Strategic Commissioning: Co-production and the compelling case for - - PowerPoint PPT Presentation

Strategic Commissioning: Co-production and the compelling case for change

Diana Hekerem, Sarah Currie, Des McCart, Thomas Dodd, Thomas Monaghan

Strategic Commissioning: Co-production and the compelling case for change

Today’s presentation

• What is co-production?
• How you develop your provider partner relationship (art of the

possible)

• Using your existing market differently
• A different set up altogether - ingredients in the market place

Strategic Commissioning: Co-production and the compelling case for change

What is co-production?

Strategic Commissioning: Co-production and the compelling case for change

• A completely different way of thinking – puts users on an

equal footing with providers Co-production is a relationship where professionals and citizens share power to design, plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities (Slay and Penny, 2014)

Where did it come from?

Strategic Commissioning: Co-production and the compelling case for change

Academics and think tanks Social movements Legislation/policy

What is co-production?

• Already exists in various contexts across Scotland
• But…not just about:

–Involving, engaging and empowering people and communities –Allowing individuals, communities, third sector to take on responsibility for areas usually deferred to state

• Occurs in ‘critical middle ground’ combining strengths and

resources of people and communities and professional skills and knowledge

Strategic Commissioning: Co-production and the compelling case for change

Guiding Principles

• Recognise people as assets
• Build on people’s existing capabilities
• Mutuality and reciprocity
• Peer support networks
• Break down barriers
• Facilitate rather than deliver

Apply where relevant!

Strategic Commissioning: Co-production and the compelling case for change

Responsibility for service design

Professional are sole service planner Professionals and users/community as co- planners No professional role in planning

Responsibility for service delivery

Professionals as sole service deliverer Traditional professional service provision Professional provision but with communities/users involved in design Professionals as sole deliverers Professional and user/communities as co-deliverers User co-delivery

• f

professionally designed services Full co-production User/community delivery with little professional User/communities as sole deliverers User/community delivery

• f

professionally planned services User/community delivery of co-planned services Self-organised community provision

Boyle and Harris (2009)

Strategic Commissioning: Co-production and the compelling case for change

Responsibility for service design Professional are sole service planner Professionals and users/community as co- planners No professional role in planning

Responsibility for service delivery

Professionals as sole service deliverer Traditional professional service provision Professional provision but with communities/users involved in design Professionals as sole deliverers Professional and user/communities as co-deliverers User co-delivery

• f

professionally designed services

Full co-production

User/community delivery with little professional User/communities as sole deliverers User/community delivery

• f

professionally planned services User/community delivery of co-planned services Self-organised community provision

Boyle and Harris (2009)

Strategic Commissioning: Co-production and the compelling case for change

A range of participative approaches

Adapted from Slay and Penny (2014)

Developing equal and reciprocal relationships Coercing

Educating

Informing

Consulting

Engaging

Co-designing Co-producing

Doing To

trying to fix people who are passive recipients of services

Doing For

engaging and involving people

Doing With

in an equal and reciprocal partnership

Strategic Commissioning: Co-production and the compelling case for change

2015 Scottish Social Attitudes Survey

96% think people should be involved in making decisions about how local services are planned and run 81% think people should be involved in making decisions about how money is spent on different local public services 86% think local people should be able to volunteer alongside paid staff to provide public services

There is a huge appetite within communities across Scotland to get involved

Why co-production?

‘Evolving’ evidence base suggesting potential for improved:

• Citizen outcomes: health and wellbeing; human and social capital

(improvements in personal competencies, personal and practical skills, social networks and inclusion)

• Public service outcomes: efficiency savings
• Democratic outcomes: citizens more socially and civically aware

and may become involved in other aspects of democratic action

Strategic Commissioning: Co-production and the compelling case for change

Co-production works best when…

• There are real choices and new ideas
• It is the start of a development process
• There is enough time to involve people properly
• Outcomes are agreed and there is a clear

understanding of shared aims

• You recognise that other organisations might be

better placed than you to meet needs

Strategic Commissioning: Co-production and the compelling case for change

Overcoming the challenges

Translating theory into practice

• How can genuine power, choice and control be devolved to people and communities,

alongside front-line professional staff?

• What happens when relationships breaks down? How can we ensure robust and viable

relationships able to withstand disagreement?

• Moving beyond pockets of innovative practice to expand coverage and scale
• Appropriateness of co-production for different groups and within different policy areas

Sufficient authorising environment

• Encouraging and enabling professional culture that values involvement and

contribution of people and communities

• Considering implications for accountability

Evidence and measurement

• Generating evidence about impact and cost-effectiveness

Strategic Commissioning: Co-production and the compelling case for change

What does co-production look like in practice?

• No set guidance or manual
• Highly relational and local context vital
• Diverse public services

Questions to consider:

• Nature and degree of change being sought?
• Types and extent of input required?
• Who initiating and facilitating change?
• Who holds power to make decisions?
• Who is currently involved?
• What perspectives have not yet been considered?
• What stage should co-production take place?
• What opportunities are there for greater participation?
• What are the barriers to this?

Strategic Commissioning: Co-production and the compelling case for change

What does co-production look like in practice?

At national level:

• Creating the conditions for co-production to thrive
• National policy frameworks
• Promoting transparency and openness
• Creating incentives and opportunities
• Developing and implementing policy in open and participative way

Collaborating and co-designing with people and communities At local level, common methods of collective co-production:

• Reciprocal exchange systems (time banks, service credit schemes, complementary currencies)
• Peer support networks (mentoring, befriending, community navigators)
• Participatory budgeting
• Citizen justice panels
• Local area co-ordination

Strategic Commissioning: Co-production and the compelling case for change

Three ways to do improvement

• 1. Don’t listen very much to people who experience
• ur services and we do the designing
• 2. Listen to our service users then go off and do the

designing

• 3. Listen to our service users and then go off with

them to do the designing

(Professor Paul Bate 2007)

Strategic Commissioning: Co-production and the compelling case for change

Collaborative commissioning practice

Doing things differently

Des McCart ,Healthcare Improvement Scotland

Strategic Commissioning: Co-production and the compelling case for change

Competition versus Collaboration

Competition

• Misguided regulation anxiety
• An over focus on needs
• Lack of useful, reliable and up-to-date local

intelligence

• Risk averse commissioning reduces opportunities for

real innovation

• Commissioning and procurement as a reductive

process

• Short-term and static specifications and contracting
• Collaboration is weak
• Orthodoxy to create economies of scale produces

static markets

• “We already do co-production”

Collaboration

• Assesses needs, aspirations and assets
• Is of real value and meaning to all
• Collaboration is the default
• Positive competition is used to drive collaboration

towards achieving better outcomes

• Actively shapes markets
• Specifications are iterative and change over time to

best meet the needs and assets

• Collaborative principles define and assess all

interactions .

• Outcomes and impacts are assessed dynamically,

using diverse methods

• Accountability panels to challenge and spread co-

production

• Is a shared learning process that builds expertise

and holds onto it

Strategic Commissioning: Co-production and the compelling case for change

Using collaborative commissioning models

• Public Social Partnerships
• Alliance Contracting
• Commissioning for Outcomes

Strategic Commissioning: Co-production and the compelling case for change

What is a Public Social Partnership?

3 stage commissioning process

Design Pilot Longer term commissioning decision/process

Strategic Commissioning: Co-production and the compelling case for change

Supported Living PSP (Falkirk)

Traditional approach

• Expert design
• Controlled decision making
• Pre-specified inputs,
• utputs and outcomes
• Model fixed for period of

contract

• Generally price is deciding

factor of Best Value PSP approach

• Co-design with person,

provider, family and commissioner

• Shared decision making
• Inputs/outputs and outcomes

vary depending on experience - pilot

• Model develops over time
• Best Outcomes drive Best Value

– alongside price/cost

Strategic Commissioning: Co-production and the compelling case for change

Community Transport PSP (Glasgow SPT)

Benefits:

• Service Users - Designing services that deliver real value through

service user engagement

• CT Sector - Equal partner in the redesign /design of services

commissioned by statutory sector

• Statutory Sector - Has provided an opportunity to continue to

capacity build the CT Sector so that they are able to deliver transport services on behalf of SPT in the future

• Statutory Sector - Creates of a more dynamic market-place for

services, offering greater choice

Strategic Commissioning: Co-production and the compelling case for change

Many More Examples

Strategic Commissioning: Co-production and the compelling case for change

• 5 National PSPs supported by SG – including Lowmoss Prison
• Increasingly used by Public Sector for services such as: Foster Care, Support for

people with Learning Disabilities living in the community, Health Transformation, Homelessness Services

http://readyforbusiness.org/case-studies-public-social-partnerships/

• New approaches including

– Alliance Contracting

http://lhalliances.org.uk/frequently-asked-questions/

– Barcelona model shows that there is continuing interest in good collaborative approaches to commissioning

http://e3m.org.uk/wp-content/uploads/2016/09/The-Barcelona-Open-Procurement- Challenge.pdf

Using your existing market differently

Commissioning strategy

Strategic Commissioning: Co-production and the compelling case for change

Tom Dodd, Red Hen Ltd

Working Collectively

Start early – inclusive locality planning Just start – it doesn’t need to be perfect Commissioning strategy - framework to encourage people to do this themselves How might services be designed and operate differently? Move from paternalistic to personalised approaches

Strategic Commissioning: Co-production and the compelling case for change

Approaches

• Borrow ideas from different settings
• Representation of multiple viewpoints
• Social Impact Bonds
• Urban Regeneration Charrettes
• SDS: commoditisation vs. coproduction
• Problem shared (never worry alone)

Strategic Commissioning: Co-production and the compelling case for change

Social Impact Bonds

Outcomes based Funding risk minimised Payment by results Principles useful, but some possible limitations Advantages to 3rd sector providers

Strategic Commissioning: Co-production and the compelling case for change

Charrettes

• Land use/urban planning ‘barn raising’
• Open public session to address specific design goals
• Run over a short period, e.g. local masterplan
• Team based Participatory Planning: equal parts

engagement and inspiration

http://www.gov.scot/Resource/0045/00458679.pdf

Strategic Commissioning: Co-production and the compelling case for change

Ayrshire Mental Health

• Commissioning advantages
• Provider forum (all on framework) discus

approaches to meeting needs

• Shared design for tendered services
• Procurement questions

Strategic Commissioning: Co-production and the compelling case for change

Aberdeen Housing

• RSL – subsidiary providing new services
• Addresses Integration principles
• Tailored service and support offering
• Principles of commissioning – promotes

independence

• Provider addressing peoples needs, has

wider contribution to public policy aims

Strategic Commissioning: Co-production and the compelling case for change

Oban Workforce Planning

• Buurtzorg based approach
• Providers, commissioners and internal services

involved in process

• HR data different to managers understanding
• Model based on perceptions, motivations and

constraints for change

• Hard to predict the future when you are busy today

Strategic Commissioning: Co-production and the compelling case for change

Market facilitation

What is it and what can it achieve?

Thomas Monaghan, Healthcare Improvement Scotland

Strategic Commissioning: Co-production and the compelling case for change

What is Market facilitation?

Strategic Commissioning: Co-production and the compelling case for change

• Developing the market to deliver personal outcomes.

Market facilitation is the process by which strategic commissioners ensure there is sufficient, appropriate range of provision, available at the right price to meet needs and deliver effective personal outcomes.

Strategic Commissioning: Co-production and the compelling case for change

Strategic Commissioning: Co-production and the compelling case for change

Strategic Commissioning: Co-production and the compelling case for change

Strategic Commissioning: Co-production and the compelling case for change

Strategic Commissioning: Co-production and the compelling case for change

Strategic Commissioning: Co-production and the compelling case for change

Strategic Commissioning: Co-production and the compelling case for change