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Developing Good Relationships between
Commissioners and Providers in Adult Social Care
Vic Citarella9th November 2016 and 28th February 2017
“I'd just like to be treated like a regular customer”. Elvis Presley
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Agenda9.30 Arrival, registration, tea and coffee
10.00 Introductions and workshop outline
10.30 Session One: Why are we in social care and what is our purpose?
11.30 Break
11.45 Session Two: Perspectives on what social care is seeking to achieve
13.00 Lunch
13.45 Session Three: How commissioners and providers go about their business – a look at what works as well as some pitfalls
14.45 Break
15.00 Session Four: Knowing that ‘good’ relationships between commissioners and providers make a positive difference for service users
15:45
Action planning: When I next go into work I will ……. and we (commissioner and provider) intend to ……. within three months.
16.15 Summary and Close16:30 Finish
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Workshop objectives˃ Effective and creative ways of
working together˃ Understand the practical,
professional and organisational roles and relationships
˃ Satisfactions and frustrations˃ Mutually meeting customer
wants and needs
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Aims˃ Effective and creative ways of working
together˃ Understand the practical, professional
and organisational roles and relationships
˃ Satisfactions and frustrations˃ Mutually meeting customer
wants and needs
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Learning Objectives and Outcomes˃ Why commission,
what is it and the roles and tasks
˃ Service providers roles, tasks and ways of working
˃ Good business relationships
˃ Practicalities of working together
˃ Success and innovation
˃ Steps that can be taken
˃ Measuring the impact of ‘good working relationships’
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The Ice-breaker˃ We don’t like them˃ But they work… because they…
get the ball-rolling set the tone have no right or wrong and are the first step in a relationship
˃ They have a purpose˃ So…in pairs here are 50 words
to break the ice with…
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Arranging Reviewing PreparingContracting Safeguarding AffordingHiring Signposting RunningAssessing Negotiating ManagingBrokering Ordering RelatingPlanning Authorising LeadingAssigning Procuring GivingCo-producing Supplying CommandingCaring Purchasing KeepingSupporting Delivering AssigningOrganising Specifying ChargingCoordinating Funding HelpingNavigating Analysing ContributingPersonalising Buying WorkingPreventing Doing BringingEmpowering Evaluating Benefiting
˃ Commissioning ˃ Providing
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Why are we in social care and what is our purpose?
˃ If we lose our why we lose our way˃ What was your first role in social care?˃ What made you stay – your motivation?˃ What drives you?˃ Tell your stories to each other˃ Purpose, Purpose, Purpose.
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What is the Purpose of Purpose?˃ To inspire people to contribute their personal energy
to a collective venture˃ To reveal the human face of what the organization is
working to achieve˃ To ensure an authentic connection between what the
organisation believes, what it says, what it means and what it does
˃ To enable people to make practical choices about what they do day to day, using the purpose as a constant reference point
Having Purpose
http://www.blueprintforbusiness.org/purpose/ accessed 16/10/16 10
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˃ Learning points around… Commonalities Differences Perspectives Relationships
˃ “What helps people helps business…the sole purpose of business is service”
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Break
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What social care is seeking to achieve˃ Happiness˃ Service˃ Outcomes˃ Care plans˃ Profits or surplus˃ Savings˃ Cost-benefit˃ Satisfaction˃ Ratings
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Market development, management and oversight˃ Learn the language – see Chapter 4 of
statutory guidance˃ It’s like business planning for the health and
well-being of an area˃ Analyse-Plan-Do-Review˃ Get involved locally˃ Market position statements, shaping,
database, toolkit, workshops˃ Commissioning the future
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Stakeholder mapping˃ Organisations and people˃ Networks˃ Not simply commissioners and providers˃ Try different perspectives˃ What are people looking for in a business
relationship with you?˃ The mind-map and the power/interest matrix˃ "Before you can have a share of market, you
must have a share of mind."
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Understanding the business environment˃ The customer is always right – discuss
The workforce The inspector The next of kin Head office The boss Corporate The bank manager or treasurer
˃ “If you can't turn yourself into your customer, you probably shouldn't be in the…….business at all”
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Message: co-production and the service user at the heart˃ …shared endeavours, with commissioners working
alongside people with care and support needs, carers, family members, care providers, representatives of care workers, relevant voluntary, user and other support organisations and the public to find shared and agreed solutions.
˃ People are experts in their own lives˃ Meaningful opportunities˃ Assets and strengths˃ Co-production – what is it and how to do it – “a
slippery concept”
Ladder of Participation
New Economics Foundation - Ladder of Participation - Arnstein 1969 as adapted by Mike Webster 2016 18
Doing with - equal partnership• Co-production• Co-designDoing for - involving people• Engagement• Consultation• InformingDoing to - fixing passive service users• Educating• Coercion
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Lunch
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˃ Learning Points around….. Markets Stakeholders Customers Co-production
˃ The challenge of putting purpose into practice
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How commissioners and providers go about their business
˃ Commissioning is about: Strategic planning, procurement and contracting Macro, meso and micro levels Policy, process and procedure
˃ Services are: 24/7 with tasks to be done People supporting people Highly regulated Low margins Risky
˃ Social care, generally, is riddled with unrealistic expectations, dependent on an undervalued workforce and relies on good relationships for any success
Levels of commissioning
Macro – health and well-being of an area
Meso – of a group or organisation
Micro - of an individual
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Customers Care & support plans Individual contracts
Partnerships and alliances
Procurement plans
Contracts with organisations
JSNA Market plan Service strategies
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Putting purpose into practice
Research Communication Dialogue Negotiation Procedures
˃ Motive
˃ Means
˃ Opportunity
Shared Purpose
Networks Forums Workshops Market
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Market Research˃ Duty
• Promote diversity and quality in the market of providers so that there are high quality services to meet people’s choices
• Protect local people when a care or support provider fails.• Work collaboratively and cooperate with other public
authorities, including duty to promote integration with NHS and other services
˃ Market Position Statements – data, information.˃ Vibrant choices and safety˃ Implications for business – the public sector (local authority)
will: Move further away from being a provider Move away from procurement & contract management only Move towards – innovation & enterprise, business support
& ‘policing’
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Implications - threats˃ Evidenced based care means more paperwork – a cost˃ Duplication between CQC and contract monitoring˃ Safeguarding a good thing but could be a threat to the provider˃ Duty of candour – more reporting and paperwork˃ Responsibility handed over to providers from LAs – a cost˃ Squeezing prices down˃ Nothing new but legalising good practice˃ Squeeze on smaller providers means that ‘diversity’ won’t
happen˃ There will be a 2 tier structure˃ LAs will not find it easy to give up responsibility for
procurement˃ Self-funder market will be squeezed
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Implications - opportunities› Services that prevent – early help› Services that delay – re-ablement, community
outreach› Services to carers – respite, training and support› Use of volunteers› Use of technology› More complex needs at admission – what is nursing
care?› Dementia› End of life care
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Dialogue - a collaborative learning effort between commissioners (customers) and service providers˃ Is the conversation end point clear or unclear? ˃ Do the comments build on those that came before
them? ˃ Is there a willingness to explore assumptions that
underlie the dialogue? ˃ Is the conversation exploratory: no topic is “off-
limits?” ˃ Is there an eagerness for new ideas? ˃ Do the provider and the commissioner each shape
the structure and content of the conversation?
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Examples˃ Looking at the dialogue,
the negotiation and the procedure to arrive at a commissioning arrangement (or contract)
˃ Individual – uses a standard contract with an appended care and support plan?
˃ Time and tasks – specifies inputs, process and outputs, quantities
˃ Prime contractor˃ Outcomes – looks more at results than
how they are achieved, qualities˃ Alliance – usually an equal and cooperative
partnership where parties share success and failures 29
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“If we accept the notion that trust presupposescooperation and cooperation is essential for successful integrated care trust does matter and there is now a need for substantive empirical evidence about its salience”.
› Lambeth Living Well and similar› Growing Communities from the Inside Out – Wakefield
asset mapping JSNA› National Market Development Forum› Support Brokerage› Help-to-live-at-home in Wiltshire› Lead provider such as Hertfordshire and others› Emerging practice in outcome-based commissioning
for social care (J.Bolton IPC 2016)› Welsh Government: Promoting Good Provider Forums› http://lancashirecare.org.uk/about-us
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Lessons about:
˃ Putting purpose into practice
˃ Dialogue˃ Relationships˃ Implications
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Break
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Making a relationship › Opportunity› Savings › Value for Money› Assets › Outcomes › Risk › Now › Collaboration › Tight › Friendship
› Competition› Loose› Income› Mutual Exploitation› Profit› Needs› Task› Responsibility› Then› Threat
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The characteristics that make a relationship a ‘good’ one
› Shared purpose› Authenticity – honesty and trust› Respect and loyalty› Making a referral› Disclosure of self – the personal› Open-mindedness, realism, not making assumptions› Solving problems together – successfully› Having fun – GSOH› Offering Something Before Asking for Something› Message: relationships are based on
communications and dialogue which must have certain characteristics whereas ‘contracts’ come in many formats
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The outcomes challengeYou know what you want. Service Users that are:
In control and having choice Involved and listened to Happy and independent Getting the right support when and how they need it
You know what the service users want? Turning the ‘I’ statements into practice Steps towards results How do you know – the individual and group?
You know the market? Views about commissioners – process, price, ideals Views about suppliers – safety, quality and VFM Over and under supply How to sustain, grow, invest and police?
What do you do to assure safety and quality?
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Measuring success› If you don’t know what to measure you
don’t know what you are doing› You don’t fatten the pig by weighing it› You only get the contract out when
something has gone wrong› Has the purpose been achieved? How
do you know? Evidence› Compliance, monitoring, control – the
bottom line is being confident that the service is of benefit to the customer
› You take more ownership of something when you have some ‘skin in the game’
Audit the audits
Check the checker
Whole system
Trust the relationship
Trust your instincts
Trust service users
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Rhetoric or Reality – getting behind the trust dividend
› Evidence of good commissioner/provider relationships – meeting standard 5
› Evidence that doing this improves outcomes or reduces costs – appears not to be available
› What evidence there is shows that relationship building: Costs both time and money. It is about skilled and
professional leadership Can reveal hitherto unmet demand Like all forms of ‘invest to save’, requires longer
term research As a part of commissioning, is a political activity as
well as a professional one Is something some providers opt out of and prefer
to deal directly with their actual customers
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But we (intuitively) know that:˃ Cooperation is quicker, easier, faster and cheaper˃ Common purpose is more likely to get results˃ Wheels don’t need re-inventing˃ The prevalent approach is not working well˃ Competition does not appear to serve the customer
well. In many localities and for some needs the market does not deliver choice, quality or safety
˃ Change is one certainty and can become debilitating; we yearn for stability on the one hand and ‘disruption’ on the other
˃ Divides need bridging, silos are functionally isolating˃ Trusting and good relationships make us feel better˃ There is a ‘holy grail’ – integration, whole systems,
partnership, person-centred coordinated care
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Auditing the Audits
CUSTOMERS
INSPECTIONS AND REVIEWS
COMPLAINTS AND
COMPLIMENTS - FEEDBACK
SAFEGUARDING ALERTS
PERFORMANCE DATA (KPIs)
INTERNAL QA ACTIVITY
WORKFORCE
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Some questions to test the relationship…
˃ How did you derive and agree what was to be measured? Outcome myths…
˃ What is agreed as evidence?˃ Do you both know and accept each other’s ‘must do’
stuff?˃ Is the acceptable minimum the same for both?˃ How do you manage risk together – harm and benefit˃ What happens when something goes wrong?˃ How do you involve service users in checking?˃ How do you relate to someone you don’t like?˃ Have you walked in each other’s shoes?
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Making a difference – some tips˃ Spend time on truly aligning purpose˃ Organisations that are open to improvement and
learning don’t die and it’s people flourish˃ Make time for improving relationships˃ Reward and celebrate success but beware of perverse
incentives˃ By far and away the majority of people go to work
each day intent on doing a good job˃ Remember social care is about peoples personal and
individual goals, aspirations and priorities˃ “Nothing is perfect. Life is messy. Relationships are
complex. Outcomes are uncertain. People are irrational”
˃ “The essence of trust building is to emphasize the similarities between you and the customer”
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Reflection and action planning Learning opportunities for those
working together in social care commissioning and providing?
At least one action individually and one joint between commissioner and provider
Such as getting better and better at specifying outcomes
How can improvement be second nature?
Commitment to engaging with other key stakeholders
What will you say to service users about what you have been doing?
Message: there are things we can all do but 'it takes two to tango'
When I next go into work I will ……. and we (commissioner and provider) intend to ……. within three months.
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Selected further reading˃ ACEVO (2015) Alliance Contracting ˃ Addicott R (2014) Commissioning and contracting for
integrated care, Kings Fund ˃ Bolton J (2015) Emerging practice in outcome - based
commissioning for social care, IPC Oxford Brookes University ˃ Local Government Association (2015) National Social Care
Category (Procurement) Strategy for local government˃ Local Government Association (2015) Commissioning for
Better Outcomes: a route map˃ National Audit Office (2016) Personalised
commissioning in adult social care˃ National Care Forum (2016) Influencing social
care commissioning and procurement ˃ Nicholson J (2014) Effective Commissioning, ˃ Skills for Care (2015) Workforce shaping and
commissioning for better outcomes˃ Stopforth S and Mansfield C (2016) All Together Now: Whole
Systems Commissioning for Councils and the Voluntary Sector. ˃ Walden D (2013) Finding Common Purpose, ADASS/Care
Provider Alliance˃ Walton R (2016) The Commissioner/Provider Divide - a
seminar paper for Landmark Chambers
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Selected websites https://www.acevo.org.uk/ http://www.careproviders.org.uk/ http://www.cqc.org.uk/ http://www.communitycare.co.uk/ https://www.gov.uk/government/publications/care-ac
t-statutory-guidance/care-and-support-statutory-guidance
http://www.local.gov.uk/care-support-reform/-/journal_content/56/10180/7740017/ARTICLE
http://www.nhs.uk/pages/home.aspx http://www.scie.org.uk/index http://www.skillsforcare.org.uk/Home.aspx http://www.thinklocalactpersonal.org.uk/
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