Our commissioning approach for adults, children and families in Gateshead

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.