Alliance Commissioning- different models for better outcomes My Time, My Community – Volunteering and Citizenship In Control Conference, Preston 18 th November 2015 Nick Dixon, Stockport MBC Commissioner

May you live in interesting times Most challenging financial environment in years Role of the sector is going to have to change Services currently based on historical rather than strategic need We need a new kind of relationship Transformation, radical redesign Tested out ‘People Powered Health’ in mental health

A set of principles… A health and social care system that mobilises people and recognises their assets, strengths and abilities, not just their needs An ability to live well with long-term conditions powered by a partnership between individuals, carers and frontline professionals A system that organises care around the individual in ways that blur the boundaries between health, public health, social care, and community and voluntary organisations …underpinned by practical, outcome- focussed, interventions New forms of consultation Support for self-management Social prescribing Peer support and time banking Coaching, mentoring and buddying Health trainers and navigators Co-designed pathways Self-directed support Personal health budgets Integrated care through collaboratives, partnerships and alliances Social action and community capacity 3 What is People Powered Health? lab lab The new Nesta Health Lab

The Stockport Mental Health People Powered Health Project: Cashable Savings and Benefits Fewer people in expensive services for shorter periods- demonstrated Improved productivity for clinicians in primary and secondary care- demonstrated Sustained outcomes and social returns- demonstrated Reduced use of personal budgets- demonstrated Capacity built in communities- demonstrated

Distinctive principles of co-production and People Powered Health Co-production conceives of service users and staff as active contributors rather than passive consumers/workers (assets-based approach). Co-production promotes collaborative rather than paternalistic relationships between staff and service users. Co-production puts the focus on delivery of outcomes rather than just services. If we commission coproduction, shouldn’t we also coproduce commissioning?

6 Started in early 1990s in UK North Sea Oil projects Strategic alliances, partnerships and other attempts to drive collaboration had not changed behaviours Move to genuine risk share through alliance contracts led to outstanding results Since then 400+ alliances in Australasia Health service alliance contracts in New Zealand In UK, used in construction, infrastructure, defence and energy First UK alliance contract in health and social care – April 2013 First UK alliance contract in health through open market procurement – April 2014 Alliance Contracting : History

7 More than a contract

Working together Collaboration between us creates value No one of us has all the answers Pooling our energy, ideas and resources will make us more than the sum of our parts Common vision Single set of outcomes Alliance of providers We all share the same vision We all judge success in the same way We work together to achieve the best outcomes we can lh alliances

9 Single contract Alliance Commissioner P P P P P P Separate contracts with each party Separate objectives for each party Performance individually judged Commissioner is the co-ordinator Provision made for dispute Contracts based on tight specification Change not easily accommodated One contract, one performance framework Aligned objectives and shared risks Success judged on performance overall Shared co-ordination, collective accountability Expectation of trust Contract describes outcomes and relationships Change and innovation in delivery are expected Traditional contract Alliance contract P P P P P P

The Stockport Mental Health Alliance: April 2013 Sharing resources and skills Greater continuity and flexibility Every person has chosen goals Collaborative not competitive Incorporates social action Efficient, adding value, reducing duplication Outcome driven Could Alliance Contracting be part of the transformation and solution needed by the Health and Social Care system?

Develop an Innovative Contract with the Voluntary sector focusing on outcomes “This is an ambitious programme to `hard-wire’ social action into a transformed health and care system, and build co-production with people living with long term health conditions”- Nesta

Overarching Aims Ensure more vulnerable people with complex need will be enabled and supported to live well and self manage. Reduce demand and activity for health and social care Improve service user reported outcomes and experience Develop and strengthen community capacity by aligning People and Place Grow social capital and social value, more people giving time Improve Targeted Prevention Pathways, connect the community capacity to the identified need through social action Develop an Innovative Contract with the Voluntary sector focusing on outcomes

The Burning Platform ‘Are you Ready?’ Preparing the market Identified £5m of funding to around 70 organisations 40% saving required Decommissioned them all Going out to market with £3m What commissioning vehicle should we use? What are the priorities for commissioners? What legally and contractually could we do?

Commissioning Options The following options were identified for possible ways forward for the main set of preventative services 1.Move in house – create in house capacity to deliver the services 2.Multiple single providers – as now, contract with individual providers for specific scopes of work 3.Framework – select a range of providers and then ‘draw down’ fro specific services 4.Single provider – identify a single provider who can cover all aspects of proposed service delivery 5.Prime provider – select a lead or prime provider who would manage a range of other providers through subcontracting arrangements 6.Consortium – invite providers to bid together as a consortium, leaving them to decide the nature of the arrangements between them 7.Alliance – invite bids from alliance of providers to work in a risk sharing, jointly responsible alliance with the Council

Option 7 – Alliance CriteriaDetailScore 1.Create sustainable models and reduce dependency? This criteria would be met through the focus on whole system outcomes which alliance members share responsibility for delivering H 2.Drive integration?Shared risk as well as delivery will promote collaboration and finding solutions through pooled expertise and approach H 3.Deliver savings?An efficient financial accountable model would be required. Building partnerships while cutting budgets is hard. The competitiveness of some organisations needs development M 4.Support vulnerable groups and carers? This option would be met as the whole system outcome set could include ones related to specific groups H 5.Meet statutory requirements? This option would meet statutory requirementsH 6.Level of disruption?There would be considerable disruption in the short term but long term gain M* 7.Value of diversityThe sharing of perspectives from the range of providers in the alliance would bring value H 8.Market conditionsThis option would require organisations to bid as alliances. This may require specific support M* * with risks

New Stockport Targeted Prevention Alliance

Alliancing success is based on: Leadership Alignment Shared risks and incentives Commitment to collaboration 17 Rigorously apply best‐for‐service, unanimous decision‐making Commitment to “no disputes”, ‘no fault – no blame’ culture Return time and again to the principles agreed at the outset and written into the contract Transparency through open book documentation and reporting Joint management structure Key features of an Alliance Contract

Our Targeted Prevention Alliance

Values Charter Genuine Creative Together

Alliance- driven by Outcomes 5 Key Result Areas: Individual Outcomes Style of Delivery- motivational, inspiring Demand Reduction Cost- including drawing in funding Social Capital- people helping people

New ways of thinking and doing Whole system change required Commissioning for outcomes New ‘social contract’ with citizens More integration – whole systems – new partnerships “We’re in this together” We are together more than the sum of our parts SUMMARY Meeting the challenges of the future Culture change, leadership and collaboration