Our commissioning approach for adults, children and families in Gateshead

Purpose of this document

The purpose of this document is to set out Gateshead Council's approach to commissioning for vulnerable adults, children and families, including priorities, commissioning practice, process and resources. The document will complement and support corporate Council and wider system strategies directed at key user groups and issues. Where activity is identified, this is set out in more detail in relevant service plans and commissioning priorities documents.

Gateshead's commissioning vision

This will be achieved through a commissioning approach which is informed, engaged, collaborative, innovative and people focused. It will manage resources and risks effectively, and align to the commissioning principles and service priorities set out in the Integrated Adults and Social Care Strategy 2023-28, Early Help Strategy 2023-2026 (PDF, 1 MB)(opens new window) and Gateshead SEND Strategy 2023-2026 (opens new window).

The main elements and features of the commissioning approach are summarised below. Where appropriate, these are set out in more detail later in the document.

Evidence led commissioning

Data sources will be diverse and used to best effect, supported in part through regional data sharing and collaboration, taking into account the health implications of decisions, identifying, planning and acting upon health inequalities to promote health equity. Exploitation of the Mosaic system, when fully mobilised will support greatly improved data capture and reporting around social care demand. Wider use will be made of stakeholder consultation, engagement of people with lived experience and quality assurance reviews to generate intelligence about needs, demands and services.

Market engagement and development

A systematic and structured approach will be taken to various sectors and markets across children's and adult social care. The approach will begin with growing the Council's market knowledge and building relationships with key providers and sectors. There will be a focus on what is offered to providers, including networking, training, technology and workforce development, allied to clear processes and contract terms and a fair approach to price. As part of our Community Wealth Building approach, we will prioritise support to providers based locally to Gateshead.

Strategic commissioning priorities

Whilst commissioning intentions and priorities are set out in the Council's strategic and service plans, there will be a focus on a number of cross-cutting and thematic priorities, which align to our transformation ambitions:

• technology
• caregivers
• self directed support
• information, advice and signposting
• community based opportunities, helping to reduce demand for formal care

Asset based commissioning in communities

Harnessing the energy, commitment and knowledge of local community groups and volunteers can enable people to stay healthy and independent for longer and make less use of formal care services. The Council is working in partnership with National Development Team for Inclusion (NDTi) to transform its strengths-based approach to supporting adults with eligible needs. This will encompass a new approach to commissioning with and for communities, opening up a range of opportunities.

Commissioning process and governance

There will be coherent forward planning for the formal governance of commissioning, allied with robust internal decision making and assurance. There will be a comprehensive yet agile approach to managing and documenting risk, and assurance that all contracts will be reviewed and recommissioned in a timely way. Commissioning business will be planned to ensure sufficient time for formal consultation, co-production, health equity assessment and stakeholder engagement, as required for each contract. There will be consistency and clarity around commissioning business tools and processes.

Engagement and co-production

Adult Social Care will shortly establish a Co-production Framework, committing it to extended and diverse partnership working with people with lived experience, including users of services and their caregivers. Commissioning planning will ensure that time and resource is built in for co-production work. People with lived experience will participate in all phases of commissioning, including quality assurance reviews and service redesign. This approach will also extend to young people. There is an agreed system wide approach to working with and engaging with children and young people and these principles will be central to our commissioning approach. In addition, the young ambassadors, employed by the Council to support engagement and co production will play a central role, alongside regular consultation with the Gateshead Youth Assembly.

Developing an expert commissioning workforce

In building an effective, dynamic and resilient commissioning function, Gateshead Council recognises that it must establish an expert and versatile commissioning workforce. This requires a three-part strategy:

• developing and maintaining the diverse skills required for modern commissioning
• attracting talent locally, regionally and nationally
• constructing a commissioning career pathway in Gateshead, allied to continuous professional development

Working in partnership

Modern commissioning is most effective when pooling the resources, statutory powers and obligations and ideas of two or more organisations. There are opportunities for partnership commissioning across all sectors and partners can be at a local, regional or national level. There is a strong tradition of Gateshead contributing to regional partnerships in procurement and quality assurance. Even within the Council, commissioning for adults and children is forging new collaborations with housing and public health. The new collaboration with NDTi provides an opportunity to re-forge partnerships with local communities. Work is also ongoing within the Council and with voluntary sector partners to establish a new Compact and agreed partnership arrangements. Governance processes are in place in relation to partnership work with the NHS, both in relation to commissioning and to the provision of services.

Assuring the quality and safety of services

Quality Assurance is fundamental to effective commissioning, to ensure services are safe and achieve outcomes for vulnerable people. They must also deliver value for money and comply with contractual expectations. Assurance is undertaken as part of the wider contract management approach, through a variety of means including a quasi-inspectorial function, conducted in partnership with the regulators; CQC and Ofsted. This is specifically required for adult services, under the Care Act 2014. Quality Assurance is undertaken in collaboration with safeguarding teams for children and adults. It is also intended to review service delivery under the health equity assessment tool.

Investing to achieve value

Gateshead Council has protected spending on adults and children's social care as far as possible, during very challenging times for local government funding, and is committed to continuing this approach. In procuring services, careful consideration is given around price and in selecting contract models. The Council will continue to be effective in drawing upon external grant funds and in commissioning with partners to share resources, utilising formal joint funding devices as appropriate. It has a track record of investing capital resources into social care and accommodation assets for high quality and sustainable facilities for vulnerable people.

In formulating our approach to commissioning, the council is mindful of the fundamentals of commissioning, which are described in part in the commissioning cycle.

To some degree these define the scope of our strategic approach, and the Council has also adopted some other parameters to provide focus and clarity:

All-age

The Council commissions care, support and community services for children and adults of all ages. This is reflected in the structure of the Commissioning function, which has adopted a "life-course" model, with commissioning teams for children, working age adults and ageing well.

Social care and education

The strategic approach to commissioning is focused on social care services for adults and for children and families, along with education services. Whilst the Council's other commissioning functions in other directorates are not in scope, it is anticipated that they may follow or adopt many of the same approaches and practices set out in this document.

Review and analysis

Often the beginning of the commissioning process. Existing services will be reviewed carefully, along with analysis of all data and intelligence which illuminates population needs, current and future demand upon provision. Where appropriate, health equity assessments should be undertaken to systematically assess health inequalities, how to reduce them and evaluate impact. Review should incorporate multiple perspectives on needs and services, including that of the lived experience of vulnerable people and caregivers.

Service design and redesign

At the heart of commissioning, this work takes the knowledge about needs and demand, both now and in the future, what has worked and what hasn't and creates proposals and models which will meet needs, increase health equity, achieve outcomes and do so affordably and practicably. An important dimension of design is modelling how services will operate in practice and in particular, what workforce is needed and how it should be configured. This modelling will determine the likely cost of services, if any, and how they should be arranged or procured.

Market shaping and development

Fundamental to strategic commissioning and introduced to the legislative framework by the Care Act. The Council must ensure that local and accessible markets are available and flourishing. Commissioners must be able to source services needed at the quality and cost required, as local as possible to the communities of Gateshead.

Contract management

This is a key tactical and strategic activity undertaken by commissioners and commissioning managers and involving;

• supporting providers and assuring the resilience and viability of services
• oversight of the deployment of council resources and value for money
• holding providers to account for delivery of services, as contracted
• helping to manage risk, during emergencies and for high-risk user groups

Contract Management is complementary to Quality Assurance work and aided and facilitated by contract support/compliance activity, including contract management meetings, collection and reporting of provider performance data and managing payments.

Brokerage, placements and home-finding

These are all terms used to describe the finding, securing, booking and liaising with the right formal care service to meet the needs of people agreed through social work assessment. The way these services are resourced, organised and operated vary greatly from place to place, across both children's and adult social care. In Gateshead, Commissioning manages placements predominantly in three areas: home care, children's residential provision and short breaks for disabled children. The staffing undertaking this brokerage activity is dispersed across Commissioning Teams. Brokerage and home-finding for other services including care home and foster placements are managed currently by social care operational teams. This is an area of activity that will be subject to further review in the forthcoming year.

Business continuity

Ensuring that commissioned services continue to operate safely and consistently whatever happens is a vital commissioning role and incorporates:

• review and assurance of provider's continuity and contingency planning
• intervening in potential/actual provider failure
• emergency planning and crisis response

The scale and scope of this work escalated significantly during the Covid19 pandemic and considerable commissioning staff resource was directed to supporting the continuity of services. There is a current focus on learning from the experience and achievements of that period and adopting and adapting preparation and response methods to be maintained, with an eye to the next emergency which may occur.

Out of scope

The following activities and areas of need or service are not addressed or included in the strategic approach:

• accommodation based services for young people 16-25, domestic abuse or complex homelessness needs
• Public Health services
• housing development
• domestic abuse and community safety services
• direct management of procurement services

Inter-dependencies and local strategic context

Our Commissioning Approach is designed to complement the following strategic positions developed by Gateshead Council and/or its local partner organisations:

Integrated Adults and Social Care Services Strategy

This directorate strategy sets out plans for adult social care and identifies Commissioning as a key priority.

Whole system strategies for Autism, Learning Disability and Mental Health

These require development with partners from 2024, commencing with the development of an All-Age Autism Strategy.

Red Quadrant review of commissioning

Commissioned by the Council and concluded in October 2023, in the light of changes to joint commissioning arrangements and staffing. It highlighted a number of opportunities for improvement which have been incorporated into service plans for the forthcoming year.

Gateshead Plan

The whole system partnership plan for health and care services in Gateshead Place, in the context of the now established Integrated Care System (ICS).

Gateshead Health and Wellbeing Strategy

Focusing on good jobs, homes, health and friends.

Thrive

Gateshead Council's corporate vision, focusing on: putting people and families at the heart, tackling inequalities, supporting communities, investment in employment, innovation and growth, working together an fighting for the future of Gateshead.

Corporate Commissioning and Procurement Strategy

Sets out the strategic framework to help us deliver excellence in terms of value for money and better outcomes in all our procurement and commissioning activity.

Gateshead MTFS

Strategic forward view projecting council resources and how they will be applied to duties and priorities, including the Thrive agenda.

Market Position Statement

Market needs and commissioning priorities, online and co-ordinated regionally. This will be subject to review and update during the course of 2024.

Supported Housing Needs Assessment and Strategy

Comprehensive data analysis and forecasting on housing and accommodation needs, encompassing a wide range of groups of vulnerable people in Gateshead.

Complex Housing Programme

This multi-agency project is led by IASCS and focused on delivering joined up accommodation solutions for adult social care customers with complex needs.

Mobilisation of Mosaic Case Management System

The mobilisation of the system for adult social care will commence in January 2024 and the system for children's services will be reset and consolidated during 2024.

The Local Area Multi Agency SEND Strategy and Improvement Plan

The whole system partnership delivery plan developed to deliver the SEND strategy and to respond to the recommendations in the 2023 joint CQC/Ofsted SEND inspection.

The Placement Sufficiency Strategy for Children and Young People

This strategy lays out the current and future needs of children in care in Gateshead and how the local area will deliver sufficient number and choice of local homes for children and young people.

Children's Social Care Improvement Priorities

Based on the current Self Assessment and recent regulatory activity, children's social care services have identified strategic priorities with an associated improvement plan reported annually into Families OSC.

The council adopts and embraces the following key principles as part of its approach to commissioning:

Measurable impact of the strategic commissioning approach

The approach to commissioning must ensure that all the principles, governance and priorities identified have tangible and practical effect in the real world. It needs to be able to demonstrate and measure the impact it has for vulnerable people needing care and support and for the Council's obligations and resources.

Effective demand management

Demography driving increasing demand for formal care amongst adults is a significant challenge for local authorities, leading to various strategies and practices aimed at managing or reducing demand. Commissioning has a critical role to play in such endeavours and the new strategic approach should contribute to improved demand management, such as through:

• formal care designed for short term interventions and/or people with most complex needs, with appropriate referral routes and placement matching
• commissioning targeted and low intensity, preventative support services which prevent or defer need for more intensive, long-term care
• communities enabled and supported to provide low intensity opportunities and support to help people stay well and independent, recognising the wider determinants of health (employment, education, housing etc.) and taking a widened approach to support to account for these
• in relation to children and young people, the complexity of children's needs is increasing and services need to be designed and remodelled to reflect this, enabling families to continue to safely support their children; to develop community based intensive interventions and services so that children can remain living locally and in family based care where possible

Effective community based and prevention opportunities and solutions

These will support demand management and whole system prevention, promoting whole population health and community participation, with Commissioning helping to achieve:

• local assets identified and deployed, to facilitate community support/opportunities
• ensuring joined up effective community focused information and signposting
• infrastructure to support community-based volunteer provision, including training, community development, legal structure and technology support
• wide range of short break options for disabled children and their families to support their access to local community provision and prevent family breakdown

Consistent, open and constructive stakeholder engagement

This will take time to achieve and careful use of available staff resources. Once established, the evidence of this work will include:

• growing numbers of people with lived experience from all user groups participating
• established co-production or "making it real" type forum or strategic reference group
• routine use of focus groups for key themes and projects
• clear impact of lived experience on design of services
• more obvious and extended service user feedback within quality assurance reviews

Value for money and return on investment

These economic measures of commissioning impact are difficult to measure and challenging to progress in current markets and the wider UK economy. They will be the product of multiple factors including demand management, along with commissioning interventions:

• carefully researched and calibrated focus on procurement practice relating to setting and evaluating price, including implementation costs, along with appropriate financial viability assessment
• robust project management of major capital schemes for accommodation, including business case development, feasibility and project delivery
• proactive and sustained market engagement, promoting local provision by local/regional providers

People living as independently as possible in safe, appropriate accommodation

This outcome is a priority for many user groups of vulnerable adults, with differentiated accommodation pathways for older people, learning disabled people, people with mental health needs and others. Several strategic initiatives have been instigated by the Council which will influence and help drive achievement in this area, which depends not only on the right accommodation but on other key factors:

• a further expansion of extra care housing provision, with high quality housing in the right locations with flexible models of support
• affordable, high quality support living services, utilising a mixed economy of housing types, tenures and landlords
• bespoke, sustainable housing for people with complex behaviour needs
• a new range of technology offers which support people flexibly to live as independently as possible

Clear, simple processes and governance

• a clear forward plan for decisions, allied with robust project planning
• simple internal governance, through Commissioning Board and Group Management Teams, and to Cabinet for key decisions
• clear, optimum contract durations with clear timelines for review, extension or re-procurement
• consistent application of procurement and subsidy regulations
• transparent and straight forward joint commissioning decision making with NHS and other partners

Increased choice and availability

Choice is a key imperative under the Care Act 2014 and is implicit good practice in the legislative framework for children's social care. In high demand care sectors, choice is intertwined with market shaping and development and there is a delicate balance to be achieved between investment, choice and supply. In Gateshead, the number and proportion of self funding adult customers is low, and most markets operate across multiple local authority boundaries. Key indicators will include:

• stable provision of home care providing choice, including in rural areas
• appropriate sufficiency of nursing and residential care provision with transparency as to quality of local homes
• increased availability of extra-care housing provision in all areas
• wider choice of local low intensity community support, aligned with comprehensive information and signposting

For children and young people, we need to ensure there is an appropriate range, choice and sufficiency of local homes for children in care to meet local needs. For young adults leaving care, including Unaccompanied Asylum Seeking young people, there needs to be a wide range of support options available.

Reduced reliance on out of area services

This is a challenge particularly in home-finding for children and young people, whether in foster care or residential provision, arising from profound problems of supply, quality and price control nationally in those markets. Whilst there are no simple solutions, the priority is sustained targeted market engagement over the next period, to secure more local provision and achieve some control of price, leading to:

• significantly increased proportion of residential care for children available within or immediately bordering Gateshead
• use of unregistered provision for children is largely eradicated
• stabled and renegotiated pricing with main local IFA providers
• newly designed and mobilised supported lodging service for older young people
• newly consolidated and redesigned residential and supported living provision for working age adults with enduring mental health needs
• increased local accommodation and provision for working age adults with learning disability or autism

Resilient services and Effective Emergency Response

There is a need to ensure services are resilient and that mechanisms are in place to provide assurance and respond to emerging risks:

• over-arching emergency response and continuity plan for commissioning, by user group and embedding learning from Covid19
• clear operational plan for intervening in provider failure, aligned to standard contract terms and subsidy rules
• assurance that all providers have up to date, robust business continuity plans
• economic viability risks in markets are identified early for effective intervention
• comprehensive commissioning risk register, with dynamic monitoring
• reduced incidence of provider failure and the handing back of care packages and placements

Sustained supply and retention of expert commissioning workforce

This will depend upon resolution of some substantial current challenges, illustrated by difficulty in recruiting to commissioning roles during 2023. Key targets will include:

• a management structure adjusted to ensure external recruitment and demonstrating career paths for existing staff
• attracting high quality external applicants through coherent roles, competitive pay and Gateshead's growing reputation for commissioning and social care
• proactive training and staff development for commissioners, drawing on regional collaboration, benchmarked to national, recognised standards

Market engagement and development

The Council is committed to further developing its relationships with provider sectors and markets. This will fulfil the Council's obligations under the Care Act and elsewhere and reflect that only through proactive engagement and market shaping, can it ensure the right services are available at a fair price and of the best quality.

Approaches to market shaping and engagement

Building market knowledge

• essential in setting objectives and targeting the right providers with the right messages
• extensive knowledge gathered routinely through contract compliance, quality assurance and placements/brokerage work but seldom captured, collated or shared in a consistent or effective way
• knowledge also held by operational and other services, but not identified or shared.
• simple system required to collect and sift/analyse intel so it can be utilised effectively in market engagement
• consider using regional networks, whilst weighing the risks of so doing
• identifying lead officers for intelligence and planning engagement with key sectors, as part of market engagement group across commissioning teams

Planning market engagement

• a simple over-arching market engagement plan set out in an internal document
• individual timed project plans for each sector, reviewed and updated
• periodical reporting to Commissioning Board and Improvement Board
• a co-ordinating group of commissioning staff and other internal stakeholders

Incentivising providers

• providers in most sectors are incentivised not only economically, but also by confidence and assurance around risk
• commissioners who demonstrate appreciation of the risks and challenges for providers and present solutions will build confidence in the market
• key factors in confidence include:
  • candour about risks relating to cohorts and individuals, so that everything is shared
  • general consistency and comprehensiveness of information sharing
  • response to changing needs or provider concerns, both from commissioning and social work services
  • good, clear and reliable payment processes
  • fairness and transparency in resolving contractual or payment issues
• commissioning can offer and develop a range of support to providers which is of value to the provider and helps build relationships, including:
  • regular provider forums and online sharing of information through newsletters etc.
  • bespoke formal training opportunities commissioned or delivered by the Council
  • sharing and cascading wider training or funding opportunities
  • opportunities for project participation, including use of new technologies
  • services and funding to support workforce recruitment and retention

For children's services in particular, having high quality and available universal and wrap around services for the young person is a motivator for providers. Gateshead has tangible offers in relation to schools, education support services and wider professional and clinical input, along with generally good transport links. There is potential to promote these more effectively through market engagement.

Building and protecting local services in Gateshead

Developing and retaining services based in borough is the priority for all sectors. Localisation is a critical priority for certain sectors where there is current reliance on a dispersed market, often sourcing in the wider region or nationally. These priority sectors include:

• children's residential care and foster care
• residential and supported living services for adults of working age
• accommodation and support for people of any age with complex behaviour needs, and particularly focused on periods of transition

Successfully increasing local provision depends on both consolidating existing local providers and attracting new or more far-flung businesses. Maintaining and expanding provision from local providers involves various factors which may also be motivating for potential new entrants to Gateshead including:

• promoting confidence in retaining and recruiting more workers
• clarifying or reducing perceived barriers and risks relating to procurement or contract terms
• help with identifying potential development opportunities for accommodation-based services and with signposting through planning and consultation processes
• certainty builds confidence in business owners. Good providers will not be put off by robust quality assurance or contract management

Attracting any providers to develop or expand in the borough depends inevitably on building relationships and in clear consistent communication.

Attracting providers through investment options

Block contracts can provide economic confidence to providers and encourage them to remain or expand in an area. However, complex or repeated procurement processes for block contracts can be disincentives, along with concerns about workforce recruitment or rising costs. The duration of a block contract is often a key consideration for commissioners and providers. Where sectors are highly commercialised and demand heavily exceeds supply, block contracts are unlikely to be attractive to providers.

Utilising procurement devices effectively is often critical to attracting providers. Frameworks and DPS arrangements are well understood generally and can give clarity to providers. However, if they are perceived to be onerous, over-engineered or complex, providers will stay away. With a DPS, there is a danger that providers will join because it is easy and to boost their profile, whilst having little intention or capacity to actually bid for services. In highly commercialised sectors, providers know that commissioners will still go outside frameworks to purchase services, if there is no alternative.

Capital investment by a Council can be a powerful incentive for providers in certain markets. However, for this to benefit a specific provider, there will have to be a transparent route to market, and this may require a procurement, if the Council is to give capital funding to an external provider. There are circumstances where procurement may not be essential, including where a capital grant scheme allows both Council and provider to apply, or where there is evidence either of a unique market position or no effective competition.

Joint development of markets

The NHS also has to consider market development and engagement where it identified gaps or risks or where it has responsibility for sourcing services for individuals. There are clear opportunities for collaboration between the council and North East and North Cumbria Integrated Care Board (NENC ICB), particularly where section 117 (Mental Health Act 1983) or Continuing Health Care (CHC) funding is involved. Following changes to local joint commissioning arrangements and the continual evolution of ICBs, there are opportunities to develop a new joint approach to building local markets.

There are recent examples of collaboration around individual complex cases, typically where the council is able to secure practically and legally the required accommodation, whilst the ICB commissions the support. Generally speaking, these have been quite reactive and where other unilateral solutions have been exhausted. The Complex Housing project offers an opportunity and a route to more strategic collaboration, linking commissioning of support with housing development and capital investment.

Assuring quality and safety of services

Quality Assurance is fundamental to good commissioning and is also enshrined in the Council's statutory obligations. The Integrated Adults and Social Care Services (IASCS) directorate has recently reviewed the quality assurance role and activity of commissioning and is considering next steps.

The Gateshead approach

• Quality Assurance is incorporated within each of the commissioning services for different age groups and its staffing and activity is closely combined with contract compliance
• the quasi- inspectoral role for both childrens and adults services is carried out consistently and in conjunction with the regulatory bodies, CQC and Ofsted
• regular visiting to services is supplemented by desktop and keep in touch reviews. Quality Assurance of the Council's in-house services for children and adults is not carried out by Commissioning, currently
• robust processes for responding to serious quality concerns are in place and have been implemented routinely and effectively, most commonly for adults services
• well established regional networks which once supported comprehensive quality assurance, sharing labour and intelligence, are now dwindling or becoming less formal
• there is joined up and effective collaboration for adults services with NHS assurance teams dealing with medicines, safeguarding and infection control
• the innovative Quality Excellence Framework (QEF) has taken adults care homes through an extended, exhaustive process incorporating self assessment and is linked to fee levels in various bands

Resources

• there is no dedicated combined team focusing on quality assurance, so the work is led on a sector basis, developing specialist expertise and relationships with providers. There is no manager specifically responsible for quality assurance
• overall the staffing of quality assurance and contract compliance is being reviewed to ensure that it is sufficient to meet key priorities and is consistent with that of other similar local authorities. The implications for resources and management structure will also be reflected upon
• consideration will be given to the balance of quality assurance and compliance activity, also acknowledging that there are not dedicated brokerage or placement teams at present
• the future configuration of quality assurance activity and staffing will reflect priority tasks and activities and the most effective use of resources

Key challenges

• managing quality assurance of placements in services dispersed outside the Borough, reflecting on the reduction in structured regional collaboration and any opportunities to replace those with something practicable and sustainable
• ensuring that the role of Commissioning quality assurance is deployed most effectively in collaboration with social care operational services, NHS and other partners
• managing the particular risks inherent in the contingent use of unregistered placements for children and young people
• ensuring meaningful feedback and participation of service users and their families within quality assurance reviews and serious concerns processes

Commissioning process

Gateshead Council recognises that robust process is essential to good commissioning, reflecting that commissioning for adults and children involves important decisions about how diverse statutory duties are fulfilled and substantial public money is spent. The Council has been reviewing and updating its commissioning processes, in light of recent structure and partnership changes and the review of commissioning by Red Quadrant. Further work is now being taken forward corporately around the Council's wider approach to and culture of commissioning.

New and updated processes

The following arrangements have been implemented or revised during 2023:

Formal governance and internal governance

All commissioning business for adults' and children's services is overseen and approved by Commissioning Board, an internal governance board supporting the two directorates. Led by Commissioning, the board's membership comprises officers from different services in the Council, including procurement, finance and performance, along with social care operational management. The Board will review and approve all major projects and issues before they are considered by the leadership groups of the relevant directorate.

Commissioning decisions will continue to be subject to formal governance through Group Management Teams. Major projects requiring key decisions will be considered by Cabinet, following the formal process and timescales set out in the Council's constitution. All significant commissioning projects, issues and decisions will be the subject of briefing to the relevant Portfolio holder/s on a regular basis.

Important commissioning projects and decisions may be reviewed by the relevant Overview and Scrutiny Committee. In some cases, this will precede the formal approval of the decision and in others, the Committee will opt to review the progress or implementation of the decision after an initial period. It is proposed that formal strategies will each be subject to a mid-term review approximately halfway through its intended lifespan. Typically, this would include a report to Overview and Scrutiny Committee.

Forward planning

Commissioning has established a forward plan document which itemises every planned commissioning project and decision, detailing and scheduling governance processes, lines of accountability and key workstreams. It also logs emerging and potential projects and plans. Such documents are effective where they are updated regularly and accurately.

The plan is overseen and reviewed monthly by Commissioning Board and informs its agenda planning. It is expected that the commissioning forward plan may help form the basis for wider agenda planning for directorate group management teams and briefing of Portfolio Holders.

Managing risk

The IASCS directorate is reviewing the use of risk registers and the formal processes adopted for risk management. The Commissioning function is updating the risk register it uses and the way risks are added, reviewed/updated and removed. Some risks are held also at Directorate or corporate level. Some risks are inevitably of long duration and others have a temporary lifespan. Risks will be reviewed monthly by leadership team/s. Some risks go beyond commissioning responsibilities alone and may be shared with social care operations for children or adults.

Project management

Major, complex or high-risk commissioning and recommissioning projects will require project management, which will be in a form proportionate to the project and work involved and will utilise good practice. Where possible, major transformational projects will be supported by a project manager or improvement officer from the directorate or the corporate centre, as appropriate.

All commissioning projects do not require formalised project management, supported by external specialist staff. However, almost all commissioning work will benefit from some of the instrumentation or disciplines of project management, including project plan, timeline, progress reporting and target outcomes and outputs. Commissioners are expected to be able to discharge that project management role proportionately as part of their work.

Contract pipelines

A new comprehensive list of commissioned contracts has been established, replacing the previous pipeline logging the salient facts around each contract. This complements the Contracts Register, which is a public facing document and a statutory requirement. The pipeline list will link with the commissioning forward plan and support effective schedule of recommissioning and contract management work.

This log of contracts is not currently linked to contract management software and so it is not a contract management tool as such. A contract management system would represent an asset to Commissioning, provided the software involved is effective and compatible with other systems.

Further review and development of Commissioning Process

The following aspects of process are the subject of further, continuing review and updated arrangements will be introduced during 2024:

• formal and public consultation
• detailed procedures and practice around co-production
• updated and detailed processes relating to quality assurance, following recent review and potential resource changes
• templates and best practice guidance for options appraisals, business cases and key decision reports
• it has been identified that all new commissioning or recommissioning projects should undertake robust analysis of service delivery models and cost modelling early in the design stage
• ensure clear resource planning and review for all commissioning projects
• consolidated approach to project management for major transformational initiatives overseen by Improvement Board or equivalent for IASCS and Children's Services
• advice and direction on project planning by commissioners for non-complex commissioning projects
• market engagement plans by sector for sectors/markets identified as a priority
• training needs analysis model to apply to commissioning staffing and reviews of commissioned services
• templates for responding to provider requests for fee increases
• annual process for reviewing uplift of fee rates in relevant sectors
• practice guide for intervention in provider failure
• contingency and continuity planning for the commissioning function

Procurement

Contrary to widespread belief, commissioning is not all about procurement and only some commissioning work will involve procurement. However, when make or buy analysis is completed, there may often follow a procurement process and most of the services Gateshead commissions are likely to follow some form of procurement. In all such matters, the Commissioning function will seek and follow the expert and experienced advice of the Council's procurement and legal services.

Route to market

In most commissioning projects and certainly where any Council resources are expected to be received or spent by another party, commissioning must be clear about how that happens in compliance with procurement law. In most cases this will be obvious or straight forward and in many will involve either an open procurement or use of an existing framework of some kind. However, there are some circumstances which are less clear or more complex.

During emergencies, such as the Covid19 pandemic, most public bodies delegated powers and took steps which enabled expedited decision making or award of contracts in some cases. This is provided for in the legislative framework.

In some situations, it can be demonstrated that there is no effective competition or viable market currently for the service to be commissioned. This may be owing to the very specialist or emergent nature of the service/product and the project may be in effect piloting or experimenting with a new approach. Alternatively, the particular restrictions of geography or logistics in a given location may mean that providers cannot or choose not to operate in the area. If these circumstances could justify bypassing a competitive process and awarding a contract directly, the Council would need to provide evidence of the market being tested or consulted recently to this effect.

The procurement position can be unclear or complex where capital assets belonging to either the Council or a provider are being deployed to enable a service. The use of a Council building or asset could be seen as a value to a provider requiring a procurement but usually only if control and enjoyment of the asset passes to the provider. When procuring accommodation services, the sourcing or providing accommodation by a bidder can be framed or handled in different ways.

Planning procurements

The Council will ensure that in approaching any procurement, commissioners, with professional advice, will work with the Procurement team to design the procurement approach in a bespoke way to reflect the specific requirements and market involved. This approach will encompass the overall method of procurement, along with scoring, lotting, invitation to tender questions, price and quality, measuring non-compliance and use of meetings and other process. The Council will ensure that all aspects of the procurement approach are transparent, proportionate, clear and fair to all.

The balance of evaluating price and quality will be considered for each procurement as the most appropriate in achieving the best and best value services. This may include evaluating 100% on quality, where appropriate.

Frameworks and other devices

Gateshead has made widespread use of frameworks over the years including flexible frameworks and DPSs and will continue so to do, where appropriate. It will ensure that all such frameworks are reviewed at an appropriate frequency and multiple lotting of frameworks may also be utilised, where effective.

The Council will continue to undertake informal or "soft" engagement with market providers, in anticipation, consideration or planning of procurement processes, in compliance with the regulations governing such activity.

The Council will also consider and deploy other methods of procurement, where the specific circumstances suggest them and subject to market engagement. These may include:

• alliance arrangements
• most capable provider
• lead provider arrangements
• approved lists

Grant aid

Whilst no longer a widely used tool of modern commissioning, there are still circumstances where grant aid is the most effective way for the Council to develop services and deploy funds. Grant may be used where:

• the Council has received external government grant intended for particular sectors or purposes
• a specific need or service requirement is not identified and there is an opportunity to explore or test different models
• services or support can best or only be delivered by very small local voluntary groups for whom procurement processes would not be suitable or the needs can only be determined by canvassing such local groups

Gateshead Council does not have an established procedure corporately for setting up or managing grant schemes. Legal services and Commissioning in collaboration with corporate colleagues will develop proposals for an approach to be considered through formal governance. Currently there is no central team or service which manages grants.

Money and assets

During an extended period of challenging times for local government finances, Gateshead Council has protected core spending on social care for children and adults to a great extent. This is very clearly the case for the funding of formal care, whether commissioned or delivered in-house by Council services. Further, potentially greater challenges are ahead for all public services and the Council is planning for this through the Medium-Term Financial Strategy (MTFS).

Revenue spending: in-house services

Gateshead has retained very substantial in-house care and support services, by comparison with most Councils nationwide. There is a continuing commitment in policy and financial strategy to retain the current suite of services for both children and adults. Indeed, there are plans for further expansion of direct provision and commissioning will lead the design and development of some major projects. Taken overall, in-house services account for more than £15m of care and support and a growing proportion of overall spend, delivering critical provision for vulnerable people.

Revenue spending: commissioned services

The IASCS and Children's directorates have managed challenging budget setting over recent years without generally cutting spending on commissioned services. Inevitably, inflation and cost of living factors continue to drive up costs of commissioned provision and in some sectors, particularly for children's care price control remains a problem. However, for the majority of placements and support packages, the Council has retained good control of price whilst working with providers to achieve the right balance between value for money and stable supply of care.

There is further challenge ahead overall for both directorates and certainly for IASCS, the MTFS shows real term reductions in the cost of care and support. The key to managing this change from year to year will be ensuring more people are supported at home through home care and community services, and where possible the need for care is prevented, reduced or delayed through strengths-based approaches. This will enable admissions to care homes to be reduced to national and regional target levels, so significantly reducing the overall cost of social care locally. Commissioning is designing and delivering in 2024 the future shape of home care, residential and nursing services through recommissioning and procurement, allied to new contract terms and conditions.

Grant and partnership funding

The Council continues to attract and deploy significant government and other grants to fund core and developmental services for vulnerable adults and children. This includes continuing large-scale funding of statutory services, such as Education Support Grant and Better Care Fund (BCF), which facilitates a significant proportion of core adult social care staffing, along with hospital discharge and avoidance provision.

The Council also has a track record of attracting substantial grants which complement statutory provision and help prevent or delay demand for formal care. This includes funding for changing futures and for tackling homelessness. There is a continuing commitment to seeking and utilising external funding to consolidate and expand core services whilst supporting innovation.

Managing investment in commissioned services

Commissioning decision making is substantially directed to managing risks and challenges in the markets for care and support provision. These are driven by commercial and market factors, or the wider economy and the risk can be either increasing costs or the threat of services closing or being unavailable. Commissioning has plans in place to manage the following circumstances:

• routine demand for inflationary increases in fees for high volume spot purchased sectors; home care and care homes and some children's services
• responding to demands for exceptional and unilateral increases in fees
• using block contracts where appropriate to guarantee supply and control price
• identifying and intervening in potential provider/service failure

IASCS Commissioning is refreshing its annual process for reviewing fees in key sectors and proposing and funding uplifts related to inflation. For some sectors the process is built into framework standard terms and conditions and will be refreshed periodically when the relevant framework is recommissioned. In other sectors, there will be annual consultation with contracted providers using surveys and workshop meetings where appropriate. Consultation material will then be fed into the overall budget setting process for the coming financial year. Confirmed fee rates will be communicated typically in March each year.

The processes for reviewing and uplifting fees for children's services relating to inflation are under consideration. It is often challenging to manage these processes through a regular annual process as for adult social care. This is owed partly to the widespread use of regional frameworks with standardised contracts and also to placement changes for young people.

One-off and exceptional requests for increases in fees for specific services or providers have increased greatly since the Covid19 pandemic. These will be handled somewhat differently for children and adults services, because for children's placements there is often only one child placed with the provider or in the setting. The response to requests from adults providers will deal with the following issues:

• if service users' needs change, there should be a social work review
• unilateral fee increases for one provider may lead the Council to be liable to significant legal challenge from other providers
• if a service or provider is at tangible risk of economic failure or closure, Commissioners will review urgently the situation with the provider to consider options for the Council to intervene

Block contracts can be utilised for short periods or on an extended basis and provide the benefit of certainty of income and cost to both commissioner and provider. Block contracts will be subject to appropriate procurement process, whether via a framework or open tender. Annual fee increases in relation to inflation will not usually be paid for block contracts.

Gateshead Council has recently reviewed its options and approach to intervention in provider failure arising from financial viability, in the light of subsidy regulations introduced in 2023. The Council also has relevant duties under the Care Act 2014. Where practicable, contractual terms and conditions will make specific provision for economic failure, closure or inability to deliver services. This will enable the Council to respond proportionately and effectively outside the scope of subsidy regulations.

The Council does not publish its specific approach to intervention in provider failure or risk of closure, as each service and situation is unique. Commissioners encourage all providers to contact the Council at the earliest stage when risk of closure or failure is identified. The matter will be managed promptly, confidentially and sensitively, with appreciation of the obligations and risks for all parties.

Capital investment and assets

Gateshead Council has a distinguished track record of capital investment, both on iconic buildings and accommodation to support essential services. Recent examples of high-quality new buildings developed to support vulnerable people, including a special school and intermediate care residential centre.

As a stockholding housing authority, Gateshead has a Housing Revenue Account (HRA) and capital investment programme. Capital projects have utilised a mixed economy of funding sources, including HRA, government grant and corporate programme investment. The Council is considering a programme of accommodation developments to support the social care needs of adults and children with complex needs, potentially encompassing acquisitions, planning gain sites and direct new build.

Joint finance

The Council's partnership with the ICB forms the main route through which investment and commissioning are jointly managed and accounted for and this relationship is continuing to evolve. Strategic planning and decision making are facilitated through the Integrated Commissioning Group, conferring with other strategic groups overseeing finance and key themes or user groups at Place. These bodies report through to the Health and Wellbeing Board and Gateshead Committee for Place.

The Better Care Fund is the main route through which much spending on health and care is funded and key partnership working is managed, notably around hospital discharge. Historically Gateshead has also made very frequent use of s256 of the NHS Act to transfer funding from the ICB to the Council. The Council through AISCS and Public Health has recently reviewed the large-scale usage of s256 transfers and the legacy funds involved. It has now opted for a new approach to potential funding transfers from health under s256 or some other provisions, along with a new template s256 agreement.

It is generally expected that Gateshead will see much less frequent or large-scale use of s256 transfers. The new approach sets out some broad timescales and parameters and clarifies the considerations the Council will have in responding to a proposed transfer:

• whether there is a reason for the Council to be involved and for the NHS not managing the proposed spending itself
• whether the proposals align with Council duties, powers and/or strategic priorities
• the process through which it would be required to manage and spend the funding, such as procurement or a grant scheme and the appropriateness or efficacy of that
• the implications for the Council of the transfer for staff time, administrative or other costs

Commissioning staffing resource

Gateshead Council employs up to 30 Commissioning staff, responsible largely for adults and childrens social care, within the All-Age Commissioning function. Some workers undertake commissioning and contract management, with staff time also devoted to quality assurance and co-ordination of placements. Other Council staff are involved in commissioning public health and housing services, located within other directorates.

The All-Age Commissioning function forms part of the Commissioning, Performance and Service Development Division within the IASCS directorate. The division operates across adult social care, children's social care and education. The commissioning function is organised on a "life-course" model with three services dealing with:

• ageing well
• working age adults
• children and families

Each commissioning service manages the whole commissioning cycle and handles review, design, contract management and compliance, placements and quality assurance. Placements management for some sectors is handled currently by social care operational services for adults and children respectively. Gateshead does not operate a Brokerage team for all adult social care services, nor a consolidated Placements or Home-Finding team for children's services. This is an area of activity that will be subject to further review in the forthcoming year. In Spring 2023 some changes were made to the Commissioning structure, ending certain formal arrangements for joint commissioning with the ICB and revising senior management roles. A review of quality assurance activity by Commissioning has been undertaken and options for the future direction and staffing of this aspect of commissioning are being considered. The review considered the operating arrangements and organisation of responsibilities between Commissioning, Childrens Social Care and Adult Social Care.

Recruitment and retention

Recruitment to a range of professional roles has proved challenging for local authorities generally and in the Northeast region. There is apparent competition for candidates amongst Northeast Councils, given the easy travel between areas for workers, occasioned by the regional geography and transport links. Pay is considered to be an important factor in regional competition and Gateshead has found it difficult recently to recruit to commissioning roles, including management posts.

There is some evidence of a wider shortage of experienced commissioning professionals nationally, linked to an ageing workforce. This is more starkly apparent since the Covid19 pandemic and may reflect alternatives including interim and remote working. In order to recruit and retain capable commissioning staff, Gateshead Council must consider and address a number of issues:

• recruiting people from other fields/professions with transferable skills
• ensuring job opportunities at an appropriate entry level
• training and staff development at entry level and for professional development
• ensuring career paths for commissioners within the Council

Gateshead Council has embarked upon a comprehensive corporate job evaluation programme, which will encompass all directorates and all roles in due course. Currently the Council deploys a range of recruitment and retention enhancements in seeking to recruit external candidates.

Commissioning staff development and training

There is no formal training programme currently for commissioning staff at Gateshead Council. Options for developing or commissioning structured training are being reviewed, considering the growth in targeted and specialist training in higher education. It is recognised that training aimed at retaining and developing an effective commissioning workforce will need to address:

• who is attracted to and can potentially be recruited into commissioning?
• what existing experience or transferable skills should be identified and prioritised?
• what are the core skills and knowledge which should be addressed at entry level or in the first two years?
• what are the different ways commissioning staff can learn and acquire skills as part of CPD and which are most effective or practicable?
• how can CPD for commissioning link with wider corporate management development training?
• what are the benefits and risks of adopting a collaborative approach to commissioning staff development with other Councils in the Northeast?

In developing a programme of training and staff development for commissioners, the following options will be considered:

• a training programme utilising courses/modules from higher education in the Northeast/Yorkshire regions
• commissioning apprenticeship/s
• online only courses, enabling access to national higher education sector
• bespoke training/workshops on key themes and topics
• structured mentoring schemes within the Council
• job shadowing schemes
• regional approaches with other Councils to bespoke courses, mentoring and job shadowing
• development of Gateshead training manuals on key themes or for certain job roles or tasks
• accessing or adapting wider corporate training related to contracts and contract management, procurement, negotiation skills and various management skills

In weighing all these options, the leadership team will reflect upon the potential to combine with other directorates with commissioning responsibilities, such as Public Health and Housing. Any plans will be subject to identifying the resources to fund the costs involved, including external and bespoke courses, apprenticeship pay and backfill of staff time.

Our commissioning approach itself establishes key expectations and principles for the Council's commissioning role, along with broad outcomes which would demonstrate impact.

Achieving and demonstrating success will depend upon the availability of timely, comprehensive and reliable dashboards and performance reports capturing both commissioned services and key commissioning activity. There is currently a development plan to have a suite of commissioning dashboards operating by Spring 2024. The delivery and value of that data depends in part on the mobilisation and consolidation of the Mosaic system for adults and children's social care respectively.

It is planned to conduct an annual review of the impact of the commissioning approach to GMTs and Corporate Management Team.

Specifications for all commissioned sectors and block contracted services are expected to have a comprehensive suite of objectives, outcomes and key performance indicators (KPIs) which are reported on as part of contract management. These can be synthesised to provide an overview of the performance of each sector or service.

It is essential for key aspects of commissioning work to have participation of people with lived experience, including procurement evaluation, service reviews, design and redesign and quality assurance. There is a commitment to embedding this approach throughout commissioning practice and identifying any resources implications. In recognition of a health in all policies approach, commissioned services will take account of the health implications of decisions, identifying, planning and acting upon health inequalities to promote health equity in service provision.

Gateshead Council will maintain a transparent approach to its commissioning role and practice, welcoming any future reviews, through peer processes, statutory assurance or commissioning its own expert scrutiny, as it did during 2023.

Care Act 2014

Consolidating legislation for adult social care and introducing key imperatives and expectations, based on projection of need, demand and other factors.

Children Act 1989

As amended provides overarching structure for children's social care and safeguarding duties and practice.

Children and Families Act 2014

Revised the law governing SEND and introducing some wider duties for children's services authorities and other agencies.

Adult Social Care Reform 2022 onwards

Introducing significant changes to the way social care services may be funded and organised, along with regulation/inspection of ASC authorities. Some provisions subject to delays.

Mental Health Acts

Complex legislative framework for statutory mental health provision for adults and children including assessment, detention, treatment, aftercare, statutory protections, criminal justice.

Supported Accommodation Regulations 2023

Introduced registration of services for 16-17 year olds and associated quality standards.

Ofsted Inspection of Children's Services

Established programme of visits and inspections, including full ILACS inspections and thematic visits, most recently to Gateshead system partners for SEND.

CQC Assurance of Adult Social Care Authorities

New programme of full inspection visits from 2023.

People at the Heart of Care

Part of social care reforms from 2022.

Mental Capacity Act 2005

Consolidates law of mental capacity including decisions about capacity and best interests and incorporating DOLS provision, in context of ECHR. Reinvigorates role of Court of Protection and Office of Public Guardian.

Equality Act 2010

Updates and consolidates previous legislation on equality, establishing concept of protected characteristics.

Children's Sufficiency

Strategic obligation on children's services authorities to ensure current and future sufficiency of accommodation, care and support for children in care or in need.

Subsidy Controls Regime

New UK legislation 2023 replacing state aid rules within EU law.

Procurement Regulations

Comprehensive framework governing procurement of products and services by UK public bodies. New regulations scheduled for 2024.