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2. Overview

2.1 Commissioning is at the very heart of providing effective care and support for both children and adults. It is the process by which councils decide how to spend their money to get the best possible services and wider supports for local people, now and in the future. ¹

2.2 The aim of all commissioning activity by social work services is to achieve the best possible outcomes for the community as a whole and for individuals who require care and/or support. This includes people who will need care and support at some time in the future. Commissioning should ensure that there are personalised approaches to meeting people's needs, in all services and settings. It must also achieve best value ² and comply with the disability, gender and race equality duties ³.

Key Point

Engaging people who use services and their carers is at the heart of effective commissioning. Commissioners also need to engage with citizens in the wider community to define outcomes that reflect the needs, preferences and aspirations of people who will use services in the future, and their carers.

WHAT IS STRATEGIC COMMISSIONING?

2.3 Commissioning involves a wide range of strategic activities, covered in detail in the final section of this guide. These include:

• agreeing strategic outcomes and priorities;
• understanding and forecasting needs, and reviewing these regularly;
• analysing the factors which impact on market supply and demand;
• appraising all the options;
• taking a long term view of which services and wider supports will deliver the best outcomes;
• taking strategic decisions about how needs will be best met in terms of preferred models of intervention, care and support;
• deciding the balance to be struck between prevention, early intervention and more intensive supports;
• developing sound financial frameworks and financial management systems;
• developing positive relationships with providers so that they are involved and informed in decisions about services;
• providing and/or purchasing appropriate services which meet agreed standards and deliver required outcomes;
• having contingency plans to deal with assessed risks and unforeseen challenges;
• having exit strategies for services which no longer meet needs or deliver best value, taking full account of the impact on people who use services and their carers, and developed in close consultation with them and their advocates; and
• conducting an equality impact assessment for all relevant policies and commissioning decisions in line with legal requirements.

Key Point

We should see commissioning as a cross-cutting activity and not a sectional or specialist function. It links strategic and financial planning with assessment and care management. It involves making decisions about how to use resources most effectively to achieve desired outcomes for people.

2.4 In evaluating your performance, some of the questions you will need to ask include:

• Are the current mix of services and supports achieving the intended outcomes for people who use services and carers?
• Does the current mix of services and supports represent value for money?
• Could we achieve the same or better outcomes more efficiently and effectively?
• What changes do we need to make to in-house and purchased services in order to deliver best value and get good outcomes in the future?
• Are we effective in engaging with people who use services and their carers, the wider community and our strategic partners?
• Do we have written commissioning strategies that communicate our strategic intentions for the short, medium and long terms?
• Have we produced written purchasing intentions to inform and guide business planning by providers?
• Are our purchasing and contracting arrangements compliant with all relevant legislation and guidance (including equality legislation) and fit for purpose?
• Do we engage well with providers, and promote their capacity to deliver good quality, sustainable services that are flexible and responsive to people's needs and preferences?

TERMS USED IN THIS GUIDE

2.5 In this guide, 'strategic commissioning' is the term used for all the activities involved in assessing and forecasting needs, agreeing desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place.

2.6 Strategic commissioning is not just about purchasing services from external providers, although this is an important element of the commissioning process.

2.7 We use the term 'statutory partners' to mean:

• all relevant council services, including education and housing;
• NHS Boards and Community Health Partnerships (in some areas, Community Health and Care Partnerships);
• other local statutory agencies, such as the police, the reporter to the children's panel, the courts and other parts of the criminal justice system;
• other local councils with whom strategic agreements and partnerships have been/could be formed;
• the care regulator and other regulatory and scrutiny bodies;
• relevant central government organisations and agencies; and
• the Scottish Prison Service.

2.8 By 'strategic partners', we mean:

• all relevant statutory partners with responsibility or interest in the services being examined;
• people who use services and their carers and their representative organisations;
• advocacy organisations;
• community and voluntary organisations; and
• existing and potential service providers across all sectors.

2.9 We use 'market conditions' and 'social care markets' to mean how the purchasers and providers of social care do business with one another. As in all markets, there are different combinations of purchasers and providers, interacting differently in all the service sectors and sometimes differently within the same authority, as, for example, between urban and rural areas in what are sometimes termed different 'market segments'. ⁴

Key Point

It is important that social work as the lead agency promotes a positive culture of engagement and consultation with a wide range of partners and stakeholders. This involves making sure that we help existing and potential partners to understand their roles and responsibilities when they are involved in strategic planning and commissioning.

2.10 It is helpful if you have explicit written arrangements for engaging with and involving different partners and stakeholders. It is good practice to incorporate the following in commissioning policies and procedures:

• a statement of commitment to the widest possible engagement, communication and consultation with all strategic partners;
• links to relevant priorities in the single outcome agreement agreed by the council and its community planning partners;
• principles for ensuring that engagement of partners is fair and transparent e.g. through agreeing mechanisms to involve the different stakeholders and their representatives;
• a clear statement of respective roles and responsibilities, recognising the expertise and contribution of all strategic partners, including providers;
• arrangements to make sure that provider involvement is kept separate from procurement decisions and the allocation of funds. This will help to avoid conflict of interests or unfair treatment of existing and potential providers; and
• arrangements for monitoring and reviewing the effectiveness and cost of strategic partnerships, including obtaining feedback from the full range of agencies which are, or could be, involved.

2.11 By 'whole systems approaches' we mean taking a broad view across the full range of responsibilities of councils (social work, education, housing, community safety, leisure/ recreation etc), the NHS, the police, the reporter to the children's panel, and the criminal justice system. A whole systems approach considers the impact of all services on outcomes defined in commissioning strategies, and the impact decisions taken by one partner will have on the demand and supply of services provided by other partners.

2.12 We use the term 'joint commissioning' for the process by which two or more organisations act together to co-ordinate the strategic commissioning of services, taking joint responsibility for implementing joint strategies. Departments within a council, for example social work, education and housing services, may jointly commission services. This may also involve key strategic partners such as the NHS or the police. You may also work in partnership with other councils. In order for joint commissioning to be effective, all partners need to have in place:

• joint arrangements for the involvement of people who use services, their carers, advocacy organisations and service providers;
• formal partnership agreements, which are supported by sound joint governance and accountability arrangements;
• jointly agreed strategic plans;
• effective joint leadership arrangements;
• joint commissioning policies and procedures;
• broad agreement about roles and responsibilities;
• a joint financial framework which includes funding agreements and commitments;
• joint financial planning, reporting and accountability arrangements; and
• joint performance management, reporting and accountability arrangements.

2.13 We use the term 'people who use services' to mean adults, young people or children who are current or future recipients of care services and/or wider supports including those who are involuntary recipients of services. The term 'carer' means a relative or friend who provides unpaid care and support.

2.14 We use 'personalised approaches' to mean approaches which focus on the individual in a child centred or person centred way, giving them the greatest possible choice and control over their care and support. We want to emphasise that personalised approaches should be taken in all social work services and settings. It is important for commissioners and providers to develop measures to evidence this.

2.15 Commissioning takes place at different levels, ranging from agreeing and arranging services and wider supports to meet the needs of individuals through to strategically commissioning services to meet the current and predicted needs of particular care groups or the whole community. It is important that commissioning strategies set out how services will deliver personalised responses and support people to make choices and to actively control and direct their services, if they wish to do so.

PREPARING TO DEVELOP A COMMISSIONING STRATEGY

2.16 Before you begin to develop a commissioning strategy, you will need to consider what preparation you require. You will have to bring together a range of staff from different teams, including research and information, those involved in service planning and development, operational managers, finance and contracts teams. Project management skills will also be important. You will need to make clear links with existing service planning structures to avoid duplication or confusion. You should keep in mind that some of those who need to be involved might not initially think of themselves as having an important role in the strategic commissioning of services.

2.17 Your preparation is likely to include:

• defining the areas for consideration, including the needs of people waiting for services as well as the needs and intended outcomes of and for those currently receiving services;
• checking that you have effective planning structures and processes in place for the group to be considered;
• getting approval and commitment within the governance structure of strategic partnerships;
• devising a work programme and timeline (we suggest you start with a broad outline and refine this as the tasks can be more accurately defined);
• initial engagement with strategic partners and stakeholders; and
• visioning exercises (if you consider that there is not already a clear vision owned by all strategic partners).

CARE GROUP COMMISSIONING STRATEGIES

2.18 In the early stages of strategic commissioning, it is likely that commissioners will start by looking at the needs of particular care groups, such as children and families, older adults, people with a learning disability etc.

2.19 This guide focuses mainly on care group strategies, since the findings of inspections to date show that this is the stage most councils are working to develop, and the one where improvement is most pressing.

2.20 You should have commissioning strategies for all the main care groups, and these should cover all priority sub-groups. For example:

• a commissioning strategy for children and young people should cover priority groups such as looked after and accommodated children, children in need, young care leavers, young carers, children with disabilities, children affected by addiction, and should cover prevention and early intervention; and
• a commissioning strategy for older adults would be expected to cover promoting health and wellbeing of older people as well as the range of housing and support they require. It should address the needs of priority groups such as physically frail older people, older people with dementia, older people with functional mental illness and issues affecting older people from black and minority ethnic communities and older people with a sensory impairment.

2.21 Commissioning strategies should take account of the geographic considerations relevant to your local area, including the needs of people living in rural or disadvantaged areas. They should also cover equality duties and consider the needs of socially excluded or hard to reach groups or communities.

2.22 You should have 'delivery plans' to support your commissioning strategies. Delivery plans should meet SMART objectives. By this, we mean plans should be Specific, Measurable, Achievable, Relevant and Time-limited.

OVERARCHING COMMISSIONING STRATEGIES

2.23 As commissioning activity develops, it is important to work progressively towards an 'overarching commissioning strategy'. This should promote coherence and consistency in commissioning across the different care groups. It will assist strategic partners to assess and take decisions about the relative priority given to different groups within the community, as well as the balance of investment in prevention, early intervention and supports that are more intensive. Overarching commissioning strategies should align with service and community planning and single outcome agreements.

2.24 We recognise that overarching commissioning plans and strategies are likely to exist where councils and partnerships already have well developed commissioning arrangements.

PROCUREMENT

2.25 It is mandatory that all public procurement, including the purchase of social care services, complies with the guidance in the Scottish Procurement Policy Handbook ⁵. This defines 'public procurement' as the acquisition, whether under formal contract or otherwise, of goods, services and works from third parties by contracting authorities. The handbook also summarises key aspects of the equality and public sector duties.

2.26 The Scottish Procurement Directorate ( SPD) published guidance ⁶ in August 2008 on the requirement to advertise social care contracts and to award such contracts through open and fair competition. The guidance underlines the need for contracting authorities to have a strategy for the procurement of social care services that recognises the need to maintain the quality and continuity of services and addresses the concerns of vulnerable people who use services. The guidance also advises contracting authorities "to exercise extreme caution when considering the appropriateness of an e-auction as part of the evaluation process for social care contracts".

2.27 During 2009, the Joint Improvement Team ( JIT) and the Scottish Procurement Directorate ( SPD) are jointly leading the preparation of guidance and good practice materials on social care procurement. You can get updates on this work from the Joint Improvement Team website ⁷.

2.28 In this guide, we use the terms procurement and purchasing interchangeably to refer to the public procurement of social care services.

2.29 A service is termed as 'directly provided' or an 'in-house service' if a council employs and manages the staff who deliver the service. This can be the social work service or another council department, or jointly with another statutory agency.

2.30 'Joint purchasing' is where two or more agencies co-ordinate the actual buying of services to meet needs, either at a community or at an individual level.

COMMISSIONING TIMESCALES

2.31 We use 'long term' to mean looking ahead at least 10 years in commissioning strategies. By 'medium term', we mean looking ahead at least three years and by 'short term', we mean looking ahead at least one year.

2.32 Strategic commissioning involves taking a long term view of the needs of the whole community. Commissioners should be planning at least 10-15 years ahead, assessing what mix of services and supports will best meet predicted needs and preferences, as well as delivering best value. A long term approach is essential for sound decision making about investments in assets and workforce planning. It is good practice to revise commissioning strategies regularly, ideally at least every three years, making any adjustments necessary in the light of changing circumstances and updated equality impact assessments.

2.33 To complement the long term approach, good practice suggests that commissioning strategies should have detailed three year delivery plans and one year action plans. Delivery plans should include a statement of purchasing intentions, which should cover at least three years ahead, and ideally five years.

Key Point

Social work services should develop statements of purchasing intentions in consultation with key stakeholders, and publish these to assist the business planning of all providers, including the council's own in-house services.

2.34 Your long term strategy will not have the same level of detail as your short and medium term plans. However, it is essential that along with your strategic partners, you remain clear about your long term strategic objectives. Otherwise, there is a risk that short term investment or disinvestment decisions will undermine the outcomes you and your partners are committed to achieving.

Key Point

Any major commissioning decisions which you take in the short or medium term must be able to be tested against the impact on the outcomes and priorities you have agreed for the longer term.

THE COMMISSIONING CYCLE

2.35 Most models of commissioning emphasise its cyclical nature, with strategic commissioning providing the context for procurement and contracting. The example shown in Figure 1 (over the page) is adapted from a model produced by the Institute of Public Care ( IPC) and is widely used. The IPC model links the commissioning and purchasing/contracting cycles, and is relevant across public care services such as health, education, social care and housing.

2.36 A key principle of the model is that the commissioning process should be equitable and transparent, and open to influence from all stakeholders via an on-going dialogue with people who use services, their carers and providers. Outcomes for people are at the centre of the model.

2.37 The model is based upon four key performance management elements - analyse, plan, do and review. The model requires that each of the four elements receive attention, and all are kept in balance.

Key Point

The commissioning cycle (the outer circle in the diagram) should drive purchasing and contracting activities (the inner circle), and these in turn inform the ongoing development of strategic commissioning.

2.38 For each of the main commissioning strategies, it is good practice to programme a regular cycle of analysis, planning, doing and reviewing. Ideally, this should occur every three years, allowing the revision of short, medium and long term planning assumptions and objectives. If there has been no revision of a strategy for over three years, the assumptions underpinning your medium and long term objectives risk becoming out of date.

2.39 In between major reviews, the frequency with which you repeat the cycle (or parts of it) will depend on the scale of what you commission or decommission, your assessment of the risks involved, and the level of uncertainty or change you have to deal with. At a minimum, you will find it helpful to programme a series of annual reviews to allow you to record progress, changes, and agree any required adjustments.

Figure 1 - Joint Commissioning Model for Public Care (based on IPC model)

THEMES FOR SELF-EVALUATION

2.40 In this guide, we suggest four themes for self-evaluation, based on the commissioning cycle.

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