Commissioning Explained

November 11, 2024

Welcome To Our QCS Pocket Guide To Commissioning

We’ve put this together to help you navigate the key aspects of adult social care commissioning. Understanding these essentials will equip you to respond effectively to your local markets and commissioners. Let’s dive in!

Part 1: Understanding Commissioning

You might be wondering, “What exactly is commissioning?” Well, think of it as a way to really get to know what our community needs and then planning the best ways to meet those needs.

According to Oxford Brookes University (2016), commissioning is all about understanding what services are necessary, coming up with strategies, and partnering with service providers to make sure we deliver the right support, efficiently and affordably. It’s about making sure everyone gets the care they need in the best possible way!

So, commissioning is like a mix of being effective and efficient. We aim for the best outcomes using the resources we have. Just a quick note: procurement (which is about buying services) is a part of commissioning, but they’re not the same thing.

What Is Procurement?

Simply put, procurement is how organisations, like councils, find and pay for the goods and services they need. This can involve processes like competitive tendering or dynamic purchasing.

In essence, it’s all about making sure we get the best value for our money while still ensuring high quality. It’s a bit like shopping wisely to get the best deals without compromising on what’s important!

Part 2: The Commissioning Cycle

You might have heard about the “commissioning cycle,” so let’s break it down. The commissioning cycle is a continuous process that applies to all services, whether they’re provided by local authorities, the NHS, the private sector, or civil society.

This ongoing process is often called strategic commissioning because it’s all about thinking long-term and ensuring that we’re always meeting the needs of our community in the best way possible.

Strategic Commissioning Includes:

Assessing current and future population needs
Setting priorities and developing strategies to meet these needs
Securing services from providers
Monitoring and evaluating outcomes
Involving stakeholders, service users, and communities throughout

Put simply, strategic commissioning helps organisations procure services to achieve their long-term goals.

Part 3: Adult Social Care Commissioning

Did you know that for most councils, Adult Social Care takes up the largest chunk of the budget? The demand for these services is influenced by things like access to support, demographics, and health inequalities.

Legal and Regulatory Framework

Care Act 2014: This important piece of legislation governs adult social care. It outlines local authorities’ duties to promote well-being and ensure that everyone receives high-quality care.
CQC/CIS/CIW Registration: All care providers must register with the regulator and meet its standards for safety, effectiveness, and quality.
Procurement Act 2023: Introduces a new public procurement regime, designed to simplify and bring more transparency to the process, ultimately ensuring better value for money. The draft regulations accompanying this act are anticipated to take effect in October 2024.

It’s important to note that all contracting authorities are required to adhere to this statement, as specified by section 13 of the Procurement Act. This applies to contracting authorities outlined in section 2, with a few exceptions listed under section 13 (10), which include:

Private utilities
Contracts awarded under a framework or dynamic market
Procurements under devolved Welsh or transferred Northern Irish procurement arrangements
Devolved Welsh authorities or transferred Northern Irish authorities.

4. The Public Sector Equality Duty (PSED), an integral part of the Equality Act 2010, is essential for public bodies and organisations performing public functions throughout the UK. This duty calls on these entities to thoughtfully evaluate how their policies and practices influence individuals with protected characteristics.

For those of us in the caregiving profession, having a deep understanding of the PSED is vital. It shapes the way we deliver our care services, ensuring they are fair and inclusive.

Needs Assessment and Planning

Local Authority Role: Local authorities are responsible for assessing the care needs of their population and planning the appropriate services to meet those needs.
Market Position Statement (MPS): Local authorities create an MPS to inform providers about the local care market and their commissioning intentions. It’s like a roadmap for providers to understand what’s needed.
Joint Strategic Needs Assessment (JSNA): This comprehensive process is used to identify the current and future health and well-being needs of a local population. The JSNA helps provide a detailed understanding of community needs, guiding the planning and commissioning of health, well-being, and social care services.

Part 4: NHS Commissioning

NHS Scotland

In Scotland, health and care services are organised through Health and Social Care Partnerships (HSCPs) and Integration Joint Boards (IJBs). These teams work together to make sure we provide the integrated services our communities need.

NHS England

Integrated Care Systems (ICSs) replaced Clinical Commissioning Groups (CCG’s) in July 2022, to bring together NHS organisations and local authorities.

The goal? To enhance health, care, and overall well-being. Each ICS includes an Integrated Care Partnership (ICP) and an Integrated Care Board (ICB) that manage NHS budgets and collaborate with local providers.

NHS Wales

The Welsh Government guides strategy with a big focus on teamwork and integrating services. The aim is to reduce health inequalities and improve outcomes for everyone. Local Health Boards (LHBs) work hand-in-hand with local authorities to plan and deliver these essential services.

Part 5: Contracting Services

Spot Purchase Contracts

Buying services as needed, which offers us flexibility but might not guarantee consistent income.

Block Contracts

Fixed-period agreements. These offer a steady income effective stakeholder relationship management and resource management.

Micro Commissioning

Usually led by a case worker and/or brokerage teams working closely with individuals and providers to secure the right support. This often involves purchasing and arranging more personalised care packages on a smaller scale.

Part 6: Personal Budgets

Personal budgets allocate money to individuals based on assessed care needs, offering more control over their care. Options include direct payments, managed accounts, or a combination.

Personal Budgets Options

These are allocated to individuals based on their assessed care needs, giving them more control over their care.

Here are the options available:

Direct Payments: Individuals receive money directly to arrange and pay for their care services.

Managed Accounts: The local authority or a third party manages the budget and arranges services on behalf of the individual.

Combination: A mix of direct payments and managed accounts, offering flexibility

Part 7: Market Development

The Care Act 2014 promotes collaboration between local authorities and care providers to shape and support the care market, creating better, more personalised care.

Market Position Statements

A Market Position Statement outlines:

Current and future care needs
Available and needed services
Future care landscape and funding
Opportunities for collaboration

The goal is to encourage commissioners, service users, carers, and providers to work together to understand and meet local care needs.

Part 8: Provider Considerations

Market Shaping and JSNA: Familiarise yourself with your local MPS and Joint Strategic Needs Assessment (JSNA) usually on LA website – Public Health area.

Top ten tips to help you stay ahead and make the most of the opportunities out there:

Attend Provider Forums: These are great for understanding local commissioners’ plans and building valuable relationships.
Funding Models: Get to know different funding mechanisms like direct payments and block contracts.
Procurement: Make sure you’re “tender ready” to seize opportunities. Sign up for the tendering portals and sites used by Commissioners.
Social Value: Work on projects with local partners to address community concerns—like jobs for the long-term unemployed or young people, tackling homelessness, reducing loneliness, and improving the environment. Have the evidence to support your efforts.
CQC Compliance: Staying compliant is crucial for contracting.
Leadership, Quality, and Governance: High scores in these areas make your services more attractive to commissioners. Identify the people in your organisation with key responsibilities e.g. Safeguarding, Finance, Information Governance, Senior Risk Officer, Caldicott Guardian – these will be required for tendering and contracting.
Operational Resilience: This is key for avoiding risks and issues.
Business Continuity: Keep this up to date, covering a comprehensive range of risks and well-tested mitigation plans.
Value for Money: Balance cost-effectiveness with high-quality care.
Training and Workforce Development: Show your commitment to improving capability and reducing workforce churn and have the evidence to support this for tenders.