Alliance Commissioning- different models for better
outcomes
My Time, My Community – Volunteering and CitizenshipIn Control Conference, Preston
18th November 2015Nick Dixon, Stockport MBC Commissioner
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
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
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What is People Powered Health?http://www.nesta.org.uk/blog/nesta-launches-health-lab
The new Nesta Health Lab
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
Distinctive principles of co-production and People Powered HealthCo-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?
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• 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
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More than a contract
IT’S A WAY OF WORKING
FOCUS ON RELATIONSHIPS
ALIGNMENTTRUST
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
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Single contract
Alliance
Commissioner
P
P
P P
PP
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
P
PP
P PP
The Stockport MentalHealth 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?
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
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
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
Commissioning OptionsThe following options were identified for possible ways forward for the main set of preventative services
1. Move in house – create in house capacity to deliver the services
2. Multiple single providers – as now, contract with individual providers for specific scopes of work
3. Framework – select a range of providers and then ‘draw down’ fro specific services
4. Single provider – identify a single provider who can cover all aspects of proposed service delivery
5. Prime provider – select a lead or prime provider who would manage a range of other providers through subcontracting arrangements
6. Consortium – invite providers to bid together as a consortium, leaving them to decide the nature of the arrangements between them
7. Alliance – invite bids from alliance of providers to work in a risk sharing , jointly responsible alliance with the Council
Option 7 – AllianceCriteria Detail Score
1. Create sustainable models and reduce dependency?
This criteria would be met through the focus on whole system outcomes which alliance members share responsibility for delivering
H
2. Drive integration? Shared risk as well as delivery will promote collaboration and finding solutions through pooled expertise and approach
H
3. Deliver savings? An efficient financial accountable model would be required. Building partnerships while cutting budgets is hard. The competitiveness of some organisations needs development
M
4. Support vulnerable groups and carers?
This option would be met as the whole system outcome set could include ones related to specific groups
H
5. Meet statutory requirements?
This option would meet statutory requirements H
6. Level of disruption? There would be considerable disruption in the short term but long term gain
M*
7. Value of diversity The sharing of perspectives from the range of providers in the alliance would bring value
H
8. Market conditions This option would require organisations to bid as alliances. This may require specific support
M*
* with risks
New Stockport Targeted Prevention Alliance
An Alliance Contract- more than a traditional contract
IT’S A WAY OF WORKING
FOCUS ON RELATIONSHIPS
ALIGNMENTTRUST
• 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
Alliancing success is based on:
• Leadership
• Alignment
• Shared risks and incentives
• Commitment to collaboration
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• 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
Our Targeted Prevention Alliance
Values Charter
•Genuine•Creative •Together
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
• 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
SUMMARYMeeting the challenges of the future
Culture change, leadership and collaboration
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