Our commissioning approach for adults, children and families in Gateshead

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