integration and externalisation re-commissioning integrated children’s services in devon
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Integration and Externalisation Re-commissioning Integrated Children’s Services in Devon. Jenny Connelly Jon Richards. What did we re-commission?. All NHS and Social care services managed as part of our Integrated Children’s Services - PowerPoint PPT PresentationTRANSCRIPT
INTEGRATION AND EXTERNALISATIONRE-COMMISSIONING INTEGRATED CHILDREN’S SERVICES IN DEVONJenny Connelly Jon Richards
What did we re-commission?
• All NHS and Social care services managed as part of our Integrated Children’s Services
• All staff, both NHS Devon and Devon County Council employees– including social workers, community care
workers, OTs, portage service, short-breaks units, speech and language therapists, community children’s nurses, health visitors, school nurses, mental health practitioners and learning disability nurses
What did we need to achieve & why?
• Transforming Community Services set out a national requirement for Primary Care trusts to separate their provision from their commissioning function by 1st April 2011
• As a result of this arrangements were put in place with Devon County Council to manage Integrated Children’s Services on behalf of NHS Devon for up to 2 years, to allow time to determine long term arrangements
• The outcome of the process would be out-sourcing of health and social care services
Programme objectives
To develop and implement sustainable solution(s) for the long term provision of Integrated Children’s Services that will ensure the safe transfer of services from their current arrangements by 31st March 2013
To explore opportunities for extending the scope of the services to be re-commissioned
To optimise the opportunities for transformation
To improve outcomes for children and young people
INTEGRATED CHILDREN’S SERVICES
Mental health and wellbeing
Primary Mental Health Service
Child & Adolescent
Mental Health specialist service
Joint Agency Child Abuse
TeamService around
the Child (Children in
care)
Physical, Sensory & Learning Disability
Joint agency multi-disciplinary teams for children with
disabilities, including children’s
community nursingSpecialist Child
Assessment CentresCommunity
Equipment ServiceSpeech & Language
Therapy Service
Family support services, including short breaks units
Public Health NursingHealth VisitingSchool Nursing
Immunisation Service
Newborn hearing
screening serviceHealth
service for children in
care
• Mapping• Gather
views• Market
Develop the mod
el
• Dialogue• Tenders• Evaluatio
n
Procure the
service
• Staff • Contracts• Finance
Transfer to
new provider(s
)
Ongoing engagement
Apr 11 Sep 11 Jul 12 Mar 13
Co-production Phase: 1
Three workshops with Stakeholders – 40 people including staff, head-teachers, GPs, Paediatricians, commissioners, statutory and voluntary sector providers
Three Staff events – c70 staff Parent/carer events – 120 parents CYP questionnaire – 56 CYP Information gathering – demography,
needs, interfaces, national policy Limited market testing/analysis
Co-production Phase: 2
• Information gathered influenced our decisions– To re-commission ICS as a whole including both NHS
and DCC services and staff– To include CAMHS consultants within scope – To seek a Single Accountable Provider
• Workshops informed outcomes and objectives that were described in the statement of service requirements
• Set of guiding principles were produced that underpinned whole process
• Review of key service areas being undertaken – first one is speech and language therapy
Guiding principles• Strengthen integration of health, social care and education in the planning and
delivery of services • Support delivery of partnership working including across statutory & voluntary
sector • Proactive engagement & communication with families, children & young people,
staff, and other stakeholders (clarity, openness, transparency)• Ensure that needs assessment and evidence based service delivery informs
future arrangements• Ensure flexibility through adaptive and responsive solutions that are fit for the
future• Ensure solutions that achieve consistency of approach but enable locally
responsive services to be delivered• Ensure the continuing improvement and development of services during the
transition• Work in partnership with staff and their representatives throughout the process,
and provide appropriate support to staff through the transition• Maintain and improve quality and safety of services during transition and in
particular the core requirements of risk management and safeguarding • Build on what is good about how things work currently
Co-production Phase: 3
Lessons learnt Consider options for more general
engagement alongside targeted approach Engage early and often - groundwork at this
stage reaps benefits later and can’t be rushed
Build in additional consultation time in case this phase leads to changes in services
Early development of service specifications Spend time understanding the current
provision in depth
Procurement Phase: 1
OJEU advertisement in September 2011 60+ agencies expressed an interest with
many attending an Information Event in October
2 ‘right to provide’ in-house bids were considered but ruled out
8 agencies submitted PQQ 7 agencies passed PQQ 3 bids received – 2 consortia and 1
standalone
Procurement Phase: 2
2 evaluation stages Stage 1 required outline bid and
technical/financial information Evaluated by c.40 commissioners, parents/carers,
staff representatives, external stakeholders Stage 2 required full bid, answers to 90+
detailed questions, and two presentations Evaluated by over 50 commissioners, service
users (children and young people), parents/carers, staff representatives, external stakeholders
Procurement Phase: 3
2 presentations as part of Evaluation Stage 2 Large daytime group of parent/carers, staff
representatives, and external stakeholders 10% of overall score attributed this way.
Reasonably clear preference expressed for the winning bid
Smaller after-school group of children representing the three service areas within ICS 10% of overall score attributed this way. Clear
preference expressed for another bid
Procurement Phase: 4
A Moderation session quality-assured process and agreed final recommendations for decision-makers
2 rounds of decision-making in July and September 2012 – ‘Preferred Bidder’ and ‘Intent to Award’
Negotiated Procedure allowed for some final clarification of ‘Preferred Bidder’ bid in August
Parallel and almost contemporaneous decisions made by NHS Cluster Board and DCC Cabinet on each occasion
Procurement Phase: 5
Lessons learnt… External stakeholders and experts can bring
significant assistance, but be clear about the basis on which they are being engaged
In a joint procurement exercise, clarify terminology and process at the beginning, and review understanding at each stage
Involving children and young people in the evaluation is challenging for commissioners, but massively so for bidders!
Robust evaluation process was lengthy but paid dividends during subsequent legal challenge
Judicial Review Phase: 1
Not part of the plan! Brought on Public Sector Equality Duty
grounds Defended robustly but at considerable
cost and effort Caused capacity challenges in next
phases The result? We lost… but also won!
Judicial Review Phase: 2
Lessons learnt… Prepare for challenge in big and potentially
controversial commissioning exercises PSED is fertile ground for challenge Build Equalities planning and internal
challenge into process right from the beginning; be assertive about the need for expert support
Evidence, evidence, evidence!
Due Diligence and Mobilisation (DDM) Phase: 1
How open should commissioners be? What level of contact with current provider
should there be? Devon example allowed incoming provider
to undertake ‘Deep Dives’ into nominated areas of practice and to engage with staff
This allowed for some re-assurance - TUPE process was fairly straightforward - but also added to contract negotiation challenges
DDM Phase: 2
Most challenging issues in DDM Phase… Premises ICT & Information Governance Business support & back office services Massive NHS re-structure as the
background Varying levels of support from other parts
of the commissioning organisations Contract negotiations (x2!) Social Care transfer of functions
DDM Phase: 3
Lessons learnt… It always takes longer and is more tricky than
you expect! In a ‘spin-out’ scenario, commissioners need
to prepare the ‘losing’ organisation(s) just as much as the current provider teams
Engage external legal advice early – don’t wait for the final contract negotiations
Staff engagement with the incoming provider organisation is critical - hearts and minds are important!
Overall lessons: 1
Challenge of doing this cross-agency Terminology Collaboration meant we didn’t always remember to test
and check understanding• Co-production and collaboration as an
underpinning principle was important but be prepared for difficult times
• Be clear about the nature of the relationship with external advisors – legal, procurement
• Benefits of engaging external experts early eg legal may have saved time and cost later and strengthened our negotiating position
Overall lessons: 2
Early engagement with staff helped reinforce messages to parents
Time and capacity – review at each stage of the process
Consistency of the core team Strong governance – including internal
audit Plan, plan and plan!