Working effectively with providers
The government want to see service users and patients more in control of their care and support and able to buy a range of personalised services that will meet their needs and desired outcomes in a holistic manner. Where necessary, the government expects them to be supported in this.
The service user and patients should be satisfied that a service they buy is flexible, meets their needs, is delivered at the right cost for them and is of good quality. The service user/patient should be at the heart of the service and the very reason for the providers’ operation and commissioning purpose.
Things like personal budgets and direct payments, backed by clear, comparable information and advice, will empower individuals and their carers to make the choices that are right for them. This will encourage providers to up their game, to provide high-quality, integrated services built around the needs of individuals. Local authorities will also have a more significant leadership role to play, shaping the local market and working with the NHS and others to integrate local services. Caring for our future (2012:3)
The government considers that developing the market is crucial to realise the vision of a more personalised and integrated care system. As set out in the Vision for Adult Social Care, the government expects to see a far greater diversity of organisations and agencies involved in health and social care in local communities.
Local authorities have a key strategic role in developing markets and encouraging the involvement of social enterprises, mutuals and co-operatives in the whole spectrum of service provision, from assessment through to provision. Plans for these organisations were expanded upon in the green paper, Modernising Commissioning, which also proposed the right for local groups and local government employees to challenge local authorities where they believe they could offer services better, encouraging the development of new provider organisations.
Moreover, Caring for our future (2012), places an expectation on Local Authorities to shape or facilitate the market and to develop Market Position Statements (MPSs) in partnership with other relevant sectors, providers, service users and their carers. Markets are expected to become more diverse in terms of funding; the development of social impact bonds and public-private partnership (PPP) arrangements are an example of these movements.
What does this mean for commissioners and providers?
- Service users/patients, their carers and relevant populations should be engaged throughout the whole commissioning process and market facilitation activities. Effective service user engagement is crucial. The local authority needs to lead on this and providers are expected to engage to help improve quality and business planning.
- Local authorities should be enabling/facilitating the provision of information, advice and sign-posting for their population.
- Local authorities and providers need to know the current and potential future market place, have a good understanding of need, outcomes, demand and supply.
- Traditional remits of commissioner and provider (contractor and supplier) will change. Commissioners may not always contract for a service but will be more facilitators in enabling providers to contract and supply. For example: a social work mutual may contract with another provider to deliver a service; a provider through an Individual Service Fund (ISF) may commission services on behalf of a service user; a service user with a direct payment may choose to commission a provider service themselves.
- Some level of integration. Commissioning units and providers may integrate or develop partnerships with other sectors to deliver a holistic need. For example, an effective housing with care scheme may be aligned with local health (either through funding or service delivery) if it is shown that an integrated intervention improves outcomes and results in efficiencies across the system.
- Commissioners and providers need to improve quality so service users or patients commission a service that meets their need and delivers the desired outcomes. Service user and patient satisfaction is fundamental as they are buying a service.
- Local authorities and providers need to be open to new ways of doing things. They will need to understand potential new models of commissioning and service delivery and be able to spot and source innovation.
- Local authorities need to demonstrate leadership to enable these changes to occur; likewise, providers have to be proactive to drive and contribute to change.
- Constructive partnerships are crucial.
What promotes constructive partnerships?
- Providers, if involved at the beginning of a commissioning strategy or Market Position Statement (MPS), can give unique insights into demand but also invaluable information regarding supply. This is beneficial for providers, who can shape their own businesses around the commissioning plan.
- It is important that local authorities ensure a consistency of message and direction of travel from strategies to plans and their consequent reviews (for example JSNA, Health and Wellbeing strategy, commissioning strategies, Market Position Statements (MPSs).
- Good co-productive practice with service users and communities. Co-produced services can only genuinely occur when commissioners and providers tap into community resources together and work in partnership with service users.
- Outcome-based approaches promote dialogue. Outcome approaches focus on the desired impact and the contracting mechanism requires commissioners, providers and service users to be involved in setting what outcomes are to be achieved and also invested in. In a social impact bond arrangement, commissioners and/or providers are required to deliver on outcomes to ensure that the investors get a return on their investment. This in turn benefits all partners because it encourages sustained and further re-investment and possible diversification to meet set outcomes.
- Positive procurement; open, equal, and consistent processes encourage constructive relationships.
- Fairer contracting. Contracts that reflect, acknowledge and protect the interests of both parties can alleviate concerns and enable a fairer playing field between commissioner and provider.
- Common and regular approaches to liaison with providers, for example, provider forums, open book accounting, shared training and workforce development. It is in both commissioners’ and providers’ interests that services are of a good quality, sustainable and financially successful.
- Specifying a clear role for services that are still delivered ‘in-house’, including internal Service Level Agreements and a clear separation of duties between commissioning and provision.
Constructive relationships can be promoted by specific behaviours on the part of commissioners and providers.
- Openness; dealing with differences and difficulties in a non-defensive or adversarial way, i.e. conflict management skills.
- Good interpersonal skills
- On-going self-reflection and assessment
- Confidence in one’s own skills and organisations to contribute to solutions (related to this is having adequate knowledge of the procurement regulations and keeping within the law)
- Knowledge of appropriate boundaries (i.e. confidentiality issues and discretion) yet also knowledge of where and how one can be flexible.
- Good negotiation skills
- Desire and commitment to seek realistic alternatives and sustainable solutions
- Shared ownership of outcomes
- Willingness to invest time and effort
- Willingness to invest emotional and creative energy
- Positive energy and outlook
- Tenacity and strength
- Willingness to support innovation and talent
Sources of further help
Review of Adult Social Care Complaints 2013 (2014). A very useful and concise report from the Local Government Ombudsman (LGO) about adult social care complaints. It shows an overview of the complaints made and then provides more details such as the increase in complaints (which comprise of a 130% increase in ASC complaints since the LGO took on responsibility for registered providers in 2009); frequent issues and the outcomes of complaints made.
Pay, conditions and care quality in residential, nursing and domiciliary services 16th April 2014. This briefing paper by the Joseph Rowntree Foundation (JRF) examines the relationship between pay and conditions for workers in residential, nursing and domiciliary care services and the quality of care experienced by people using the service. The briefing sets out what is important to staff and what is helpful in retaining quality staff.
Bringing care home: promoting independence through integrated working 2014 Skills for Care and the Housing Learning and Information Network (LIN) have made three films that demonstrate how good care and support, when delivered at home, can make a real difference to older people and those with complex needs to lead independent lives. These short films show how housing, care and support staff in three different organisations work well to respond to the needs and wishes of residents and clients.
Commissioning Sustainable Care & Support Services: A call for action March 2014. In an opinion piece for Inside Housing last year, Brendan Sarsfield, CEO of Family Mosaic, criticised current approaches to commissioning and contracting for care and support services. He described a 'Wacky Races' approach to winning new contracts which results in driving down wages, destabilises services and hampers innovation. In this Housing LIN Viewpoint no 60, he expands on this article and sets out how the housing sector can best deliver sustainable care and support services for older and vulnerable adults.
Risk assessment framework for independent sector providers of NHS services April 2014. This document by Monitor describes how it will carry out their role to ensure the continued delivery of essential healthcare services at independent providers of commissioner requested services (CRS). It sets out a framework for annual and in-year monitoring processes for independent providers of CRS; composition of an initial assessment of risk and other elements of Monitor’s oversight and compliance regime.
Commissioning in adult social care: the LGiU and Mears thought leader series – a summary 2014. From May 2013 to February 2014 LGiU worked in partnership with the social care provider Mears to deliver a series of roundtables as part of their Adult Social Care Thought series. This was developed following the LGiUs publication Outcomes Matter: effective commissioning in domiciliary care, October 2012 and further roundtable events. The areas explored and reported on in this document include Market Management, Monitoring and Evaluation, Personalisation and Co-Production and Workforce issues.
A minimum price for home care February 2014 A report from the UK Homecare Association (UKHCA) which details the real cost of home care and recommends a greater transparency by commissioners and providers. It states that there are major issues of sustainability and that a fair rate for care was only paid in just 4 of 101 cases it reviewed.
A healthy partnership: predicting future demand for Extra Care Housing in Calderdale A case study by Paula Broadbent, with contributions from Sue Lewis, Chris Willis and Stephanie Furness which details the procurement and development of Willow Court, Elland, Halifax. The case study details the journey leading up to the decision to provide ECH housing for both the provider (Pennine Housing 2000) and the commissioner (Calderdale Council) The case study looks at lessons learnt from earlier schemes and how the future development of ECH schemes will be influenced by changing expectations of older people and the challenges of reduced budgets.
Commissioning the Future: Workshop materials to start a new conversation. July 2012 (Think Local, Act Personal). This series of five workshop scenarios have been designed to help those involved in strategic commissioning to rehearse and explore new ways in which the public care market might develop. The ‘Commissioning the Future’ pack offers all those involved in strategic commissioning - including providers of services, people, carers and commissioning officers - an opportunity to: rehearse the issues they face; do this outside the context of a particular negotiation, contract or agreement; play different roles than they do in 'real life' to explore issues from a range of perspectives. Each exercise represents real issues faced by all involved in commissioning public care and will support commissioners, providers and people who use services and carers to adopt the key skills and behaviours advocated in ‘Stronger Partnerships for Better Outcomes’. Click here for workshop one; Click here for workshop two, click here for workshop three, click here for workshop four, click here for workshop five.
Stronger Partnerships for Better Outcomes: a protocol for market relations. July 2012 (Think Local, Act Personal). This paper promotes a set of principles and behaviours that will enhance the environment in which good adult social care and support is developed and sustained. It outlines a protocol which could be adopted by all key parties to enable more productive local market relations. The protocol is designed to assist commissioners and providers alongside people using social care with the local delivery of Making it Real: markers of progress towards personalised community based support. October 2011 (Think Local, Act Personal).
The Institute of Public Care (IPC) have produced three papers on behalf of the National Care Forum (NCF), examining the distinctive contribution of the not-for-profit sector to improving the quality of social care provision.
- Paper 1 – People (March 2012) focuses on the contribution of not-for-profit organisations to good employment practice. It looks at the evidence for a stable, diverse and flexible workforce in the sector, the organisational values that are attracting increased levels of recruitment and retention, and the tangible benefits to quality of care that those values and practices bring.
- Paper 2 – Innovation (June 2012) focuses on the achievement of not-for-profit organisations in leading innovation in the design, delivery and funding of services, both in residential and community-based care, at a time when improved outcomes providing good value have never been more urgently needed.
- Paper 3 – Added Value and Social Capital (June 2012) focuses on the concept of social capital and added value and describes how these concepts are particular features of the approach of organisations in the not-for-profit sector