Health Commissioning Masterclass
Various locations
April-May 2015
Emma Baylin
EXERCISE
• Introductions
• What is your experience with commissioning /
tendering?
• What have been the biggest challenges?
• What are you hoping to get out of the day?
By the end of the day you will :
• Know more about the commissioning landscape
and where tender opportunities might be available
• Be more aware of how to use evidence and data to
build a case for our work
• Better understand how to be 'tender-ready'
(e.g. in terms of systems and paperwork)
• Feel more able to create/ respond to opportunities
for partnership working and consortia
development
• Know more about other sectors’ drivers,
motivations and culture
National
Secretary of State for Health
and Department of Health
Care Quality Commission
Sub national
Healthwatch
England
NHS England (the
Commissioning Board)
Public Health
England
Commissioning
support Units
15 Public Health Centres
(Leeds)
4 regional
commissioning
sectors (NHS
North)
Clinical
senates and
networks
Area teams
of NHS
England
Local
Local authorities• Director of Public
Health
•Social services
Overview &
scrutiny
Health and wellbeing boards
•JSNA
•JHWS
•Commissioning plans
Local Healthwatch
Providers
Clinical commissioning groups
(may be more than one per local
authority)
Policy Context
• Open Public Services
• Personalisation and choice
• Changing funding environment and structures
• New commissioners
• New investors
• Outcomes focus
• Integrated commissioning
• New mechanisms (e.g. Payment by Results)
• Localism
5 Year Forward View
• Focus on "stronger partnerships with charitable and voluntary sector
organisations" and an understanding of the diverse roles the sector can
play in supporting healthy people and healthy communities.
• Commitment to developing a shorter national alternative to the NHS
standard contract, to grant funding and to multiyear funding.
• Recognition of the value of carers, volunteers and the wider VCS- to
support people gain more control of their own care, and the commitment
to work more closely with the VCS.
• Drive for more integrated care, between physical and mental health,
between health and social care and between GPs and hospitals, between
generalists and specialists.
• NHS England is in agreement with the findings from Due North, that
there's a need for stronger public health-related powers for local
government- help communities take more control over their wellbeing.
• Starting to break out of silo working and partner with DWP on work based
health
Evidence into Action
•
•
•
•
Early Intervention and prevention
Stronger partnership approach
Addressing all wider determinants of health
Mental and physical health are equally important to
wellbeing
• Reduce health inequality and ensure everyone is
able to benefit
• The importance of place and the strength of building
on all of a community’s assets
Voluntary Sector Strategic Review
•
•
•
•
•
•
•
•
Co-design in commissioning
Social value embedded in commissioning
The building of local VCSE infrastructure
Closer collaboration between statutory bodies &
grant giving trusts.
More support to VCSE organisations in
demonstrating impact (against suitable metrics)
Longer term funding
A focus on reducing inequalities and improving the
experience of the most disadvantaged
A simplified grants programme based on a smaller
set of aims
EXERCISE – Fact or Fiction?
• Commissioning is a separate process to providing
grants
• A grant is a lump sum of money that is essentially a
gift. It does not have a legally binding status
• Public bodies are allowed to give priority to local
providers
• Methods for monitoring performance & QA schemes
are required in order to pre qualify for submitting a
tender
Answers
• Commissioning is an overarching process, which includes
needs analysis, service design, procurement, delivery and
evaluation. If needs best met through providing a grant, then
this is what will be offered
• The funder can set out terms & conditions but a grant does
not give rise to a legal partnership. With a contract the
relationship is defined by contractual law
• This would go against EU treaty principles that all contracts
must adhere to. Although difficult for LA to specify need for
local knowledge, VCSE’s may be able to best demonstrate indepth kowledge of user needs as part of their added value.
• The invitation to Tender doc will set out what is required. In
majority of cases, performance monitoring, QA systems will
be required along with other polices, references, & audited
accounts (3yrs)
• Tenders will always be evaluated according to who
can offer the cheapest price
• The commissioning agency has the right to insist on
the transfer of existing staff from the current service
provider to the that of the successful bidder
• Charities are allowed to apply for funding to deliver
services outside of their objects and powers
• Voluntary Sector can influence the commissioning
process
• Under EU rules, contracts can be awarded either on lowest
price or most economically advantageous. This can take into
account price, environmental and social criteria. Evaluation
criteria & weightings must be set out clearly in the Invitation
to Tender and used throughout tender evaluation
• TUPE – legislation protecting the rights of employees
currently delivering service. If TUPE is applied to a contract,
them staff will be transferred across with costing impacts. You
will need to consider pension & redundancy arrangements.
• It can be tempting to follow a funding opportunity but the
decision should always be governed by orgs mission, objects
& powers. Changing a charity’s objectives is a legal process.
Beware of mission drift!
• VCS can influence by feeding in evidence about needs of
communities & helping to shape service design. Dependant
on establishing good relationship with funder (LA / CCG)
14
Challenging some assumptions…
Procurement and Contracting are not the same
as commissioning
• Procurement is the process of acquiring goods, works or
services from (usually external) providers / suppliers and
managing these through to the end of contract.
• Contracting is the process of negotiating and agreeing the
terms of a contract for services, and on-going management of
the contract including payment and monitoring.
• These two elements or tools amongst others, form part of the
commissioning cycle. They do not constitute all elements of
the cycle.
Commissioning Cycle
16
Exercise
• Where within the commissioning cycle does the VCS
have a role?
• Where are you currently engaged?
• What are the barriers?
BREAK
Data Sources
http://datagateway.phe.org.uk/index.html
http://www.phoutcomes.info/
http://healthierlives.phe.org.uk/topic/mortality
http://healthierlives.phe.org.uk/
http://www.apho.org.uk/default.aspx?QN=P_H
EALTH_PROFILES
Commissioning for Value
http://www.england.nhs.uk/resources/resourcesfor-ccgs/comm-for-value
The role of NICE
• To identify good practice using the best
available evidence
• To help resolve uncertainty for
the public, patients and
professionals
• To reduce variation in the availability
and quality of practice and care
NICE Guidance and Quality Standards
A set of systematically developed
recommendations to guide
decisions for a particular area of
care or health issue
Evidence
Guidance
Research studies - experimental
and observational, quantitative
and qualitative, process
evaluations, descriptions of
experience, case studies
Quality
Standards
A NICE quality standard is a concise
set of statements designed to drive
and measure priority quality
improvements.
NICE Quality Standards
• Define high-quality, cost-effective care
across a disease, condition or clinical area
• Presented as a set of specific, concise
statements that:
• act as markers of high-quality, cost-effective
patient care;
• are derived from the best available evidence;
and
• are produced collaboratively with the NHS and
social care, along with their partners and service
users.
“As a provider of care services, I can
“As a provider
ofQS
caretoservices,
can use NICE quality
use NICE
ensure Iand
standards
to ensure that
and demonstrate
I provide high
demonstrate
I provide highthat
quality
qualitycare,
care,based
based on
on the
the best
bestavailable
availableevidence. They
help me
in my auditing
to improve
the auditing
quality of services I
evidence.
They help
me in my
provide,
support
in discussions
with
to and
improve
the me
quality
of servicesI have
I
commissioners.”
provide, and support me in discussions I
have with commissioners.” "As a user of care services, they
support me in my choices about
“As a practitioner working in
who provides care for me, and in
social care they: give me
knowing what to expect from a
reassurance that the care and
good quality care service."
support I provide is based on
the best available evidence; help
me with practical support in my
decision-making; and keep me
up to date."
“As a commissioner, I can use NICE quality
standards to commission the best quality, most
cost-effective care, and to support more
integrated health and social care services in
my area.”
NICE Quality Standards and guidelines for social care
Topic
Guidance
QS
Health and wellbeing of looked after children
Published
Published
Supporting people to live well with dementia
Published
Published
Autism in children and adults
Published
Published
Mental wellbeing of older people in care homes
Published
Published
Managing medicines in care homes
Published
Published
Challenging behaviour in people with learning disability
May 2015
2015/16
Home care
July 2015
2016/17
Older people with multiple long-term conditions
Sept 2015
2016/17
Children’s attachment
Oct 2015
2016/17
Transition between health and social care
Nov 2015
2016/17
Transition from children’s to adults’ services
Mar 2016
2017/18
Child abuse and neglect
May 2016
2017/18
Mental health problems in people with learning disability Oct 2016
2017/18
Local Government Briefings
• Concise information on cost-effective and evidence-based solutions
for local government, public health and, from April 2014, social care
• For local authorities and their partner
organisations in the health and voluntary
sectors, in particular those involved in Health
and Wellbeing Boards
• Demonstrate potential role of NICE guidance
as the basis of solutions to public health
issues and problems at a local level
• Introduction
• Key messages
• What can local
authorities achieve
• What is effective
• Examples of good
practice
• Developing an action
plan
• Costs and savings
• Background to
recommendations
• Support
• Other useful resources
• Derived from existing guidance
• Web-based format with links to other sources of information – but
also printable
www.nice.org.uk/lgb
NICE Into Practice Guide
• Web based guide to help health and
Who is it for?
social care organisations use NICE
guidance & quality standards to achieve a
This guide is for anyone who is …
high quality of care in local settings
• Suggests what an organisation can put in.
place, and what staff can do, to use NICE
guidance & quality standards to improve
outcomes and get the best value for
money
• Includes helpful tips, links to other
resources and shared learning examples
of how other people have used NICE
guidance and quality standards
• a commissioner or provider of health
or social care
• responsible for ensuring that
evidence-based guidance is put into
practice by their organisation
• involved in quality improvement
• involved in planning, delivering and
scrutinising care services
• leading on implementing a specific
piece of guidance
• using a quality standard to improve
quality across a team or service.
Recommended
examples from Guide
the QIPP collection
NICE
Into Practice
Advice and resources to help you:
•establish how services/local pathways compare to NICE quality standards
•locally prioritise quality improvement
•support changes in services that fall short of the NICE quality standard
•develop an action plan (or commissioning plan)
•assess cost & service impact, and develop a business case
•measure quality improvement
•evaluate, provide assurance and share success
If you want to ensure that services you provide or commission are safe, effective,
good value for money and striving for continuous quality improvement then this
guide is a good starting point.
www.nice.org.uk/intopracticeguide
NICE Shared Learning
Would you like to understand how other people
implement NICE guidance or use NICE quality
standards in practice? Are you willing to share
your own experience with others?
The NICE Shared Learning Database - part of
the Local Practice Collection - contains
hundreds of searchable examples covering a
wide range of topics.
To search for examples or to make a submission,
see the NICE Local Practice Collection at
www.nice.org.uk/sharedlearning
NICE is particularly keen to hear your experience
of using quality standards to improve the
commissioning and/or delivery of high quality
care.
EXERCISE
How would you use the data outlined to help your
conversations with commissioners or during the
tendering process?
i.PHE
ii.C4V
iii.NICE
LUNCH
Three tips on how to influence commissioners (who I
always think of as the customer, as they have the
money!):
Chriss Dabbs Unlimited Potential
• Listen – don’t talk! It is what the commissioner is buying
that is important (not what you are selling). It is about what
the commissioner wants, making life easier for
commissioner and the commissioner’s perceived needs.
 Key questions for the commissioner: What is the main
problem you want to solve? How might we help you? [And
getting them to the point when they ask themselves, “Why
would we not use them?” – rather than “Why would we use
them?”]
• Make your case in terms, formats and language that are
most comfortable for the commissioner.
• Always offer more than the commissioner is asking for –
added value, better outcomes, etc.
EXERCISE
• What makes a good sales pitch?
Good selling is about:
• Building the right relationships
• Being clear about what differentiates you/your
services
• Adding value by the way you engage
• Being able to evidence your capabilities
• Listening and being responsive to your customer
• Reaching mutual agreement
• WIN-WIN-WIN
39
Partnership working and
Consortia
Why consortia?
Barriers Facing Small Organisations
• The procurement process
(long, complex, expensive)
• Unable to find out about opportunities
• Contracts are too big
• Pre-qualification
• Cashflow
41
Consortia – overcoming barriers
• Scale
• Development of specialist tendering and contract
management infrastructure
• Greater bargaining power
• Adding value at the frontline
• Building capacity
42
Different Contracting Forms
•
•
•
•
•
Provider
Managing Agent
Managing Provider
‘Super Provider’
Joint venture
43
Provider
Commissioner
Provider
Provision of Services
44
Managing Agent
Commissioner
Managing Agent
Sub-contractors
Provision of Services
45
Managing Provider
Commissioner
Managing Provider
Provision of Services
Sub-contractors
Provision of Services
46
Managing Agent/Provider
Contract top slice
Percentage of contract to pay for
management of sub-contractors:
• Performance
• Quality
• Financial management
47
‘Super Provider’
Provider
Provider
Provider
Provider
Provider
Provider
48
Super-provider:
How does it work?
• Incorporation to form new legal entity
• Providers become members of this company
• Hub and spokes operating model
49
Hub & Spokes operating model
50
Ownership & Management Structure
51
Exercise
• What are challenges in developing consortia?
• What key points must you keep in mind?
• What extra barriers / benefits come from
partnerships with i) VCS ii) Public Sector iii) Private
sector
Key stages of collaboration
• 1. Identify
Think carefully whether collaborative working is appropriate for your
organisation. Be clear about your own goals and understand your strategic
environment. This will help you in identifying and approaching your
partners.
• 2. Plan
Work closely with your partners to develop your collaboration. Draw up
shared aims, structures and agreements and develop positive
relationships.
• 3. Implement
Manage the collaboration effectively with a strong action plan and
communications plan. Prepare yourself for any possible frustrating times
ahead by building in effective problem solving and understanding some of
the key challenges that may arise.
• 4. Review
Review your collaborative experience and use what you've learned to
prepare a forward strategy.
To bid or not to bid?
Show of hands
Tender Strategy
•
•
•
•
•
•
Just interested or all in?
Partner up?
Decide who’s in charge?
Check points
Plan for procurement outcomes (good or bad)
Be brave
Mission-Money Matrix
on mission
majority activity
prime target
(love it here)
stay out!
less57
money
–
off Commercial
mission
Masterclass, Day
One
proceed with caution
more money
To bid or not to bid?
•
•
•
•
•
•
Mission
Risk Management
Capacity
Collaboration
Financial
Legal
58 –
Commercial
Masterclass, Day
One
Key Stages in a typical procurement
process
Deciding on a
procurement
procedure
Advertising
the contract
Prequalification
Inviting
tenders
End of
the
Contract
Monitoring
Awarding
the
Contract
Evaluating
Tenders
Pre-qualification questionnaire
•
•
•
•
•
•
•
basic details of your organisation
financial information
business activities
references from previous clients
insurance details
details of any recognised quality management certificates
copies of your health and safety, equal opportunities and
environmental management policies
• professional and business standing of the organisation and
its directors/trustees, for example, details of any criminal
records or bankruptcies
• examples of relevant experience
• first indications of how you propose to deliver the service.
Completing your tender
Exercise
• 2 points that you need to consider before completing
a tender application
• 2 points to keep in mind while completing a tender
application
• 1 ‘Top Tip’
Benefits and Value for Money
• Core
▫ You must deliver the core specification.
▫ Demonstrate how, and your experience of delivery.
▫ You must do this at a competitive rate.
• Winning
▫ What is the additionality you can offer?
▫ What can you identify for free?
63
Tender
Ready!!
10
The 10 Steps
Create a
‘Tender’ Desk
7
8
Policies and
Standards
4
Responding to
Technical &
Quality questions
5
Introduction to
Do your research
Tender Documents – who buys what?
1
Commitment,
passion, drive
2
9
3
Understand the
Know your
changing landscape business – why us?
Presenting
Professional
tenders
6
Foster good
relations to
influence
commissioners
Where to look
•
•
•
•
Public Tenders www.publictenders.net
Contracts Finder www.gov.uk/contracts-finder
Blue Light www.bluelight.gov.uk
Funding Central www.fundingcentral.org.uk
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