This is an example of commissioning co-production. Although the service itself may have elements of co-production, the commissioning process was not co-produced. Those using services were not involved in the process and there was no relationship between the commissioner and those using services.
This could be improved by:
- Working with people who use services, carers and service providers to review existing service provision and identifying existing local assets and resources.
- Engaging people with lived experience through-out the service design and procurement phase, including involving people on procurement panels and giving equal weight to their decisions.
- Reviewing the procurement method used. Competitive tendering approaches do not make it easy for local provider organisations to collaborate and make best use of all of the local assets available. Developing an alliance contracting model like they did in Lambeth builds collaboration into the service model and can engage a wider variety of providers to take part.
Commissioners needed to re-commission a failing mental health day service. The commissioners spent time reviewing the outcomes they wanted the service to achieve, drawing from national best practice examples. Some service users that the commissioners had previously worked with were consulted on these outcomes.
The service specification was released with a clear outcomes framework. Commissioners also included a set of quality characteristics which set out how they wanted providers to work with people who use services. The quality characteristics set out that co-production should be a key feature of the services and that providers should show how they would work with people using the service, and with the wider community.
The winning tender was a consortium of third sector organisations. The service used a timebanking approach to recognise and reward the time that people using the service, their carers and the wider community contributed.
This is an example of co-production in commissioning because this process involved people who use services from the very beginning and throughout the whole process. Commissioners in this example worked alongside those using services to develop a MPS as the first step towards shaping opportunities in the area.
A coalition of neighboring councils decided to write a Market Position Statement (MPS) in order to ensure that there are interesting and flexible services, opportunities and support available in the area.
The decision to write the MPS was taken by the Partnership’s Right to Control board, whose membership includes those who use services. The development of the Market Position Statement involved user-led organisations working alongside the councils. Each council used the Working Together for Change framework to make sure that their work was really co-produced.
This is an example of market management because those using services are not involved at any stage of the commissioning process and the services are chosen based on cost rather than quality or co-production.
This example could be improved by:
- Involving people who use services and their carers to assess the quality of the current services (before combining them).
- Local asset mapping with people who use services, their carers and provider organisations to provide information that can be used alongside the joint strategic needs assessment. This should include wider community assets as well as resources directly relevant to the planned service. This will enable potential providers to make most effective use of existing local resources.
- Working with people, carers, commissioners and providers to identify what outcomes this service should enable them developing this into a common outcomes framework.
- Developing the new service specification with a focus on outcomes, without tightly specifying the activities and outputs that must be delivered. This will enable the service to reflect existing local assets and build on the skills and expertise of local people, carers and providers.
- Discussing the intended procurement approach with providers (particularly smaller, locally based organisations) to understand how to ensure it is accessible. Encourage consortia approaches or develop an alliance contracting model.
Three councils pooled their budgets for day care. Commissioners created the new service specification by combining the previous three local contracts. Information from each council’s Joint Strategic Needs Assessment and Market Position Statement was used to inform the new service.
The new service specification contained clear details of the activities and outputs that should be delivered and the anticipated unit costs of these. The total budget for the new service was reduced by 15% as commissioners needed to make savings. Commissioners did not talk to people who use services or carers. They did not speak to provider organisations because they were worried about breaching procurement law.
The new service commission was put onto the online portal. Due to the large area that the service was required to cover commissioners only received three submissions each from large private or third sector organisations. Commissioners held a meeting to assess the applications and invited a service user to attend. The proposals were assessed as 60% quality and 40% price. ?
This is an example of market management/control because people using services were not involved in the development of the Market Position Statement at all. Once the document was written, it was not published widely and it was written in a language that may exclude a number of people with a stake in its content.
This could be improved by:
- Involving people who use services in the development of the Market Position Statement from the very beginning, to:
- Identify what outcomes are important.
- Say how social care provision can help people to make these things happen.
- Identify any gaps.
Be prepared to start with small numbers of people. Invite this group to help plan activities to involve more people after the Market Position Statement is published.
Although technical information about demographic trends and financial costing are important parts of a Market Position Statement, this information should be easy to understand and be given alongside information about quality gathered by involving people in co-production.
Once the statement has been published, the council should try very hard to keep talking with providers and people who use services. Market Shaping is more than just producing a Market Position Statement; this document is just the start of an ongoing process.
Council officers were asked to produce a Market Position Statement for adult social care. Council officers focussed on working with council colleagues to develop and publish the statement. They sent out a questionnaire to local provider organisations and decided that publishing the Market Position Statement could be the starting point for a conversation with local people who use services, their cares in the future.
When the final statement was published, it contained financial costings and statistical information about the local market. It was technical and complicated and people who use services were not told about the Market Position Statement.
This is an example of co-production in commissioning because commissioners share power equally with those using services. People are involved in an equal partnership throughout the process and have a real say in about the opportunities commissioned.
In 2010, a collaboration of people who use services, carers, commissioning across the local NHS CCG and the Council, voluntary and community sector, secondary care and primary care was established to provide the context within which every citizen whatever their abilities or disability, can flourish, contribute to society and lead the life they want to lead.
The Collaborative support a whole range of organisations that have Peer Support. People with lived experience have been part of the co-designing and commissioning of services in the area and play a constant role in strategic decision making.
People with lived experience are involved in all stages of the commissioning process: from co-designing the service specifications through to taking part in tender panels alongside commissioners. In these setting people have an equal voice.