EXPLORING STRATEGIC COMMISSIONING

Jane Shuttleworth Consultancy Ltd for Dorset CYPSP

October 2004

“The primary purpose of a Children’s Trust is to secure integrated commissioning leading to more integrated service delivery and better outcomes for children and young people.” Every Child Matters Next Steps

Contents

1. Introduction
2. Definitions
3. Frameworks for Developing Commissioning Strategies
4. Contents of Commissioning Strategie
5. Commissioning Principles

1. Introduction

This booklet draws together information on strategic commissioning from a number of sources.

The booklet was initially developed as a paper for Dorset Children and Young People’s Strategic Partnership.

It includes information from the following agencies and authorities:

• Department of Health “An Introduction to Joint Commissioning” 1995 
• Audit Commission Take Your Choice – a commissioning framework for community care.
• National Treatment Agency for Substance Misuse
• National Primary Care Trust Development Programme   “The Commissioning Friend for PCTs” 
• Making Ends Meet a web-based resource - module on commissioning. The resource was initially produced by the Audit Commission and Social Services Inspectorate Joint Review Team.
• Telford and Wrekin Pathfinder Children’s Trust
• A Catalyst for Change – Health and Social Care Change Agent Team – written for Department of Health by Warwick Insight Limited
• Institute for Public Care, Oxford Brookes University -   Framework for Commissioning and Purchasing
• Jane Shuttleworth Consultancy Ltd – Commissioning Framework
• Lincolnshire Commissioning Strategy for Older People a good practice example included in Making Ends Meet
• Bexley Commissioning Strategy – Older people’s services
• a good practice example in Making Ends Meet)
• Metropolitan Borough of Tameside

2. Definitions

Most definitions appear to be derived from 2 main sources.

A Department of Health definition outlined in a 1995 publication “An Introduction to Joint Commissioning” and the definition used by the Audit Commission in Take Your Choice – a commissioning framework for community care.

These are outlined below:

Department of Health 1995
“Commissioning is the strategic activity of assessing needs, resources and current services and developing a strategy to make best use of available resources to meet identified needs.”

Audit Commission
“ The process of specifying, securing and monitoring services to meet individuals’ needs both in the short and long term. As such it covers what might be viewed as the purchasing process as well as a more strategic approach to shaping the market for care to meet future needs.”

The National Treatment Agency for Substance Misuse use the DOH definition. It is also the definition that I choose to use in my work on commissioning largely because it emphasises the importance of making use of available evidence and refers to use of resources. It also makes it clear that commissioning is about more than procuring and purchasing services although on the downside it makes no reference to this aspect of the commissioning process.

The definition used in “The Commissioning Friend for PCTs”  produced by the National Primary Care Trust Development Programme also includes some of the essential features of the DOH definition but develops this to give it more of a health focus.  

“Commissioning is the process by which PCTs identify the health needs of their population and make prioritised decisions to secure care to meet those needs within available resources.”

Making Ends Meet a web-based resource includes a module on commissioning. The resource was initially produced by the Audit Commission and Social Services Inspectorate Joint Review Team. They develop the Audit Commission definition noted above.

“Commissioning: the process of specifying, securing and monitoring services to meet individuals, needs at a strategic level. This applies to all services, whether they are provided by the local authority of by the private or voluntary sector.

Telford and Wrekin Pathfinder Children’s Trust also use the Audit Commission definition as the basis for their work:

“Commissioning is the process of specifying, securing and monitoring services to meet identified need.”

3. Frameworks for Developing Commissioning Strategies

This section includes a number of frameworks used by different agencies and local authorities. All have their particular strengths.

3.1 A Catalyst for Change – Health and Social Care Change Agent Team – written for Department of Health by Warwick Insight Limited

“Within this document the word commissioning is used in its broadest sense and in this respect covers the following cyclical sequence of events:

• Understanding, mapping and forecasting the supply and demand factors within the market to meet the current and evolving needs of the users/recipients of care services.
• Ensuring that there is alignment between all system partners on what needs to be achieved to ensure this demand is met.
• Involving all systems partners (including users) in the development of plans strategies to achieve these goals.
• Ensuring that the resources across the system are applied for the best effect to maximise attainment of the strategic commissioning goals (including providing a clear and strong context for individual partner organisations to align their activities and organisations behind the strategic commissioning plan.)
• Reviewing and evaluating the services provided with a view to any necessary re-provisioning and of those services to meet ever-changing population needs.

3.2 Institute for Public Care, Oxford Brookes University

Framework for Commissioning and Purchasing follows:

3.3 Telford and Wrekin Pathfinder Children’s Trust

Commissioning Cycle

3.4. Audit Commission Take Your Choice – a commissioning framework for community care

Take Your Choice covers the following:

Reviewing the market and developing a strategy

• Mapping the market to understand both demand and supply
• Understanding current resource allocation
• Developing an informed strategy
• Planning for decommissioning

Making commissioning user-led

• Helping users influence and control their care
• Supporting user choice
• Making services more user focused

Enabling care managers to play a more effective commissioning role

• Removing organisational barriers to commissioning
• Improving the effectiveness of care management
• Aligning management and financial responsibility for commissioning

Getting a better service from providers

• Developing a more mature relationships
• Developing a clear role for in-house services
• Fair and open contracting
• Developing better contracting
• Contract monitoring and compliance
• Communicating with providers

Supporting the Process Centrally

• Developing commissioning skills
• Financial support systems
• Information strategy and systems
• Managing the market

3.5 Jane Shuttleworth Consultancy Ltd – Strategic Commissioning Framework - (See Strategic Commissioning Handbook for more information)

Stage 1: IDENTIFY KEY STAKEHOLDERS AND DECIDE HOW THEY WILL BE INVOLVED
Stage 2: ANALYSE NEEDS and Be Clear About NATIONAL and LOCAL PRIORITIES
Stage 3: ANALYSE INFORMATION ON FINANCE & ACTIVITY and the LOCAL MARKET
Stage 4: Analyse information on needs & services & AGREE STRATEGIC AIMS, OBJECTIVES & PERFORMANCE TARGETS
Stage 5: Use analysis of needs and services and assess this against aims, objectives & targets then DEVELOP COMMISSIONING PRIORITIES
Stage 6: Undertake options appraisals to inform PROCUREMENT & PURCHASING PLANS including developing service specifications and plans for letting any contracts
Stage 7: PRODUCE IMPLEMENTATION PLAN including communicating the strategy and monitoring and review

3.6 Joint Review Team – Making Ends Meet

• Stages of Commissioning
• Agree the strategic framework
• Analyse the data on needs and performance
• Build up knowledge of the social care market
• Consult
• Determine service objectives and priorities
• Undertake an options appraisal
• Develop a contracting strategy
• Set and monitor standards of service delivery
• Revise commissioning and contracting strategies

3.7 National Primary Care Trust Development Programme  “The Commissioning Friend for PCTs” 

Key Steps in Commisisoning

• Service level agreements
• Local delivery plan
• Comparative performance
• Capacity planning
• Current ptterns of service
• National targets
• Health equity audit
• Health needs analysis

4. Contents of Commissioning Strategies

4.1 Joint Review Team – Making Ends Meet – Model Commissioning Strategy

• Introduction – including purpose
• Resume of Needs Assessment
• Current Services
• Local Care Market
• Cost of Services
• Contracting Arrangements
• Changing the Focus of Services
• Monitoring Arrangements
• The Way Forward

4.2 Jane Shuttleworth – Contents of Commissioning Strategy

• Introduction, includes vision
• Strategic Aims and Objectives of the Commissioning Strategy
• Developing the Commissioning Strategy
• National and Local Priorities
• Assessing Need
• Financial Information
• Activity and Performance Information
• Market Analysis
• Priorities for Action  
• Summary of Planned Changes in Expenditure and Activity

4.3 Lincolnshire Commissioning Strategy for Older People

(Good practice example included in Making Ends Meet)

• Introduction
• Map of Lincolnshire
• National Agenda for Older People
• Lincolnshire County Council
• Lincolnshire Social Services
• Older people – the context
• Financial overview
• Performance information
• Market management strategy
• The next year
• Lincolnshire NHS
• Contacts 

4.4 Bexley Commissioning Strategy – Older people’s services
(Good practice example included in Making Ends Meet)

• Introduction
• Strategic Context
• Needs analysis
• Older people – purpose of services & older people needs analysis
• Commissioning and Contract Monitoring Arrangements
  • Commissioning principles
  • Residential and Nursing Home placements
  • Respite and day care
  • Day centres
  • Home care
  • Meals
  • Voluntary sector – grant-aided services

• Housing services
• Commissioning intentions

4.5 Institute of Public Care

• Summary
• Introduction
• National Guidance and Research
• Needs Assessment
• Market Analysis
• Financial position
• Changing the focus of services
• Monitoring arrangements

5. Commissioning Principles

Bexley’s commissioning strategy for older people includes a section on principles. These focus on services. For example:

• Enabling older people to remain longer in the community rather than entering full-time residential or nursing home care.
• Home care support that offers personal care at the times and intensity required to enable older people to remain at home.
• Services that meet the older person’s ethnic and cultural needs.

Tameside have also developed a set of principles which underpin the development of commissioning strategies. These focus on the commissioning process and include the following:

• That the population based data influences decision making.
• That the strategy offers clear and measurable objectives for the population requiring social care.
• That evidence from service users and carers has a direct impact on the strategy.
• That the strategy presents a commissioning rational based on departmental policy and national objectives.
• That the strategy has a service user and carer focus enabling service users and carers to define desired outcomes.

The Pathfinder Children’s Trust in Telford and Wrekin has developed principles which underpin their approach to joint commissioning. These also underpin the work of the Joint Commissioning Team which has been established. The principles are:

• To work impartially across partner organisations to specify and if necessary change the provision of care services to deliver a better experience and best value for money.

To invest in high quality services within a mixed economy of statutory, voluntary and independent providers that link with the wider community.

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