Integrated approaches are fundamental to how Liverpool City Council commission and procure services and they have recently taken this integrated approach to commission and procure jointly all community support services. This case study describes their rationale, how they went about it, what the challenges were, lessons learnt, and future implications for commissioning.
The project had clear strategic objectives which were to:
- Increase service user and carer satisfaction by improving choice, equity of access and quality of provision.
- Continue the drive for personalisation so care packages for Service Users met needs and outcomes.
- Increase service flexibility and the potential for co-operation amongst providers particularly for small specialist providers.
- Improve value for money via market competition, co-operation and competitive standardised rates with premiums for more complex care.
- Stimulate the health/care market and commission new/innovative services where a gap has been identified in current provision.
- Provide clarity to providers regarding expected performance indicators, including outcome measures and monitoring regime.
What prompted the organisation to develop this approach?
Liverpool City Council and their PCT partners decided that a joint approach to commissioning and procuring all community services was needed because:
- Varying quality of service and varying user satisfaction levels.
- Wide variation of contracts and fees across PCT/LA for similar types of services.
- Duplication of services and also service gaps and inequities within the market.
- Very little joint commissioning and procurement activity despite growing numbers of jointly funded packages of care/health/housing support.
- Ad hoc contractual monitoring and the desire to develop outcome based contracts.
- Lack of overall strategic partnership working between commissioners and providers.
- Increasing costs for complex and jointly funded packages of care.
- Reduced in house provision.
- The requirement to move towards personalisation.
- Liverpool City Council had never undertaken a procurement exercise with the voluntary sector and previously had 1 year grant funding programmes, which whilst simpler to apply for, these prohibited longer term market development activities.
What has the review involved?
The review started in 2008 and had three stages. Phase 1 involved learning disability and mental health service users and Phase 2 older people and people with physical and sensory disability. Phase 3 entailed small specialist services and/or services that delivered to a range of client groups. The project cost £39 million per annum and was funded by community care budgets, PCT and Supporting People.
The procurement route decided upon was an open tender process and entailed the following tasks and activities:
Pre-procurement activities were undertaken to ensure maximum buy in and communication reach and involved:
- Extensive communication with elected members and internal stakeholders regarding the scope of project, joint objectives, timeframes, lead roles, governance structure and project planning.
- Several communication, information and advice sessions with providers were arranged to inform providers of local authority and PCT plans and were followed by Opportunities for one to one informal discussions.
- Questions raised and answers given in these sessions were recorded, made anonymous and sent to all providers to ensure fair and transparent competition.
- Presentations were delivered from various organisations that could best support the different types of providers that were likely to submit applications and included:
- Chamber of commerce – general help and advise around procurement and signposting to organisations/government bodies that could assist.
- Liverpool Charity and Voluntary Services (LCVS) who offered tailored and specific help with the PQQ process outlining where marks could be gained and lost.
- Information and presentation from Confederation of Social Entrepreneurs who explained the merits of collaboration and the additional benefits social enterprises have to offer.
- Advice on the approach to engagement of providers was sought from Liverpool Business Federation and their comments were fed into the design of the day and the presentations.
- Service users were also invited to presentations in order to gain more understanding about the process and the reasons why it was being done.
Procurement Activities:
- Development of outcome based specifications for tender:
- The outcome based specifications were drawn up from the existing knowledge of contracting/commissioning staff as well as social workers and health professionals.
- Information around outcomes and practicalities utilised from previous provider forums and meetings.
- Service users and their carers/families were invited to workshops and forum discussions were held with commissioners to enable aspirations and needs to be captured. This was then developed into a standardised outcome template (based broadly on the domains within The White Paper Our Health, our care, our say 2006).
- The following communication methods with providers were established to ensure that everyone got the same information in the same format at the same time to ensure fair and transparent competition:
- E-procurement.
- Further information and advice sessions.
- Web based FAQs.
- Regular bulletins.
- Service users were then updated on the procurement process from progress meetings and newsletters and regular presentations to service user forums/groups.
Post procurement activities:
- A review of the procurement process was conducted via an on-line questionnaire developed alongside marketing approaches sent to those who submitted a PPQ.
- A questionnaire sent to staff from both organisations within finance, legal, contracting and commissioning teams that were involved in the process to ascertain what it was like for them and how it could be improved next time.
- A questionnaire to service users and carers involved in the workshops and evaluation process again to ascertain what it was like for them and how it could be improved next time.
- Production of a ‘Lessons learnt’ report that will inform future commissioning activity.
The procurement exercise has resulted in:
- A Framework Agreement for the delivery of community support services.
- A list of approved providers.
- Outcome based service specifications and standardised monitoring processes.
- Standardised fees across community support providers allowing easier and more accurate financial planning.
- Increased satisfaction levels amongst services users involved in the process.
How have things changed for the better?
The review revealed that there were significant positive outcomes from the tendering exercise, and the process demonstrated good practice in joint commissioning, particularly around stimulating the market to deliver value for money and positive outcomes. For example:
- Pricing is now standardised with premiums for complex care, providing a clear and open playing field for both provider and purchaser.
- Further choice and improved quality of service by developing outcome based tender specifications.
- Commissioners can now provide clarity to providers regarding expected performance indicators, including outcome measures and monitoring regime.
- Providers feel that they now have improved dialogue and better relationships with the city council, for example:
- Providers reported that the tender process was very thorough “One of the most thorough we have seen” (National provider).
- The process also gave providers an opportunity to identify further support/ learning for future procurement exercises, for example, that the local authority should ensure feedback from presentations as a matter of course.
- Providers recognised efforts from the council to try and ensure regular communication throughout the procurement process (for example, the bulletin and FAQ cleared up misunderstanding and flaws within the e- procurement system).
- Support provided via the Liverpool Charity and Voluntary services was appreciated by providers and felt useful.
Major challenges and drawbacks
There were challenges throughout the project that largely related to: difficulties around joint working, fully engaging and supporting stakeholders in the process and obtaining ‘buy in’ from all the key players.
- Challenges in working across organisations:
- Different use of language regarding policy and processes. For example, what is an outcome?
- Different IT systems and different data collation. This created difficulties in interpretation and analysis of data.
- Different finance systems, funding streams and reporting mechanisms.
- These areas proved to be very time consuming.
- Fully engaging and supporting all stakeholders:
- Service users were mostly engaged at the start of the procurement process rather than being fully integrated in the process throughout. This was largely due to lack of resources within the projects and the amount of time set aside for provider engagement.
- Although the Local Authority offered support to providers to tender, they under-estimated the level and amount of support that the market required to be fully engaged and up to ‘speed’ with procurement. Providers fed back to the council that they found the format and language of tender documents difficult to understand, and that training in The Chest was needed.
- How this support was managed was a challenge for the council as some providers felt that support was biased towards those in the voluntary sector. Trying to reach a level playing field and ensure fair competition was a tension for the Local Authority.
- Obtaining ‘buy-in’ was also a sensitive area, particularly political ‘buy in’, as a new joint procurement process entails significant changes to service delivery and some decommissioning of services.
Lessons Learnt?
Significant learning curves were gained from the project given the above difficulties. Lessons learnt are as follows:
- Need to scope time-tabling better at the start of the project and to adequately take account of the time involved in engaging and getting all stakeholders on board. Time needs to be realised for contingencies in the overarching project plan.
- Not to under-estimate the resources needed from financial and legal teams, for example, the purchasing authority has to be well versed in the implications of TUPE: the importance of having them on board and advising from the start of the project.
- Greater involvement of providers and service users in commissioning prior to the procurement process, for example, in the development of new innovative models of care and support specifications.
- Plan communication channels and systems right from the start to ensure all stakeholders can adequately and appropriately be engaged throughout the process.
- Purchasers to ‘let go’ of organisational jargon and language and try to understand other organisation’s perspective, and systems.
- Keep messages simple for example “This is where we want to get to, this is why we are doing it and this is who we are doing it for”.
- For all professionals keep a positive mind set.
How might this affect commissioning longer term?
- Transparency over pricing enables further foundations for personalisation.
- Presents a move in the right direction towards true partnership and lays further ground for innovative service designs in a more strategic and systematic way.
- The local authority and the PCT are now in a better position to know who will need a service, the likely level of complexity of need and how much provision is likely to cost. This information assists with future projections of demand and feeds in to the JSNA data set as well as enabling future thinking around supply.
- Future procurement exercises can be used to facilitate the market, improve value for money and outcomes.
Contact
For more information about this case study please contact Dyane Aspinall, Head of Adult Social Care Assessment, Care Management and Commissioning, 4th Floor, Millennium House, 60 Victoria Street, Liverpool, L1 6JD, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
June 2010
