GUIDANCE ON STRATEGIC COMMISSIONING of CHILDREN AND YOUNG PEOPLE’S SERVICES IN DORSET

DRAFT FOR CONSULTATION

CONTENTS

1. Introduction
2. Definitions
3. Stages in the Commissioning Cycle

1. INTRODUCTION

The 5 Year Strategy for Children and Learners and draft guidance on implementation of the Children Act 2004 make numerous references to the importance of commissioning.

There are a number of definitions of commissioning and a number of models have been developed to describe the commissioning process.

The Dorset Children and Young People’s Strategic Partnership (CYPSP) created a short term group to undertake some work on Models for the Future. This work included developing a Dorset approach to strategic commissioning. The Models for the Future Group has been assisted by Jane Shuttleworth an independent consultant working with the CYPSP.

In November the Models for the Future Group reported on their definition of commissioning and a commissioning cycle. The Chief Officer Group agreed to circulate the definition and the commissioning cycle more widely for comment.

This guidance outlines the definition and provides an explanation on the work which needs to take place at each stage of the commissioning cycle.

Comments are being sought from CYPSP members and from a number of planning groups. There is separate information on the key consultation questions. If you have not received this information please contact Tessa Bishop on 01305 224347, email t.j.bishop@dorsetcc.gov.uk.

2. DEFINITIONS

The Dorset Children and Young People’s Strategic Partnership has agreed the following definition of strategic commissioning:

Commissioning is a process which involves service users and other stakeholders working together to improve outcomes and make the best use of resources.

To do this well in Dorset we plan to follow the process outlined in the commissioning cycle outline below. This will ensure we do the following:

• Involve the right people at the right time.
• Make use of all the information available.
• Make realistic plans.
• Make sure everyone is clear about what needs to be done.
• Ensure we get the right people to deliver services and to make sure those services meet needs, are of a high quality and are cost effective.
• Keep checking out we are doing what we said we’d do.
• Learn from our experience and make sure we are making a positive difference to children, young people and families who live in Dorset.

We want to make the best use of the resources available.  By following the commissioning cycle we  will find cost effective solutions which provide best value. This means we will be making sure that the right services are in  place, delivered at the right time and to a high standard.

3. COMMISSIONING CHILDREN’S SERVICES in DORSET – THE COMMISSIONING CYCLE

SERVICE USER INVOLVEMENT & IMPROVING OUTCOMES

1. Understanding Local Needs
2. What is happening now?
3. Identifying Priorities and Gaps
4. Identifying the options
5. Deciding what to do
6. Planning Service Change
7. Implementing the Plans
8. Evaluation and Review

Stage 1: Understanding Local Needs

Before you start looking at local needs remember:

• How are you planning to involve children, young people and families in identifying local needs?
• Think outcomes. Organise your findings around the 5 Every Child Matters outcome areas.
• Set a time limit for collecting and analysing the information. There are likely to be some gaps but use what is available.

What to Look At

The commissioning strategy should be informed by a sound understanding of local need. This will tell you what the local population is like and the special features which need to be taken into account when developing services. Information will come from a number of sources including:

• National data from the census and other public information data bases, including information on deprivation levels.
• Local public health information.
• Specific national or local research studies.
• Information on what might happen in the future – trends and projections.
• Estimates of what is expected to happen based on national and local research - information on prevalence rates.

More qualitative information can come from asking children, young people and their families what it is like to live in Dorset?  What are the advantages and disadvantages?

Once you have collected the information analyse it. What does it tell you about how resources should be used in the future and the type of services required. You might want to organise the information using the format suggested in the table below.

OUTCOME AREA	KEY FACTS	IMPLICATIONS FOR THE COMMISSIONING STRATEGY

Stage 2: What is Happening Now

Before you start looking at what is happening now remember:

• How are you planning to involve children, young people and families in analysing what is happening now?
• Think outcomes. Organise your findings around the 5 Every Child Matters outcome areas.
• Set a time limit for collecting and analysing the information. There are likely to be some gaps but use what is available.

Focus on inputs, outputs and outcomes and wherever possible compare what happens in Dorset with what happens in similar authorities.

INPUTS	OUTPUTS	OUTCOMES
What goes into providing the service.	Measure of activity that has taken place.	The impact of the services on the lives of service users. The difference made
Where the money goes and what it is spent on?	What happens?	What changes?

Information can be drawn from a number of sources including:

• Budgets – including income, expenditure and spending projections.
• Human resource information including the staffing establishment, vacancy and turnover rates and sickness levers.
• Returns sent to central government on performance indicators and management information reports on outputs and outcomes.
• Analysis of how well you are doing using the Change for Children indicators.
• Analysis of the local market and the range of services available and the capacity of local service providers in the statutory, voluntary and private sectors.
• Audit a sample of case files
• Ask those who assess need and those who provide services for their views.
• Views expressed in questionnaires and feedback surveys and information from complaints and compliments.

Once you have collected the information analyse it. What does it tell you about how resources should be used if the future or the type of services required. You might want to organise the information using the format suggested in the table below.

OUTCOME AREA	KEY FACTS	IMPLICATIONS FOR THE COMMISSIONING STRATEGY

Stage 3: Identifying Priorities and Gaps

Before you start identifying priorities and gaps remember:

• How are you planning to involve children, young people and families in identifying priorities and gaps?
• Think outcomes. Try and group the priorities and gaps around the 5 Every Child Matters outcome areas.

National Priorities

Commissioning strategies need to take account of national priorities and initiatives. Information on these will be available from various websites. In particular take a look at everychildmatters.gov.uk.   Early on in the process it will be useful to make a list of the main priorities and initiatives and note the implications these will have on the commissioning strategy.

Local Priorities

Local agencies will have an agreed set of priorities. These are likely to be included in the Community Plan and similar documents. The priorities of all partner agencies need to be considered. Focus on the priorities which will have most impact on achieving the 5 Every Child Matters outcomes. As with the national priorities it will be useful to make a list and note the implications for the commissioning strategy.

Gaps

Examine the information on needs and what is happening at the moment collected in stage 1 and stage 2.  Use this to identify unmet need, service deficits and gaps.

Agree Strategic Commissioning Objectives

Use the analysis of needs, current services and gaps to inform your strategic   objectives. You may also want to consider the following:

• Are there particular factors about the population or level of need which will affect use of resources now or in the future?
• How well are national and local priorities being met?
• What are the financial and cost pressures?
• Are there any areas where performance is particular good or poor?
• In comparison with similar authorities are there any areas where performance is significantly above or below average?
• What do stakeholders say about needs and services?
• What do children, young people and families say about current services and what they would like to see in the future?  

Develop the strategic objectives   of the commissioning strategy for the next 3 to 5 years. Focus on what will have been achieved at the end of this period. Remember that the commissioning strategy focuses on how resources will be used to meet local needs and achieve national and local priorities. The strategic objectives need to reflect this and should focus on use of resources.

The strategic objectives should establish the main intent of the commissioning strategy and provide a general direction for the future use of resources. The objectives should be SMART:

• Specific
• Measurable
• Achievable
• Realistic
• Time bound

For each objective select some performance indicators with targets which can be used to measure progress in achieving the objective. Try and focus these on outcomes.

Stage 4: Identifying the Options

Before you start identifying options remember:

• How are you planning to involve children, young people and families in identifying the options?
• Keep thinking outcomes? Which options are more likely to lead to successfully achieving the Every Child Matters outcomes.
• After you have identified options the next stage is to obtain a decision on how to go forward. You need to think about who needs to be involved in the decision making process, the information which decision makers will require, the format this will be presented in and the timetable for meetings.

Exploring Options

Be clear about the resources available ie. money, staffing, buildings and information and communications technology. The analysis of current services undertaken at stage 2 will assist you with this.

Take each strategic objectives and consider the following questions:

• What do you need to change, do differently or get better at?
• What should you continue to do?
• Should you stop doing something?
• Do you need to develop a new service or a new approach?
• What range of services is needed to achieve your objective?
• In terms of the services available. Where is there too much or too little?

Once you have done this initial work begin to explore the emerging options in more detail. At this stage you will need to consider:

• The most cost effective solutions for achieving the strategic objectives. You will need to do some initial costings.
• Is it possible to make a long term impact quickly? (But avoid quick fixes which might cause problems in the longer term).
• Will a multi-agency solution be more effective than a single agency approach?
• Are there advantages in creating a pooled budget?
• What does this local market look like. Is there spare capacity? Are there local providers with the skills you want? Will you need to support local providers to diversify or encourage new providers into the local market?

Stage 5: Deciding What to Do

Before you start identifying options remember:

• How are you planning to involve children, young people and families in the decision making process?
• Think outcomes. Make sure reports to decision makers focus on making a difference and on achieving the Every Child Matters outcomes.

Decisions on the way forward are likely to involve reporting to both multi-agency and single agency groups.

At the moment the governance of Children’s Trust arrangements are still being developed. Draft guidance produced by the Department for Education and Skills on interagency co-operation and the development of a children’s trust approach indicates that there will be a need to have a governing board or “structure through which senior representatives of all partner agencies can give strategic leadership and direction and drive through change.”

Even with this type of Board it is likely that decisions on changing use of resources or, for example, creating pooled budgets will need to be made through existing statutory decision making processes. (Children’s Trusts are not statutory organisations).

This means the decision making process is complex and there will be a need to map the process out so that accountability is clear and everyone, including children and young people is clear about the process.

It is also inevitable that there might be some over-lap between stages 4 and 5. For example, some initial work might be completed on possible options. This might be tested out with key decision making groups at an early stage in order to obtain views on which options to explore in more detail.

Depending on the size of budget and scale of changes proposed there might be a need to do some very detailed work which will involve advice from finance, legal and human resource specialists.

Stage 6: Planning Service Change

Before you begin to plan changes remember:

• How will you involve children, young people and families in the decision making process?
• Think outcomes. Focus the project plans on achieving outcomes.

Implementation Plans

Project plans allocating responsibilities and identifying key tasks and  milestones will need to be developed.

Procurement

Local Authorities are expected to have a procurement strategy.. This will outline policies and procedures for procuring services. Procurement or contracts staff will be able to provide detailed advice. It is useful to involve these specialists early on in the commissioning strategy process rather than waiting until this stage. Other agencies may also have policies and guidance on procuring services

Developing Service Specifications

All services procured, regardless of the agency who will be providing them  will require a service specification. This applies to assessment and case management, social work services, the work of multi-agency teams as well as more traditional “provider” services.

The specification should identify the outputs and outcomes expected linked to the objectives and targets identified in Stage 4 of the commissioning process.

The difference between inputs, outputs and outcomes is explained in the table below.

INPUTS	OUTPUTS	OUTCOMES
What goes into providing the service.	Measure of activity that has taken place.	The impact of the services on the lives of service users. The difference made
In the past there was a tendency to focus in detail on where the money should go. Avoid doing this.	What do you expect to see happen. For some services you may want to focus on outputs as there may be statutory requirements or guidance which must be adhered to. The unit cost of the service to be provided is important.	Good specifications need to focus on expectations about outcomes. What is expected to change?

Who is Best Placed to Provide the Service

A range of agencies might be in a position to provide the service/s required including:

• The local authority
• Health service
• Other statutory agencies
• Voluntary sector providers
• Private sector providers

The analysis of the market undertaken when exploring options will assist you with this decision. Procurement procedures will also provide guidance on how to go about selecting providers. 3 things to remember:

• It may not always be appropriate to competitively tender. In some cases you may be developing new and innovative integrated services. This might be good reason for selecting a partner and developing a partnership agreement rather than following a formal tendering process with a standard contract.
• Whatever you do you need to ensure there is a level playing field for potential providers and that best value principles are followed.
• Use full and formal market testing exercise with caution as these can be costly exercises which take time.

Stage 7: Implementing the Plans

Before you begin the implementation phase remember:

• How will you involve children, young people and families in implementation, including monitoring arrangements.
• Think outcomes. Focus monitoring on the achievement of outcomes rather than analysing inputs.

Implementation plans will include:

• Letting any contracts.

Contracts specialists will need to assist with this process.

• Negotiating detailed service specifications with the service providers.

The initial service specification is likely to be broad. At this stage it will be useful to go through the specification line by line in order to ensure that there is clarity about what is expected and that indicators and targets are agreed and realistic.

• It will also be important to have clarity about the monitoring arrangements.

Who will be involved, what information is required, the process which will be used and the frequency. If the service is new it might be useful to monitor more closely in the early stages.

Stage 8: Evaluation and Review

Before you begin to evaluate and review the commissioning process  remember:

• How will you involve children, young people and families?
• Think outcomes. An evaluation of the process is important but the process will only be of value if it has resulted in improved outcomes.

Once the monitoring process is underway it will be useful to stop and evaluate the process. Review each stage noting down what went well, what were the problems and identify the lessons learned for the future.

After 12 months it might be useful to begin to work round the commissioning cycle again. If services are making the desired impact and outcomes for children and young people are improving then the analysis of local need and the current position will change.

In practice this should mean less need and demand for high cost specialist services. There should be a consequent shift of resources towards services which reach more children and young people by intervening early.

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