As part of the national Value Improvement Project, Knowsley Metropolitan Borough Council undertook a series of activities, the aim of which was to remove obstacles preventing joint procurement between social services and Supporting People (SP), and to improve the quality and range of providers able and willing to provide services in Knowsley for people with learning disabilities. There were three main strands to this work:
- Developing a single contract and point of contact, and set of streamlined monitoring arrangements for all providers of learning disability services regardless of the funding stream.
- Providing better value for money for the whole learning disability service by reviewing and negotiating services with providers.
- Carrying out a capacity building exercise to increase the number of providers willing and able to work in Knowsley.
It was hoped that, by jointly procuring care and support services for adults with learning disabilities, there could be a better match between the needs and wishes of service users and services that offer improved value for money. This has proved to be well founded, as reviewing services and establishing a single set of arrangements and point of contact, has resulted in better relationship management with providers, and decreased administrative costs and improved efficiency. Cashable savings of approximately £900,000 have been achieved from a combined learning disability budget of circa £8m, with another £200,000 identified.
What prompted the organisation to develop this approach?
- Inefficiency caused by duplication of administration across procurement and social care commissioning teams. Providers were subject to monitoring from CSCI, commissioning teams, procurement teams, and Supporting People teams; this was over burdening providers, driving up costs and reducing the amount of front line delivery.
- Feedback from providers highlighted inconsistent contract monitoring arrangements carried out by both teams. This led to the decision to work in a more 'joined up' way by establishing a single contract and set of streamlined monitoring arrangements to be implemented across both teams.
- The learning disability provider market was dominated by 4 large providers and it was felt important to increase contestability and develop a wider provider base.
- Funding for the initial work could be sourced through the Value Improvement Project.
What has the work involved?
- The council commissioned an external consultant to produce a Unified SP and care contract template, which accommodates a single hourly cost, and set of monitoring arrangements to be implemented across Supporting People, Health and Social Care - see Knowsley's Joint contract monitoring protocol and Joint contract monitoring standards.
- In order to successfully carry out the work, a close working relationship was needed between the commissioning, procurement and SP teams, as well as a great deal of provider engagement in the process.
- The Lead Officer - the Integrated Commissioning Manager, Supported Living (SP team) - and Procurement Manager met with the consultant on several occasions to discuss the purpose and content of the contract template. One issue to be addressed was the timing of payments to providers - Supporting People paid in advance whilst social care paid in arrears. A compromise was made and both teams decided to "meet in the middle" by agreeing that any joint contract would pay two weeks in advance and two weeks in arrears.
- To manage relationships with providers, a single point of contact was set up (LD Change Manager) - regardless of the nature of the query.
- Whilst the aim is to have providers' official sign-up and full implementation of the programme by January 2008, in reality providers are already on board; a single hourly price is already being paid and joint contract review meetings are taking place. The frequency of review meetings are determined on a risk basis (risk versus contract price matrix) and are attended by the Integrated Commissioning Manager - Supported Living, the Integrated Commissioning Manager - Learning Disabilities, Physical Disabilities and Vulnerable Adults, and the Procurement Manager for Health and Social Care. There are also more frequent technical meetings that look at specific operational issues, which occur monthly and are attended by the LD Change Manager.
- Knowsley SP team developed and are maintaining a Tender Marketing List from and on behalf of Supporting People teams in the North West. The list contains the contact details of providers interested in receiving information on contracts being tendered for people with learning disabilities in the North West. It can also be used to let organisations know about regional events relating to delivering Supporting People services.
- So far Knowsley has carried out one tender exercise using the list - for a support service for vulnerable adults - 21 tender submissions were received, mostly from organisations not previously known to the borough.
How have things changed for the better?
- Better working relationship between the SP, commissioning and procurement teams i.e. by working more closely, procurement have a much better understanding of SP e.g. about shared providers and SP services aims and objectives. For a long time, SP was perceived as 'separate'.
- Sharing expertise, for example, Knowsley is currently in the process of awarding a contract for a supported living service that is fully funded via social care monies, but will be monitored by and submit performance information to the SP team.
- By establishing a single set of arrangements and point of contact, providers are no longer "bounced around" by the procurement, social care and commissioning teams, resulting in better relationship management with providers. Since establishing the new arrangements, positive feedback has been given by providers who feel that they now have a "better dialogue" with Knowsley compared with other authorities.
- Greater clarity as to funding arrangements has created greater stability for providers as there is a commitment to mirror inflation payments and work on the whole cost of the service to the public purse rather that focusing in on separate funding streams.
- The technical meetings improve relationships and allow commissioners to monitor utilisation better, giving a clearer idea of where there is excess capacity or pressures on services.
- Improved needs analysis and understanding of the market across sectors.
- Decreased administrative costs and improved efficiency as a result of less burdensome monitoring arrangements and reviewing of all high cost services with a similar methodology regardless of funding stream. Better relationships with providers and a far better understanding of costs and the market have enabled efficiencies to be identified. Efficiencies have been achieved without cost shunting between funding streams.
What have been the major challenges/drawbacks?
- The need to compromise in creating a single hourly cost and contract for both social care and SP. Whilst it hasn't been possible to create the 'slickest' contract for social care and SP, the single contract works and is realistic.
- Creating healthy relationships with providers and getting them on board.
- The tender marketing list is not an approved list and providers have not been validated in any way, which has drawbacks for tendering, but advantages in terms of market testing and other capacity building activities.
What lessons have been learnt?
- Have to be prepared to compromise and work in partnership with providers not beat them with a big stick.
- Have to be prepared to work outside one's remit of SP or Social Care or Health - need to be able to work across disciplines rather than in silos. Need to tackle issues together regardless of which funding stream services stem from.
- Need high level of commitment due to time consuming process - implementation of the unified arrangements and the efficiency savings took two years from start to finish.
- Need to agree service user risk management framework in order to better manage risk other than always increasing staffing levels.
How might this affect commissioning in the longer term?
- A single hourly price means that the market will be better geared up to implementing individualised budgets i.e. less confusion and more security around the one contract.
- The council currently has block contracts in place for much of its supported living, but in the medium to long term, these are expected to be reviewed and services may be purchased from approved provider lists. This will facilitate the development of individualised budgets and support people to purchase their own support services safely with approved providers if they choose to.
- The work provides a clear base line for negotiating with providers.
- Supporting People Team will have more formal links with wider Health and Social Care Commissioning and become part of the Integrated Commissioning Team.
Contact
For more information about this case study please contact Louise Carrington, Integrated Commissioning Manager, Supported Living, Knowsley Metropolitan Borough Council
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
.
May 2007
