Implementing Fulfilled Lives, Supportive Communities Commissioning Task Group

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Implementing Fulfilled Lives, Supportive
CommunitiesCommissioning Task Group

• IPC

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Institute of Public Care

• Work on commissioning in Wales over the last
  three years
• Seminar series across Wales on the IPC
  Commissioning Model for SSIW.
• Commissioning Framework programme followed by
  certificate courses for all SMATS .
• Seminar programme across Wales on Developing
  Accommodation Strategies and Commissioning ECH.
• SSIA reviewing commissioning with regard to
  Children in Need and putting in place a
  development programme.
• Work with up to 10 LAs or consortiums of LAs in
  helping develop their individual strategies.

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Institute of Public Care

• Work on commissioning in England over the last
  three years
• Development of Commissioning Exemplar Strategy
• Development of two guides concerning fairer
  access to care.
• Three projects for CSED providing tools to assist
  with JSNA.
• Assistance in the national implementation of the
  joint planning and commissioning frameworks for
  Children's Services.
• Regional projects on commissioning in the North
  West, East Midlands and Eastern region.
• Development of Commissioning Strategy on Long
  Term neurological conditions.

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Institute of Public Care

• Work on commissioning in England over the last
  three years
• Improving commissioning capability in Learning
  Disability for the South West Centre of
  Excellence.
• Assistance to some 40 LAs on the development of
  their individual commissioning strategies.
• Current work
• Developing a model for outcome based contracting
  in home care.
• Developing a national approach to market planning
  and facilitation.

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Institute of Public Care

• Current joint project across England and Wales
• Developing and improving commissioner-provider
  relationships

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General Issues

• Most authorities have a range of commissioning
  strategies.
• In simple demand and supply terms there is a
  better understanding of how to evaluate demand
  than there is of how to evaluate supply. Little
  real market awareness.
• Still often missing agencies in terms of
  joined-upness.
• A very slow shift from being provider orientated
  production line managers to being strategic
  commissioners. Lack of support / critical friend
  in developing new approach.

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General issues

• Consultation still often means consulting with
  the usual suspects.
• Majority of contracting arrangements still very
  conservative.
• Great uncertainty about where direct payments,
  individual budgets and self directed care fits
  with a commissioning and contracting functions.
  Danger of confusing ends with means
• Muddle from government departments and
  ministries, with confusion over language and
  emphasis, eg, distinctions between commissioning
  and contracting.

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Issues in Wales

• Uncertainty about where the focus of activity
  should be regions, LAs, localities.
• Slow to move from provider to facilitator.
• Welsh market more fragmented, less mature than
  the English market.
• Difficult relationships between the LAs and the
  LHBs. LHBs not much leverage over trusts.
• Lack of clarity about where commissioning fits
  with other strategies, plans and initiatives.

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What do we conclude commissioning strategies
should offer.

• Long term at least ten years.
• Draw in all the key players health, housing,
  social care, regeneration, planning.
• Comprise an overarching framework with strategies
  for specific groups, eg, older people, phys dis,
  etc.
• Need to be analytic not descriptive, proactive
  not reactive, outcome focussed rather than output
  driven.
• Need to recognise that the majority of care is
  delivered by families, followed by the private
  and voluntary sector.

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Potential initiatives for Welsh Assembly
Government

• Establish clarity over the role that
  commissioning should perform, establish a
  framework within which strategies should be
  developed, set expectations of performance and
  support LAs and LHBs to get there.
• Recognise there is a need to go beyond training
  and seminars and into support, coaching and
  mentoring
• Explore how the private and voluntary sectors can
  be stimulated and how LAs can facilitate this
  happening.
• Be wary of seeing choice as paramount, recognise
  quality and consistency as equally important and
  move to put outcomes at the centre of
  commissioning and contracting.

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Potential initiatives for Welsh Assembly
Government

• Encourage the development of new, simpler
  tendering arrangements, with an emphasis on
  investment rather than purchase.
• Looking at establishing a simple single
  depository for population data and other national
  information to support commissioning.
• Stimulate the development of local performance
  indicators around national outcome based
  expectations.