Joint Commissioning of Domiciliary Support Services Leicester City Council and Leicester City Clinical Commissioning Group

Scope of Review To consider the best model for domiciliary support services from October 17 when Council contracts were due to expire To identify risks/benefits of jointly commissioning these services with the CCG To scope work required to implement the new model once this was agreed To successfully procure and ‘go live’ with the new service

Governance Established a joint project board with relevant CCG and LA officers. Chaired by two Divisional Directors. Commissioner assigned across the LA and CCG (jointly funded post), project manager from the CCG, Contract Lead from the LA Reporting into Joint Commissioning Board which in turn reports into H&WBB

Stage 1 - analysis Wanted to understand the different models around, our own models locally and risks/benefits of all Contacted other authorities, read reports, research and best practice Gathered data on our own services e.g. volume, demand, cost etc. Market engagement – 4 sessions prior to procurement looking at models e.g. block purchasing, geographical zones, outcome based contracts etc. User engagement – what is important to users in the services they received? Targeted to some groups where little was known e.g. LGBT

What did we learn at this stage? Both LA and CCG spend around £10million each per year on domiciliary support to around 2,500 people at any one time Market were very pleased to be engaged early on but largely wanted stability rather than change (existing model worked for most) Service users were most concerned about timeliness of calls, consistency of carers and communication/attitude of staff. Payment by results – difficult if you are only paying basic rate of pay in first place, need to add to this for ‘results’ but from where? Outcome based was welcomed by commissioners but difficult to regulate and monitor without large scale changes to structure and IT within LA (if done as part of a PBR approach etc.)

Should we commission jointly? Made sense to work together as shared market Strengths within the LA currently around contract management and QA but could be even better if combined with clinical knowledge of the CCG Risks around the complexity of agreeing on how to do things – combining our approaches, policies for providers, QAF, governance, communications etc. Risks around decision making – may lead to drawn out negotiation each time a decision is needed

Chosen model Options appraisals led to: Decision to jointly commission with the LA leading on procurement, brokerage, contract management and payments Continuation of framework approach to contracting Continuation of city-wide approach to provision No adoption of PBR Outcome based approach for support planning by commissioners and providers that would be checked as part of quality assurance but not tied to payment Two lots – one general and one specialist (nurse oversight)

Stage 2 - Planning Specification drawn together by both organisations and including specifics from user engagement LA led procurement plan and exercise with panel members from both organisations Joint mobilisation plan with 6 months from point of award to ‘go live’ Joint communication plan spanning earlier engagement through to mobilisation

What did we learn at this stage? Communication plan was our first joint challenge! Different approaches wanted by the two organisations Mobilisation plan was looking tight on time Procurement plan was overlapping with ‘go live’ on a big new framework in the County – not the best timing as shared market

Stage 3 – Making it happen Warming the market – lots of engagement about procurement timescales and process Procurement joint panel of 30 members with around 60 tenders to evaluate (we wanted 25 for lot 1 and 10 for lot 2). Very complex evaluation to co-ordinate Result was a fairly stable market with around ¾ of providers awarded already working with LA or CCG S75 agreement between LA and CCG, ISA and agreements on cost sharing Mobilisation Complex communication with each set of users at different stages and with providers accepting transferring cases

What did we learn at this stage? Procurement – should have given more basic info about completing the paperwork. Some submissions were low quality, misunderstood, missing info etc. Procurement – only just secured the numbers of providers needed. Pleased to have invested effort in bringing the market with us as numbers may have been lower if not Joint agreements – S75 and ISA negotiations weren’t difficult but took a long time as lots of negotiation and back and forth. This was the same with the contract for providers Mobilisation is a huge undertaking with many exiting on DP/PHB if they face a change in provider – leave a lot of time and work well with your market as they will spend a lot of time putting support plans in place with people that then take DP

Stage 4 - Review Majority of this work is yet to come although lessons learnt are recorded at each stage Agreed the approach to review, governance and oversight from ‘go live’ Agreed quarterly joint meetings Agreed an annual review

Key lessons about joint commissioning Good relationships established between officers but different drivers to the two organisations – can cause delays and conflict and takes time, good negotiation and strong control over actions It takes a long time… think about how long it takes to get sign off in your own organisation. Adding another one to the mix doubles it at least Each time we do it, we hopefully set up the systems to make it easier the next time

Any questions? Contacts Sally Vallance sally.vallance@leicester.gov.uk Andy Humpherson andy.humpherson@leicester.gov.uk