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Commissioning for Outcomes challenges and
opportunitiesLeadership in the joint
commissioning of services for children with
SLCNConference 2nd June 2009
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Who we are

• Philip Franklin, Business Development Manager,
  Thurrock Childrens Trust
• Sue Brunton-Reed, Director of Effective Training
  and Consultancy, experienced children's service
  manager, and independent consultant
• Justine Henderson, Willoughbys Limited,
  experienced in commissioning and procurement
  within the Care sector, specialising in
  Childrens services

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Our presentation

• A brief outline of the approach taken by Thurrock
  Childrens Trust in the joint commissioning of a
  range of preventive services
• Challenges and opportunities presented through
  outcomes based commissioning
• Engaging providers in the commissioning process
• Support requirements of the community and
  voluntary sector
• Developing outcome based reporting and monitoring
  mechanisms
• Lessons learned which can be applied to other
  joint commissioning exercises

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The approach that Thurrock Childrens Trust
sought to achieve through joint commissioning of
a range of preventive services

• Thurrock Children's Trust allocated 3 million
  over three years from a pooled budget
  arrangement to commission a range of Early
  Intervention and Preventative services
• Identified Outcomes
• Prevention of care and significant harm
• Improved parenting skills
• Improved access to services for young carers
• Improved mental and physical health through
  healthy living and eating programmes

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Aims of the Commissioning Approach

• To engage providers in the design of the
  commissioning approach to stimulate the market
  and attract quality tenders from a wide range of
  potential providers
• To support the voluntary and community sector
  during the tendering process
• To undertake a one tendering approach for a wide
  range of provision
• To ensure sufficient availability of provision to
  meet a wide range of needs, promote choice and
  flexibility
• To ensure best value and good quality services
• To promote integrated and partnership working
• To adhere to Procurement regulations and EU
  directives and the local Compact agreement
• To put in place robust performance management and
  outcome reporting mechanisms

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What has been achieved?

• A two tiered Preferred Provider Framework
  arrangement e.g. 8 providers on Service
  Contracts, and 12 providers on Framework
  Contracts, to start service delivery from April
  2009
• Successful providers are a mix of small, medium
  and large voluntary organisations, some of whom
  are new to Thurrock
• A wide range of services have been commissioned
  to meet the identified needs
• All providers are committed to working with
  Thurrock to report on outcomes achieved

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Challenges and opportunities presented through
outcomes based commissioning

• Opportunities
• Clarity about outcomes promotes innovation in
  delivery processes
• Service users are involved at an early stage in
  determining how the service should be provided,
  and in giving feedback
• The process promotes partnership working all
  parties have to be involved
• Challenges
• Getting accurate and up to date needs data
• Tensions between whole service level outcomes and
  individual outcomes for children
• Providers who already report on a range of
  outcomes measures
• Capacity of both providers and commissioners to
  collect and use the information

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How we engaged providers in the process

• Engagement before, during and after
• One to one meetings, provider forums and
  questionnaires were used to gain early feedback
  into the design of the commissioning approach and
  to understand present market conditions affecting
  providers
• To gain input into the development of an outcomes
  focused service specification, the terms and
  conditions, pricing structures, adequate
  timescales to complete documentation
• A central point of contact for questions and
  queries and feedback on progress Thurrock CVS
• To promote partnerships and integrated working
• Promote a learning environment

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Support requirements of the community and
voluntary sector

• Community and voluntary organisations may not
  have expertise in completing tenders, or the
  capacity to do so
• Thurrock CVS were able to allocate someone to
  support the small organisations but it was
  recognised that more technical advice and
  training on completion of tenders, particularly
  help to cost services and understand cost
  breakdowns, would have been very helpful

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Particular challenges for the community and small
voluntary sector organisations

• Insurance requirements
• Understanding of terminology
• Time to complete the documentation whilst doing
  the day job
• Implications of Framework Contract arrangements
  no up front funding to put services in place
• Lack of understanding of how to cost the service
  and the importance of full cost recovery

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Developing outcome based reporting and monitoring
mechanisms what do we want to measure?

• Contract compliance safe practice, recruitment,
  policies and procedures, training, service
  delivery
• Quality of service provided progress against a
  set of outcome measures (service level outcomes)
• Impact what difference does this service make
  to individual children or young people linked to
  Individual Service Agreement (child/young person
  level outcomes)

info_at_effectivetraining.co.uk 01604
643610 Willoughbys_at_mac.com 01245 363 778
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Developing outcome based reporting and monitoring
mechanisms the process
info_at_effectivetraining.co.uk 01604
643610 Willoughbys_at_mac.com 01245 363 778
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Developing outcome based reporting and monitoring
mechanisms putting it in place

• Child/Young person level outcomes
• Consultation with young people, key workers,
  decision makers, providers
• Systems to support process referral forms to
  identify desired outcomes at onset, Individual
  Service Agreement to specify outcomes and agree
  baseline, review process to evaluate progress
  against baseline
• Contract monitoring which measures percentage of
  ISAs completed and outcomes achieved
• Challenges
• Identifying the right outcome measures at the
  start need opportunity for these to be reviewed
  and revised

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Developing outcome based reporting and monitoring
mechanisms putting it in place.

• Service Level Outcomes
• Consultation with providers and commissioners
  about a range of Key Performance Indicators which
  all providers will collect and report on
• Linked to ECM Outcome measures examples below
• Keeping Safe
• Incidence of children and young people becoming
  subject of child protection plans whilst
  receiving service
• Incidence of children and young people ending an
  existing child protection plans whilst receiving
  service
• Making a positive contribution
• Number and of children/young people receiving
  the service who have contributed to the planning
  or delivery of the service
• Numbers and of children, young people and
  families who give positive feedback about service
• Challenges
• Systems and capacity for collecting, reporting
  and collating information

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Lessons learned which can be applied to other
joint commissioning exercises

• Appropriate use of terminology to facilitate
  effective communication and understanding
• Preparation is key - Obtain needs, trend, number
  of anticipated referrals at the start. Be clear
  about your service requirements and build all
  these factors into your specification
• Know your market and the impact a commissioning
  approach will have on it
• Put the necessary processes in place to avoid
  potential conflicts of interest arising
• Engage key members e.g. procurement, finance and
  legal early on in the process
• Develop and stick to the project plan
• Communicate Keep Communicating !!

info_at_effectivetraining.co.uk 01604
643610 Willoughbys_at_mac.com 01245 363 778
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Contact Details

• Philip Franklin 01375 652 652
• pfranklin_at_thurrock.gov.uk
• Sue Brunton-Reed 01604 643610
• sue_at_effectivetraining.co.uk
• Justine Henderson 01245 363778
• willoughbys_at_mac.com