Alliance Commissioning- different models for better outcomes My Time, My Community Volunteering and Citizenship In Control Conference, Preston 18th November 2015 Nick Dixon, Stockport MBC Commissioner May you live in interesting times
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Presentation Transcript
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Alliance Commissioning- different models for better outcomes My Time, My Community – Volunteering and Citizenship
In Control Conference, Preston
18th November 2015
Nick Dixon, Stockport MBC Commissioner<br>
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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<br>
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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? http://www.nesta.org.uk/blog/nesta-launches-health-lab The new Nesta Health Lab<br>
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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<br>
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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?<br>
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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<br>
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7 More than a contract It’s a way of working
Focus on
Relationships
Alignment
Trust<br>
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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<br>
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9 Single contract Alliance Commissioner P P P P P P Commissioner 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<br>
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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?<br>
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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<br>
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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<br>
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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?
www.lhalliances.org.uk<br>
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Commissioning Options The following options were identified for possible ways forward for the main set of preventative services Move in house – create in house capacity to deliver the services
Multiple single providers – as now, contract with individual providers for specific scopes of work
Framework – select a range of providers and then ‘draw down’ fro specific services
Single provider – identify a single provider who can cover all aspects of proposed service delivery
Prime provider – select a lead or prime provider who would manage a range of other providers through subcontracting arrangements
Consortium – invite providers to bid together as a consortium, leaving them to decide the nature of the arrangements between them
Alliance – invite bids from alliance of providers to work in a risk sharing , jointly responsible alliance with the Council<br>
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Option 7 – Alliance * with risks<br>
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New Stockport Targeted Prevention Alliance An Alliance Contract- more than a traditional contract
It’s a way of working
Focus on
Relationships
Alignment
Trust
In place from July 2015, value £4.5m over 3 years
Part of the new Community and Voluntary Sector Offer with the Wellbeing Independence Network, Advocacy and Alliance for Positive Relationships
Leaflets<br>
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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<br>
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Our Targeted Prevention Alliance<br>
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Values Charter Genuine
Creative
Together<br>
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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<br>
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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<br>
