional & strategic approach Personalising care services

Key Components for Market Shaping Strong engagement – develop mechanisms that enable service users to set the direction for commissioning & service development Market intelligence – build an evidence base about the local care sector & how it operates Provider development – build constructive relationships Success relies on partnerships, shared risks and a willingness to put service users in the driving seat

A picture paints a thousand words

Currently exploring opportunities for collaborative approaches Want to capitalise on our size and exploit opportunities to make connections – does not make sense to do everything 22 times Across traditional organisational & geographic boundaries – regional commissioning Cross-sectoral collaboration to deliver outcomes for citizens Shared service planning between health & social care Making the Connections The best outcomes are obtained when those who commission, use & provide services work together in collaboration

Commissioning is NOT procurement Commissioning MAY include competitive tendering Tensions exist – confusion re applicability of EU regs. Perception of procurement - providers see tendering as an opportunity & re- tendering as a threat Using competitive tendering to secure care services – Not always about the lowest price (almost never) – Seeking added value in relation to sustainable development – Seeking widest possible benefit for citizens. Commissioning must drive procurement Role of Procurement

Lessons learnt Starting point - maximum possible transparency about vision & objectives. Commissioners & providers must work as equal partners Collaboration takes time & requires trust & shared risk taking Allow room for tension & anxiety Build on the strengths of existing relationships Don’t let the process get in the way of what you are trying to achieve. Don’t seek complex solutions when simplicity will do Make sure every thing you do adds value for service users

Final Thoughts Success relies on Partnerships and collaboration Shared risks A willingness to put service users in the driving seat