Achieving Varied Outcomes through Collaborative Commissioning

Future Collaboration and Cooperation Future Collaboration and Cooperation for Outcomes Commissioning for Outcomes Commissioning Presented by Graham Phillips, Norfolk County Council, and Antony Oram, The Benjamin Foundation

Are these the outcomes everyone seeks? Are these the outcomes everyone seeks? Healthier Wealthier Happier Fairer Safer Faster Easier Cleaner Greener Civil Tolerant Sustainable Communities, VCSEs, local authorities, businesses and investors can be interested in any combination of these 12 outcomes, including all of them

I If they are f they are then to help achieve all these varied outcomes, balance competing pressures and priorities, and to do all that more efficiently and effectively, we might need to work more creatively

Unintended consequences of Unintended consequences of any approach approach any commissioning commissioning Can be too hasty and poorly telegraphed (advance warning) Can stifle creativity if over-prescribing approach wanted Can breed distrust and resentment among providers Sitting around, waiting for the commissioner (reactive)

N Negative behaviours that can arise among potential egative behaviours that can arise among potential providers in providers in any any commissioning approach commissioning approach Unhealthy Competition keep it all to yourself, beat your competitors, get the contract Back Biting how much better we are than they are Cutting Out smaller providers with potential innovative and scalable solutions One of the worst features is NOT enabling smaller VCSEs to get in and do, when they could deliver aspects of services really well if supported to do so including by larger VCSEs. Commissioning for Outcomes as an approach could help reduce the risk of negative behaviours arising.

Commissioning for Outcomes is consistent with Commissioning for Outcomes is consistent with the evolution of thinking the evolution of thinking NHS and Community Care Act 1990 (purchaser-provider split 1991) Health and Social Care Act 2012 (CCGs replace PCTs) Five Year Forward Review 2014 signalled cooperation and collaboration as the way ahead, but no new legislation planned to enable

C Commissioning for Outcomes might work if it ommissioning for Outcomes might work if it fosters positive behaviour's fosters positive behaviour's While (still) guarding against Collusion X Price fixing and other no no s Cartel X Shutting others out, cornering markets The Cavalier X Reckless decisions causing damage Behaviours such as Cooperation pooling info, skills, knowledge, and resources Collaboration working together to achieve outcomes Courageousness being brave, which includes saying no and NOT competing

C Commissioning for Outcomes might ommissioning for Outcomes might work, if it is work, if it is Founded on shared understanding good long range needs assessment, including service user involvement, is vital Encourages proactive behaviour that takes courage all round, at all levels Managed judiciously some past BVPI s were a NIGHTMARE, but some measures are very good to know

C Commissioning for Outcomes might even ommissioning for Outcomes might even survive survive the test of time, if it the test of time, if it Is given ENOUGH time to achieve verifiable results that deliver on manifesto commitments, statutory requirements and local people s needs and imperatives (and works financially for all) Is linked to a clear, shared VISION for Norfolk and its people, with all sectors signing up Is spoken about openly and honestly The good, the bad, and what may occasionally be ugly

Some things to like about where this might be Some things to like about where this might be heading heading Opening doors to creativity, cooperation and collaboration Are we best placed to deliver the outcomes sought? Who might we be best advised to collaborate with? Clear decision making do we lead, follow, or get out of the way? By Stating needs, outcomes sought and measures to prove achievement Moving further away from over-prescribing methodology and approach Lifting collective sights to the bigger horizon Keep commissioning high level and more strategic focused, to draw out real innovation (and put providers to the test too)

Different means of doing things Different means of doing things Taking solutions to commissioners (proactive) Social enterprise development Social Investment and Social Impact Bonds The e.g. of Social Investment Bonds Baseline funding, with staged BONUS payments? Commissioner/investor share the risk and the rewards? Collaborative working assessment bonus points? Helping smaller VSCE s to engage?

Some closing thoughts Some closing thoughts It s bold it could be revolutionary A new way of doing business based on some sound, old principles Has more chances of success if co-produced between the 3 sectors systems survive & thrive because of the strength and VARIETY of connections Could do with VCSE capacity building, growth in shared knowledge and some chances to experience it in reality (safely) to maximise learning and the potential benefits.

Thank you Question time