INTEGRATION AND EXTERNALISATIONRE-COMMISSIONING INTEGRATED CHILDREN’S SERVICES IN DEVONJenny Connelly Jon Richards

What did we re-commission?

• All NHS and Social care services managed as part of our Integrated Children’s Services

• All staff, both NHS Devon and Devon County Council employees– including social workers, community care

workers, OTs, portage service, short-breaks units, speech and language therapists, community children’s nurses, health visitors, school nurses, mental health practitioners and learning disability nurses

What did we need to achieve & why?

• Transforming Community Services set out a national requirement for Primary Care trusts to separate their provision from their commissioning function by 1st April 2011

• As a result of this arrangements were put in place with Devon County Council to manage Integrated Children’s Services on behalf of NHS Devon for up to 2 years, to allow time to determine long term arrangements

• The outcome of the process would be out-sourcing of health and social care services

Programme objectives

To develop and implement sustainable solution(s) for the long term provision of Integrated Children’s Services that will ensure the safe transfer of services from their current arrangements by 31st March 2013

To explore opportunities for extending the scope of the services to be re-commissioned

To optimise the opportunities for transformation

To improve outcomes for children and young people

INTEGRATED CHILDREN’S SERVICES

Mental health and wellbeing

Primary Mental Health Service

Child & Adolescent

Mental Health specialist service

Joint Agency Child Abuse

TeamService around

the Child (Children in

care)

Physical, Sensory & Learning Disability

Joint agency multi-disciplinary teams for children with

disabilities, including children’s

community nursingSpecialist Child

Assessment CentresCommunity

Equipment ServiceSpeech & Language

Therapy Service

Family support services, including short breaks units

Public Health NursingHealth VisitingSchool Nursing

Immunisation Service

Newborn hearing

screening serviceHealth

service for children in

care

• Mapping• Gather

views• Market

Develop the mod

el

• Dialogue• Tenders• Evaluatio

n

Procure the

service

• Staff • Contracts• Finance

Transfer to

new provider(s

)

Ongoing engagement

Apr 11 Sep 11 Jul 12 Mar 13

Co-production Phase: 1

Three workshops with Stakeholders – 40 people including staff, head-teachers, GPs, Paediatricians, commissioners, statutory and voluntary sector providers

Three Staff events – c70 staff Parent/carer events – 120 parents CYP questionnaire – 56 CYP Information gathering – demography,

needs, interfaces, national policy Limited market testing/analysis

Co-production Phase: 2

• Information gathered influenced our decisions– To re-commission ICS as a whole including both NHS

and DCC services and staff– To include CAMHS consultants within scope – To seek a Single Accountable Provider

• Workshops informed outcomes and objectives that were described in the statement of service requirements

• Set of guiding principles were produced that underpinned whole process

• Review of key service areas being undertaken – first one is speech and language therapy

Guiding principles• Strengthen integration of health, social care and education in the planning and

delivery of services • Support delivery of partnership working including across statutory & voluntary

sector • Proactive engagement & communication with families, children & young people,

staff, and other stakeholders (clarity, openness, transparency)• Ensure that needs assessment and evidence based service delivery informs

future arrangements• Ensure flexibility through adaptive and responsive solutions that are fit for the

future• Ensure solutions that achieve consistency of approach but enable locally

responsive services to be delivered• Ensure the continuing improvement and development of services during the

transition• Work in partnership with staff and their representatives throughout the process,

and provide appropriate support to staff through the transition• Maintain and improve quality and safety of services during transition and in

particular the core requirements of risk management and safeguarding • Build on what is good about how things work currently

Co-production Phase: 3

Lessons learnt Consider options for more general

engagement alongside targeted approach Engage early and often - groundwork at this

stage reaps benefits later and can’t be rushed

Build in additional consultation time in case this phase leads to changes in services

Early development of service specifications Spend time understanding the current

provision in depth

Procurement Phase: 1

OJEU advertisement in September 2011 60+ agencies expressed an interest with

many attending an Information Event in October

2 ‘right to provide’ in-house bids were considered but ruled out

8 agencies submitted PQQ 7 agencies passed PQQ 3 bids received – 2 consortia and 1

standalone

Procurement Phase: 2

2 evaluation stages Stage 1 required outline bid and

technical/financial information Evaluated by c.40 commissioners, parents/carers,

staff representatives, external stakeholders Stage 2 required full bid, answers to 90+

detailed questions, and two presentations Evaluated by over 50 commissioners, service

users (children and young people), parents/carers, staff representatives, external stakeholders

Procurement Phase: 3

2 presentations as part of Evaluation Stage 2 Large daytime group of parent/carers, staff

representatives, and external stakeholders 10% of overall score attributed this way.

Reasonably clear preference expressed for the winning bid

Smaller after-school group of children representing the three service areas within ICS 10% of overall score attributed this way. Clear

preference expressed for another bid

Procurement Phase: 4

A Moderation session quality-assured process and agreed final recommendations for decision-makers

2 rounds of decision-making in July and September 2012 – ‘Preferred Bidder’ and ‘Intent to Award’

Negotiated Procedure allowed for some final clarification of ‘Preferred Bidder’ bid in August

Parallel and almost contemporaneous decisions made by NHS Cluster Board and DCC Cabinet on each occasion

Procurement Phase: 5

Lessons learnt… External stakeholders and experts can bring

significant assistance, but be clear about the basis on which they are being engaged

In a joint procurement exercise, clarify terminology and process at the beginning, and review understanding at each stage

Involving children and young people in the evaluation is challenging for commissioners, but massively so for bidders!

Robust evaluation process was lengthy but paid dividends during subsequent legal challenge

Judicial Review Phase: 1

Not part of the plan! Brought on Public Sector Equality Duty

grounds Defended robustly but at considerable

cost and effort Caused capacity challenges in next

phases The result? We lost… but also won!

Judicial Review Phase: 2

Lessons learnt… Prepare for challenge in big and potentially

controversial commissioning exercises PSED is fertile ground for challenge Build Equalities planning and internal

challenge into process right from the beginning; be assertive about the need for expert support

Evidence, evidence, evidence!

Due Diligence and Mobilisation (DDM) Phase: 1

How open should commissioners be? What level of contact with current provider

should there be? Devon example allowed incoming provider

to undertake ‘Deep Dives’ into nominated areas of practice and to engage with staff

This allowed for some re-assurance - TUPE process was fairly straightforward - but also added to contract negotiation challenges

DDM Phase: 2

Most challenging issues in DDM Phase… Premises ICT & Information Governance Business support & back office services Massive NHS re-structure as the

background Varying levels of support from other parts

of the commissioning organisations Contract negotiations (x2!) Social Care transfer of functions

DDM Phase: 3

Lessons learnt… It always takes longer and is more tricky than

you expect! In a ‘spin-out’ scenario, commissioners need

to prepare the ‘losing’ organisation(s) just as much as the current provider teams

Engage external legal advice early – don’t wait for the final contract negotiations

Staff engagement with the incoming provider organisation is critical - hearts and minds are important!

Overall lessons: 1

Challenge of doing this cross-agency Terminology Collaboration meant we didn’t always remember to test

and check understanding• Co-production and collaboration as an

underpinning principle was important but be prepared for difficult times

• Be clear about the nature of the relationship with external advisors – legal, procurement

• Benefits of engaging external experts early eg legal may have saved time and cost later and strengthened our negotiating position

Overall lessons: 2

Early engagement with staff helped reinforce messages to parents

Time and capacity – review at each stage of the process

Consistency of the core team Strong governance – including internal

audit Plan, plan and plan!

ANY QUESTIONS?