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Commissioning & Procurement

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  1. What is Commissioning?
  2. Why is Commissioning Important?
  3. World Class Commissioning
    1. Changes to  NHS commissioning
    2. Children
    3. Adults
  4. Contestability
  5. Transforming Social Care 2008-9 and ongoing

What is commissioning?

Commissioning is essentially a structured way of deciding how and on whom public money should be spent. Commissioning is a cycle that involves:

The Audit Commission defines commissioning as “the process of specifying securing and monitoring services to meet people’s needs at a strategic level” (Social Services Inspectorate / Audit Commission (2003) Making Ends Meet). This emphasises the importance of first identifying and then meeting need.
Commissioning should be a needs-led activity. Many public bodies closely link commissioning with contracting - this is strictly procurement - the way commissioning needs are met. Services can be procured by formal contracts with outside bodies although this is not essential.

Here is an article from LVSC explaining history and policy behind commissioning  and a useful guide to basic definitions and commissioning cycle from LVSC.
Once it is identified what services are to be commissioned then public bodies will use a range of ways to buy what they need. These will be known as procurement strategies.  There are complex legal rules as to how they can do this.   NAVCA and NCVO have produced a very useful book with the help of Antony Collins Solicitors - Pathways through the Maze – A guide to procurement law

NAVCA has a Commissioning and Procurement Unit with a wide range of resources and information on the NAVCA website

NCVO also have a range of information - a good start to show you what the process should look like is their Commissioning from the VCS: step by step

There are useful resources on commissioning on the LVSC website
Locally Bromley Children’s trust (see below) has also produced a glossary as part of its strategy.
''Bromley Children's Trust Commissioning Glossary [34 KB]

Why is commissioning important?

In recent years central government policy has emphasised public service reform. Government policy identifies improvements in the commissioning (or “buying in”) of services as being crucial to this reform. Government policy supports the view that the voluntary and community sector has the potential to deliver some services more effectively than other public or private sector providers. This has led to many government policies to increase the commissioning of services from the voluntary and community sector.

This offers both opportunities and challenges for voluntary and community organisations. Firstly they need to be aware of commissioning processes and to see that the needs of their members and service users are reflected within it. They then need to judge the extent to which their services or way they are delivered fit within the commissioning strategies. Finally they need to consider whether they need to change the focus of their activities as a result.

This will be important for those wishing to secure financial support from public funds but others may place their independence and members’ wishes above this but will need to seek funding from other sources.

For more information on any of the contents below contact Stephen Blann Policy & Networks Officer stephenb@communitylinksbromley.org.uk 020 8315 1907
Bromley Children’s trust (see below) has also produced a glossary as part of its strategy.
''Bromley Children's Trust Commissioning Glossary [34 KB]

Will things change?

The new government’s “Big Society” agenda has a greater role for voluntary and community organisations and a smaller role for the state. Big Society is based on a greater role for communities in public services including communities being given the right to take over local services.  There are also proposals for community groups to be able to open schools – the so-called “free schools”. If put into operation these new arrangements will require different approaches to commissioning. Big Society task about a  range of funding  mechanisms  from  contracts to payment by results mechanisms  as well as funding following  people’s choice  - like personal budgets in social care which are being introduced already.  This all implies less centralised commissioning and contracting and more flexibility and potentially uncertainty.
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1) World Class Commissioning

To meet the aspirations of a “world class service” for health and social care the World Class Commissioning programme has been introduced – recognising there are weaknesses and inconsistencies across the country at the moment.
Commissioners will undergo training; there will be an impact on how and why services are commissioned with an aspiration that commissioning becomes more outcome focussed. Those voluntary groups receiving Lottery funding will appreciate the significance of outcome funding. There is also a link back to Joint Strategic Needs Assessment. Follow this link for a CLB briefing on this; follow this link to Department of Health information for a national perspective.

Locally the PCT has committed itself to world class commissioning. As part of the adoption of World Class Commissioning PCTs have to identify 10 outcome indicators, 2 of which are mandatory and a further 8 chosen from a list of 54. The two mandatory outcomes are the average Index of multiple deprivation score and life expectancy at birth. Bromley scores well overall on these but there are areas of inequality between wards and within wards. The 8 additional outcomes Bromley PCT will address through world class commissioning are:

  1. Proportion of children who complete MMR – increase from current 40-50 % take up for first dose to 70%
  2. Number of people stopping smoking – a lower target than current unmet target
  3. Increased percentage of hospital patients seen with 18 weeks – pressure from Department of Health
  4. Reducing Cardio-Vascular and Coronary Heart Disease mortality – linked targets and among the most common causes of death
  5. Chronic Obstructive Pulmonary Disease – better community services to reduce hospital re-admissions - also an LAA target
  6. Increased percentage of people screened for diabetic retinopathy – addressing the increase in diabetes
  7. Increased percentage of deaths that occur at home (rather than in hospital) – increasing patient choice in terminal conditions.

The PCT has a general commissioning strategy for all the services that it purchases -

This is based on evidence of need which the PCT has gathered with others such as the local council.
Two important sources of evidence are used. One is the joint Strategic Needs Assessment (which is done we with the council and affects council commissioning as well).

The other is Annual Public Heath report - which focuses on a particular topic each year. For 2009 it was work and health.

Both are focused on relations with acute hospitals and also separating the PCT’s direct provision from its commissioning role. Bedsides direct commissioning of acute and other services the PCT is a key agent in many partnership bodies (eventually reporting to Local Strategic Partnership – see partnership section).

Will things change?

Possibly. The coalition agreement says that changes will be made to NHS targets. NHS professionals will get more clinical freedom and that the government wants to see targets based on outcomes - such as survival rates for cancer as well as dealing with the health inequalities.  Some of this is within the World Class Commissioning framework but in other ways WCC represents the “target culture” that the new government want s to remove. One to watch. 

2) Children

Of the various health and social care commissioning approaches, present the arrangements for children & young people through the Children’s Trust is most detailed. The Children’s Trust has a Commissioning Strategy Group which is leading the development of the Trust's commissioning strategy framework. The framework will include a range of documents:

Currently the following information is available to read:

There is also an online presentation on the Children & Young People’s Trust Commissioning Cycle

In May 2010 the Children & Young People Trust board considered a Commissioning Strategic Change Plan and Proposed Project plan for 2011-2014

More information about the Children & Young People’s Trust commission and plan is available from their website.

3) Adults

There are also strategies for specific client areas in the social care field. Reflecting the different client groups and partnership bodies reporting to the Health Social Care and Housing Partnership (see partnership and the LSP) there are strategies for a range of client groups. These set out general principles and desired change rather than specifying particular services or how they will be purchased. Each client specific area has a commissioning group in some form. Officers within adult and community services are currently determining how to develop a more co-ordinated commissioning process. This is expected in the New Year.
Below you can find links to copies of strategies.

An important issue to bear in mind is that commissioning in adults services will need to be in the context of the Transforming Social Care Agenda (see below) and services purchased through individual budgets.

4) Contestability

Under the previous government a number of government departments and public bodies beyond health and social care were moving to a process they call “contestability” - a step beyond competitive tendering whereby service is specified and anyone can “contest” their ability to deliver it.
Services often have specific outputs and outcomes with payment by results and large complex single contracts which involve many organisations coming together as a single consortium. In the longer term this may see large service delivery voluntary organisations in receipt of public contracts and those who are not. The Department for Work and Pensions has also recently issued guidance on the “right to bid” for independent sector organisations following on from the Welfare Reform Green Paper.

Will things change?

Big Society, not Big  Government  and the Coalition Agreement both talk about  neighbourhood groups being given the right to take over services facing closure and in some cases to bid to take over or create new services. Both documents also talk about payment by results and funding following personal choice. This would seem to imply that the ability to challenge current provision will remain and be encouraged, but with different ways of funding.  Another one to watch.

5) Transforming Social Care – Supporting Independence in Bromley

LLB Bromley received a Transforming Social Care Grant - to enable it to pilot the “personalisation” agenda. Personalisation is the phrase used to describe changing social services - away from designing services t and assessing people’s eligibility towards identifying what each individual needs and identifying where to buy services to suit them. People will be allocated a budget - but this may not pay for all the services they need. This will be a major change in attitude and way of working for social services, voluntary sector and service users and carers.

Bromley Council set up a Transforming Social Care Programme Board which includes some voluntary sector membership.  The programme manager is Jean Penney - and she prepared a report on progress on TSC to the Adult and Community services PDS committee which you can download from the council website. The report says that by March 2011 a third of social care service users should have a personal budget. However to have a personal budget with the council people will still have to be assessed as being eligible to support. The majority of people will still be responsible for funding their own provision. 2 levels of service will be available - “universal” which covers a wide range of support services and targeted - specialist social care services for those that need them. Developing a new mixed economy of public private and voluntary sector provision will be important. Brokers will be important in assisting client s – whether council funded or otherwise – to build up the right package for them.

This project has now been re-branded as Supporting Independence in Bromley.  It will also mean a change in the way the council buys services - as units to make up a package rather than as block contracts. This will have a long term impact on the council’s wider commissioning approaches. 

The Supporting Independence in Bromley team have produced a ranges of updates and fact sheets – you can find information on LBB's website. this includes

There have also been Stakeholder meetings organised with Bromley LINk (the replacement for Patient Forums). Jean and colleagues have also produced a range of presentations and briefings. If you would like to receive copy by email contact Stephen Blann Policy & Networks Officer at Community Links Bromley.

A key part of making personalisation a success is brokerage - linking people with social care needs with potential providers. Currently both Age Concern Bromley and Bromley Mencap have brokerage programmes.

The following is extracted from LVSC policy bulletin

“Individual budgets are of particular interest to VCS groups working in the health and social care or support field, as they will produce a major change in the way these services are funded. Organisations will need to ensure they develop a business model that markets their service to individuals, rather than social service departments, and can cope with different levels of demand.

“The Department of Health has now published its response to the evaluation of the first individualised budgets pilots Evaluation of the pilots of this scheme demonstrated that holding an individual budget was associated with better overall social outcomes and higher perceived levels of controls for those using them. However, the report identified there were significant barriers to take up of the scheme amongst people with mental health problems and older people had less positive findings than other groups. Amongst older people qualitative interviews suggested that many did not want the additional burdens that they associated with planning and managing their own support. Significantly the evaluation showed that the cost of service packages under individual budgets was slightly lower than standard packages (£280 per week versus £300 per week)”.

You can download more briefings and background information here
Centre for Economic and Social Research

As well as progress on personalisation in social care there are proposals to introduce personal health budgets.

Personal budgets in health

Pilot schemes for personal health budgets similar to personal social care budgets were started by the last Labour Government (more detail on this website). The department of health published a leaflet setting out how personal budgets in health may work. They won’t cover emergency care and there will be restrictions on how it can be spent – specifically not on alcohol, gambling or anything illegal!  The new Coalition government has   also committed itself to expanding personal budgets. 

Page updated: 25 June 2010