Joint Strategic Commissioning Raising the Bar

Tony Homer, Joint Strategic Commissioning Lead, Joint Improvement Team

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JIT is a strategic improvement partnership between the Scottish Government, NHS Scotland, CoSLA, the Third Sector, the Independent Sector and the Housing Sector

Content About the JIT

Context –The Challenge, Key drivers, Legislation

Public Bodies (Joint Working) Scotland Bill 2014

Implications for Joint Strategic Commissioning (JSC)

Challenges for Partnerships

About the Joint Improvement Team (JIT) JIT is a strategic improvement partnership between the Scottish

Government, NHS Scotland, COSLA and the Third, Independent and Housing Sectors

We work with partnerships to create the conditions for improvement, to implement national strategies and to deliver better outcomes in health, social care and housing services, including through: Building capacity and developing skills Sharing knowledge Improving outcomes through joint strategic commissioning processes which

include effective analysis and needs assessment. Constructive challenge

Strategic Planning (Joint Strategic Commissioning) Advice Note Learning and Development Framework

ContextThe Challenge

“public service providers must be required to work much more closely in partnership, to integrate service provision and thus improve the outcomes they achieve”.

Statutory powers and duties focussed on improving outcomes. Embedding community participation in the design and delivery of services.Developing joined-up services, backed by funding arrangements requiring integrated provision.Applying commissioning and procurement standards consistently and transparently.

Public Services (Christie) Commission (2011)

Why? Key Drivers for Change

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Key Legislative Drivers

Public Bodies (Joint Working) (Scotland ) Bill

2013

Social Care (Self-directed Support) Act 2013

& wider framework

Community Empowerment (Scotland) Bill

Human Rights (SNAP)

Community Planning & SOAs

Reshaping Care for Older People

National Legislation & Strategies inc Criminal

Justice, Learning Disability

Children & Young People’s Bill

EU Procurement Directives

Procurement Reform Activity

The Public Bodies (Joint Working) (Scotland) Bill

Integration- The Vision

People are supported to live well at home or in the

community for as much time as they can

They have a positive experience of health and

social care when they need it

The Purpose of the Public Bodies (Joint Working) (Scotland) Bill

•To improve the quality and consistency of services for patients, carers, service users and their families;

•To provide seamless, joined up quality health and social care services in order to care for people in their homes or a homely setting where it safe to do so;

•To ensure resources are used effectively and efficiently to deliver services that meet the increasing number of people with longer term and often complex needs, many of whom are older.”

Public Bodies (Joint Working) (Scotland) Bill (2014)

Defines…

Principles for integrated health and social care

Nationally agreed outcomes for health and wellbeing

Integrated governance arrangements for health and social care:

delegation to a body corporate or lead agency

Integrated budgets for health and social care

Integrated oversight of delivery: Chief Officer (body corporate)

Strategic planning

Locality planning

Joint Strategic Commissioning “Strategic commissioning is the term used for all the activities involved in assessing and forecasting needs, links investment to all agreed desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place.”

“Joint commissioning is where these actions are undertaken by two or more agencies working together, typically health and local government, and often from a pooled or aligned budget.”

Public Bodies ( Joint Working) (Scotland ) Bill 28.05.13 – Policy Memorandum para 117

Adopted from the National Steering Group definition

The Public Bodies (Joint Working) (Scotland) Bill - legislative requirements

• Strategic Plans to be developed for all adult care groups, (Joint Strategic Commissioning Plans) to include specified functions and a Financial plan by April 2015

• Strategic Planning Group to be established by Partnerships for the purpose of preparing a Strategic Plan

• Localities - Partnerships will establish at least 2 localities to undertake locality planning and inform the strategic plan

Good Strategic Plans (Joint Strategic

Commissioning plans) should:• Identify the total resources available across health and social

care for each client group and relate this information to the needs of local populations;

• Agree desired outcomes and link investment to them; • Assure sound clinical and care governance is embedded; • Use a coherent approach to selecting and prioritising

investment and disinvestment decisions; and • Reflect closely the needs and plans articulated at locality

level.

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Strategic Planning Group• Purpose is to prepare a Strategic Plan and to maintain an ongoing role in

reviewing and improving the Strategic Plan• Membership will include:

– People who use services and unpaid carers– Third and independent sector providers, representative organisations and

advocacy groups– Local authority and Health Board nominees– Social work and social care professionals– GPs, clinicians, nurses, AHPs and other professional groups– Housing representatives– A representative from each locality planning group– Staff side and/or trade union representatives

The Role of Localities To feed into the strategic commissioning process a

collective view on what needs to be made available in respect of their locality

On an on-going basis decide on proposals from local professionals, users and communities on ways to improve the delivery of services for the locality.

In time, greater responsibility over financial & service planning, changes and decision making.

Localities – securing real added value

Not just a talking shop.... From care groups to assets, multi morbidities and real lives Community empowerment and understanding people’s

priorities Making space for ‘individual commissioners’ to be heard and

to share their thinking Empowering clinicians, users and carers all to play their part Where service changes can have a real and quick impact on

outcomes

Critical success factors...

Group Discussion

• Do the key themes and legislative drivers reflect your experience of the current landscape?

• Pace of change – what’s the reality?• How easy is it to put together and ‘good’ strategic plan- what

helps/hinders?• What is your expectation of the future commissioning role in

a world where ‘Individuals become commissioners’?• Outcomes- is commissioning sufficiently linked to outcomes?• Is ‘co-production’ achievable with ALL players at Strategic

Planning Group and locality level?

• Joint Improvement Team http://www.jitscotland.org.uk/• Scottish Government and COSLA (November 2010) Self-directed Support: A

National Strategy for Scotland – section 5 “The Shift” http://www.scotland.gov.uk/Publications/2010/11/05120810/0

• Public Bodies(Joint Working) (Scotland) Bill, Delegated Powers, and Policy Memoranda and Explanatory notes, 28.05.13

http://www.scottish.parliament.uk/help/63845.aspx• SWIA Commissioning Guide for self evaluation www.swia.gov.uk• Procurement Scotland www.scotland.gov.uk/Topics/Governement/Procurement• Age, Home and Community 2012; A Strategy For Housing For Scotland's Older

People: 2012 - 2021 http://www.scotland.gov.uk/Publications/2011/12/16091323/0

• Scottish National Action Plan for Human Rights http://www.scottishhumanrights.com/application/resources/documents/SNAP/SNAPpdfWeb.pdf

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Additional Slides for reference

Social Care (Self-directed Support) Act 2013

Social Care (Self-directed Support) Act 2013

• Comes into force in 2014. Replaces the previous legislation on Direct Payments & Self-Directed Support (SDS).

• Requires a step change in how we view individuals – as commissioners of their own support regardless of their chosen option

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“Individuals will have greater choice and

control over the services they use through self-directed support for

social care and person-centred

healthcare.”

Potential Implications for future commissioningPoints for consideration

• Shift in Culture – using the SPG and locality planning as a means for the voice of the ‘individual commissioner’ to be heard; making a reality of ‘prevention’ and ‘upstream options’ in the Strategic Plan

• Financial flexibility – ensuring that good quality, value for money services are available for people who decline self-directed support, or for users who choose not to become employers

• Clear individual pricing mechanisms required in house and externally

• Workforce – workforce planning essential to ensure sufficient numbers of Personal Assistants to address potential demand.

• Commissioners as facilitators- Strategic Planning includes facilitating markets and building community infrastructure links, between existing assets.

• Provider diversification- Providers may find the transition to self-directed support challenging. Market facilitation and re-visiting the in-house / external position will be key

• Independent advisors/advocacy- enabling individuals to make choices- change existing support

• Care Management System - greater emphasis on providing information about choices and facilitating decision making

• Add in shifting procurement parameters..

Procurement

Procurement Changes • ‘Person centred services’ will be subject to a lighter- regime for the

procurement of certain social, health and education services with a higher threshold of €750,000 applying

• Public bodies may take into account the need to ensure quality, continuity, accessibility, affordability, availability and comprehensiveness of the services, the specific needs of different categories of users, including disadvantaged and vulnerable groups, the involvement and empowerment of users and innovation

• The Procurement Reform (Scotland) Bill, 2013 focuses on sustainable public procurement that supports economic growth by delivering social and environmental benefits including community benefits, supporting innovation and promoting public procurement processes and systems which are transparent, streamlined, standardised, proportionate, fair and business-friendly

• http://www.scottish.parliament.uk/parliamentarybusiness/Bills/68170.aspx

Human Rights

Approach for Change

• Human rights – PANEL Approach– Participation– Accountability– Non discrimination– Empowerment– Legality

Joint Strategic Commissioning Cycle

The Commissioning Cycle

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• All four elements of the cycle are sequential and equally important.

• The commissioning and purchasing/procurement cycles are linked.

• The commissioning process must be equitable and transparent, and open to influence – a co-productive approach.

• Have a written joined up commissioning plan, focusing on how to meet needs, improve outcomes and standards, to be met by all public service providers, with a clear financial plan

Key principles of the model

A Tool for…. Understanding long term demand giving a common perception

of the world. Understanding the best approaches and methods for meeting

that demand. Improving and modernising supports and services to achieve

better outcomes. Encouraging innovative solutions by ALL providers. Achieving best value by better configuration of delivery and

greater efficiencies. Managing and facilitating the market in a climate of changing

independent and third sector providers. Working across boundaries

Levels of commissioning;

National

Regional

Sub-regional

Area or strategic

Locality

Individual34