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Alec Fraher and Associates Ltd

June 2008

Sub-Regional

Specialist CategorySourcing

ProgrammeSustainable Futures, Positive

Futures

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Sub-Regional Collaborative

Specialist Category Sourcing

Programme (Substance

Misuse)

Project Initiation Document

Draft Version 1.0

June 2008

Author/Owner

Alec Fraher

Alec Fraher and Associates Ltd June 2008 | 101 Heslington Lane, YorkYO01 4HP tel 07811 590071

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Director, Alec Fraher and Associates Ltd

Contents

Part One

Summary

Part Two

Farming the Opportunity

Part Three

Outcomes of the Sunderland Approach

Part Four

The Programme

Part Five

Programme Management

Part Six

Approval and Permission

Part Seven

About Alec Fraher and Associates Ltd


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Part One: Summary

The South of Tyne NHS PCT and the three local authorities of

Sunderland, South of Tyne and Gateshead, spend in excess of

xxxx annually in bought in services to tackle substance misuse.

The current contracting landscape is fragmented and

uncoordinated. It has evolved in unplanned manner overtime

without broad strategic vision.

Whilst procurement collaboration in across the North East has a

good track record, North East Local Authorities and PCTs, could

do much better, ensuring the delivery of strategic outcomes

whilst mitigating risks; through the harnessing of spend and

optimisation of activity into a collaborative strategic approach

aligned with the sub-regional commissioning lead of the South

of Tyne NHS PCT, the local understanding of Local Strategic

partnerships and Third and Fourth Sector Providers and

community interest groups.

This programme aspires to the development of a sustainable

Sub-Regional collaborative specialist category sourcingprogramme for substance misuse to:

Deliver a better deal for Strategic Partnerships and the

South of Tyne NHS PCT by understanding, managing and

leveraging the xxxxx identified annual spend on bought in

substance misuse services currently bought separately

but provided sub-regionally

Deliver co-ordinated, intelligent and efficient local andsub-regional approaches to market management,

releasing xxx, over 3 years to support front line delivery in

tacking substance misuse problems

Drive forward the adoption of Excellence Models by the

provider market in order to realise the back office process

efficiencies and satisfy the requirements of World Class

Commissioning


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Deliver consistently high calibre, value for money and

world class contracts for everyone

Optimise procurement activities into a collaborative,

performance management framework, removingduplication and reducing resource requirements by as

much as two-thirds for non-lead commissioners

Offer a strategic approach, driving forward world class

commissioning transforming local delivery and delivering

the Public Sector Transformation agendas.

Embed collaborative procurement into world class

commissioning, sharing expertise and knowledge with a

public service and performance management ethos

Shape procurement sourcing requirements into a strategic

forward plan to maximise opportunity to stimulate the

sub-regional delivery of broad policies; drive innovation

and market shaping, supporting local regeneration,

addressing inequality and promoting social protection.

Optimise cashable savings and mitigate the risks of

sustaining the savings ensuring Third and Fourth Sector

providers with a commitment to world class

commissioning and predicated outcomes that are truly

designed for demand and meet patient and customer

need.

In the medium term, having harnessed the category sourcing

into a cyclical programme, the opportunity will present itself toreview the organisation of procurement and commissioning

skills and capacity across the sub-region and transform this

activity into a fit for purpose structure for World Class

Commissioning of future delivery in substance misuse services.

Summary of Recommendations

Recommendation One


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Adopt the framework process approach for category sourcing

for the Strategic Category, using Article 81(3) exemptions to

ensure that cashable savings are realised.

Recommendation Two

Develop a Sub-Regional (Strategic Category) standing list

owned by the South of Tyne NHS PCT

Recommendation Three

Take advantage of the Strategic Category programme, building

on the Sunderland approach, to agree the form and content of

a sub-regional concordat. Adopting in whole or in part the

Sunderland approach to total quality management

Recommendation FourThe evaluation and assessment criteria of Strategic Categoryproviders are as follows:

Excellence in drawing down funding, for the benefit of

themselves and others

Excellence in employee and staff management

Excellence in customer/patient care, treatment andmanagement

The master score system ( balance scorecard) from theSunderland APPS is available can be utilised or adapted for use.

Recommendation FiveThe sub-regional meetings of the Head of Service and JCMs as

the Expert Group, with representatives from the three localarea Joint Commissioning Groups nominating one localgovernment representative, a clinical specialist and inviteproviders to nominate a provider side representative to act asthe Quality Assurance Group

Part Two: Framing the Opportunity


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In 2006-2007, the Safe Sunderland Partnership established the

building blocks necessary to procure substance misuse services

to deliver efficiencies and ensure an increase in wellbeing

across the city. This approach was known as Better, Brighter

Futures and has provided a rich source of intelligence to

support the business case for a sub-regional collaborative

specialist category sourcing programme.

The primary focus was supporting the Safer Sunderland

Partnership to develop commissioning baselines, identifying

who was providing what, was it effective and at what cost,

economically and socially.

The visibility of the evidence and intelligence gathered has

enabled this Partnership to make progressive steps, showing

how a whole system approach delivers efficiencies, establishing

contract registers and comprehensive contract programmes

that deliver, meet and exceed delivery targets.

The Partnership has reported that the approach has enabled:

Setting realistic efficiency targets

Ability to capture savings

Development of workflow to realise saving potential and

increase wellbeing

Development of comprehensive contracts framework

Business platform for additional resources on an invest to

save basis

Understand the capabilities and capacity of local provider

markets and the impact on communities

Provide the opportunity for improved budget management

Provide the basis for a considered approach to

procurement


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Opportunity for improved provider management and

overall statistical controls to ensure fair play and capture

innovation

Offers the basis for meaningful collaborative procurementpossibilities

Mitigates the risk of hyper growth and competition whilst

stimulating innovation

Provides a modern procurement model that is suited to

World Class Commissioning and can be re-freshed in

future years.

Part Three: Outcomes of the

Sunderland Approach

The objective of the Sunderland approach was to establish the

grounds for market segmentation, and having undertaken a

major assessment of competency establish a provider

enablement programme.

The following diagrams provide a strategic overview of the

categorisation and analysis of the Safer Sunderland Partnership

Category Sourcing Programme, Better, Brighter Futures - this

process is known as APPS.

Diagram .1 An Overview of the Framework Assessment,

Evaluation and Provider Enablement Process


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Source: Using P4 methods to Establish strategic Control of commissioning Process, Alec Fraher

2008/National Procurement Strategy/Duncan Olive NECE 2007.

The Categories Explained

Bottleneckcategory providers handle significant social

problems and risks for the system as a whole, require

contracting flexibility, financial assurance and back room

support, relatively high levels of provider control and back up

plans. The role played by this category of provider is often

central to developing a detailed understanding of customer

(patient need is covered later) needs, identifying unique waysof creating value and tackling inequality head on. This category

can drive up competitive urgency, and the providers are likely

to be vocal about their perceived competitors capabilities and

competencies, cynical about performance management as a

feel good exercise in meeting core competencies rather than

addressing peoples needs. Love them or loathe them is

category of provider is pivotal to driving forward change,


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fosters local accountability and acts as a natural check and

balance to other parts of the system.

Routine category provides are those typically best suited to

open or restricted procurement procedures where efficientpatient/customer processing logistics and service specifications

have already been standardised and outcomes are measured

by volume of patients seen and other targets like retention

rates, completions, DNAs. This category of provider welcomes

the use of open competition, is usually technically competent

with good business acumen and seeks to increase its market

position by offering leverage to the purchaser and employment

opportunities to local residents. This category is vulnerable tohyper growth and hyper competition which can have adverse

effects on both the bottleneck and leverage categories,

undermining both the contractual footing and overall

performance management of a Partnership.

Leverage category providers allow commissioners to fully

exploit its purchasing power and are best suited to mixed

procurement procedures where target pricing and service

substitution are required to make efficiencies and improve

quality. Care must be taken not to react to the pressures, as

great as they may be, and not to confuse the use of open or

restricted procedures, best suited to the Routine Category, as a

reaction to hyper-growth or hyper- competition that is driven by

both the Bottleneck and Routine Categories. The leverage

category is concerned solely with the overall health of the

provider market and serves as conduit to the strategiccategory.

Strategic category providers are those that can show that

they are the embodiment of excellence or have the potential to

be so. The providers are characterised by an ability to

understand population need, demographics and the challenges

of working in a global economy; working in an integrated and

fair way with providers from other categories knowing when

and how to invest and divest its own patient interests; with a


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requirement for high end clinical and managerial governance

and service excellence. This category of provider is best suited

to specialist procurement procures, like competitive dialogue

and negotiated procedures or a call off. This category of

provider may also act as a hosted service and let second stage

awards on behalf of the strategic commissioners.

Summary Observations based on the Sunderland

Approach

The historical focus on provider contract management and the

micro performance management of individual providers was

lacking strategic focus, drawing the back room strategic

resources of the commissioning team into the day to day

activities of providers and attention away from whole system

management resulting in reactive short sighted market

development.

In this scenario hyper competition is likely to increase the

Bottleneck category providers compete with routine category

providers; Routine category lobby for strategic category

position and public sector services are used as leverage thehistorical reliance on open or restricted procurement becoming

the accepted commissioning response with little or no scope to

pay attention to the overall impact on communities.

Diagram 2 below shows the self reported priorities of all

providers completing the EFQM1iself assessment. The diagram

shows that for all providers, based on their own self assessed

form performance was a reaction to the function of marketconditions and not community needs.

1 EFQM is the European Foundation for Quality Management and is the industry standardfor assessing procurement excellence, it was adapted for use in the Sunderlandprogramme, the evidenced submitted being tested against an algorithm and balance

score card;.2 Kion is the Greek word for meaning and the system shown was validatedby Cipfa/City in Guilds academic/professional Exam Board in March 2008.


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Diagram 2

Source: Using P4 Methods to Establish Strategic Control of Commissioning, Process Alec Fraher,2008


StrategicCommission

ing Gap

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iThe strategic commissioning gap identified required that a new

approach be used; this approach is now known as Kion and is a

validated performance management framework for whole system

transformation.

Diagram 3 below shows the framework to the Kion System, it isunlikely to make sense to the lay professional, but makes use of

and adapts otherwise disparate performance management tools

and techniques which formed the backdrop to the Sunderland

approach.

Diagram 3. The Kion System - A Framework Process for TotalQuality Management

Source: Using P4 methods to Establish Strategic Control of Commissioning Processes, Alec Fraher 2008

The Kion System simply sets out to provide a framework for theintegration of the National Procurement Strategy and World ClassCommissioning, and one year on from the start of these processesthere is sufficient operational evidence to support Sunderlandsefforts to transform its services in line with national expectations.The recent successes of the Sunderland Approach are commented

on in the National Treatment Agency Annual Report 2007.

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Comment and Opinion about the feasibility andtransferability of the Sunderland approach at a sub regionallevel

In theory, the Sunderland Approach could be replicated on a

Partnership by Partnership basis, or adopted at a regional and sub-regional level. We could go as far to say that the North East hasalready paved the way for collaborative category sourcingprogrammes and has an established track record regionally andsub-regionally, with initiatives like the Tees Valley Partnership, theTyne and Wear Efficiency Group and the NorthumberlandProcurement Forum already in existence. The Local authoritymandate for a comprehensive collaborative category sourcingprogramme was taken at the First Summit for Chief Officers and

Senior Procurement Officers ( 19th

March 2007), the extension ofthis mandate to health and social care is less clear althoughpermission has been given at CEO level within local authorities.

The new sub-regional position of the South of Tyne NHS PCTnecessitates the sifting and sorting of standing orders and contractregisters, will allow for the identification of duplicated back roomeffort, streamlined administration, and a coordinated response, aslead commissioner, to section 31 obligations with local authorities.

It is important to note that the Sunderland approach was both braveand bold. Acting from the back foot and in response to the NationalTreatment Agency and the Health Care Commission, Sunderlandhad to make rapid improvements. It was this sense of urgency thatprompted the mandate to go ahead with the scheme.With hindsight and reflection the Sunderland approach has allowedfor the identification of the key attributes that supported this

initiative. These attributes are listed below, in no particular order ofimportance, with commentary about whether or not the Sunderlandapproach is transferable at a sub regional level. The attributes arein effect pre-requisites for sub-regional commissioning, they arelisted below:

TimingQ: What if the contract end dates differ for each local area? Will thishave an impact on prioritisation of category sourcing and thetimeframe for optimal benefits?

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A: The approach advocates market segmentation and contractedservices provided in the Bottleneck and Routine categories are bestsuited to local arrangements, the Sunderland approach hascaptured all the main regional and national providers and mitigatestheir inclusion on a sub regional standing list concerned solely with

increased purchaser leverage and strategic commissioning. In thisway existing contractual commitments are assessed according tothe market category, and will not interfere with any existingobligations.

Differing PrioritiesQ: Will variation in spend and the differing objectives of the localareas mean that priorities are very different.

A: The demographics for the three local authorities show significantcommonalities mitigating the development of sub-regionalcommissioning in the strategic category, offering increased focus,setting new standards of excellence, harmonising operationalvariation and addressing key service omissions, like services toasylum seekers and refugees, travellers or other underservedgroups, like gays and lesbians, women and sex workers. Strategicprioritisation within this category levels up service provision as awhole and adds value to the system as a whole.

The Joint Strategic Needs Assessment for Gateshead showenormous potential for strategic sub-regional commissioning in theareas of mental health, circulatory disease, and alcohol andsupported housing. That substance misuse is shown to be a causalfactor in poor health, poor health attainment in all these serviceareas and disproportionately effects those living in moredisadvantaged communities are reason enough to give a mandatefor this approach.

One size fits All ApproachQ: How will the Sunderland approach meet with the other two localauthority and their Partners legal and democratic obligations?

A: The Sunderland approach has adopted the keyrecommendations of the National Procurement Strategy, is inkeeping with meeting Gershon efficienciesand endorses the flexibilities of section 31 and LAA agreements.

The categorisation of the market segments is aligned to the level ofprocurement expertise and specialised commissioning needed

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according to the service needed against population anddemographic demand. This will allow Partner agencies greatercommissioning control in each category. An earlier version of theapproach was piloted and road tested at North Tyneside Councilduring 2004-05 for all adult customer groups, being held up as a

model of best practice by CSIP and NIMHEW, in developing providermarkets in mental health. The road test included senior levelprocurement backing and was approved by the authorities s151Officer.

Although the Sunderland approach is the main focus of thisfeasibility appraisal, the road testing at North Tyneside Councilshowed that the use of open and restricted procurementprocedures was premised upon early externalisation and service

modernisation programmes and designed to meet the demands ofservice substitution where customer need was assessed as beinglow to moderate.

The learning showed that both open and restricted procedures aresuited to Routine Category services, where specifications andcontracting arrangements standardised the administrative burdenand contracting for a service is relatively straight forward. Thepractice wisdom gained now shows that the blanket application of

these procedures to other categories has diluted expertise, stifledinnovation and been applied to more specialised areasinappropriately, undermining confidence in the provision offered.

The National Procurement Strategy modernises outdatedprocurement procedure and make sense of procurement generally,elevating the term procurement to mean public servicemanagement. This means that there is now a wider strategic rangeof procurement options, meeting the requirements of section 135

LGA 1972 obligations, in response to the changing landscape andnew horizons commissioning brings.The Sunderland approach embraced these advances electing to usefull EU advertising, and in doing so has applied Article 81 of theTreaty of Rome. This in turn, allows for the use of Article 81(3).

Article 81(3) allows for the exemption from competition law in thepursuit of efficiencies when direct benefits to the community andcustomers must also to be satisfied. The use of Part B rules doesnot allow the subsequent use of Article 81(3).

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More than this the Sunderland approach has drawn down learningfrom the EU on social protection, of how issues of social welfare andglobal economy interact, and in doing is has become sensitised tothe expectations of World Class Commissioning, Safeguarding andSocial Protection. All this, when combined with the National

Procurement Strategy recommended Provider EnablementProgrammes, has put in place the necessary building blocks toachieve excellence in commissioning.

Lastly, in many respects the Sunderland approach is not new. Thereare many authorities using Approved Schemes, its unique sellingpoint is that it also provides the basis for continuous qualityimprovement. Having assessed and evaluated each providersoverall competency, the Sunderland approach has relied as much

on local track record, as well as each Providers own sense ofoptimal delivery and excellence, driving up local standards andcreating leverage and strategic value to those organisationsdesigned for the demands our communities face.

Availability and Quality of Management InformationQ: Is the intelligence available sufficiently comprehensive, completeand reliable enough to undertake such a programme?

A: The impetus for the Sunderland approach was taken from anAudit Commission report in 2004. The report Reducing the LocalImpact concluded that where local substance use services lack ashared vision or suffer from competition driven by individualpersonality, service delivery is inconsistent and incoherent ( AuditCommission 2004.)

The platform created by Joint Strategic Needs Assessments, thecompetency based provider assessments of the Sunderland

approach and the adoption of Provider Enablement Programmesnow means that we are data rich and less reliant on beauty contestapproaches to purchasing and commissioning.

That base line data on spend in this service area has been clearlyidentified over recent years, the sub regional presence of the Southof Tyne NHS PCT mitigates the realisation of outcome basedapproaches offering each local area the opportunity to takeadvantage of sound needs and demographic analysis, robustfinancial and quality management systems that offers visibility andtransparency to commissioning and contracting for all stakeholders.

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It will come as no surprise that in accurate data can and doesnegatively impact tender and commissioning process, outcomes ofspecifications or volume and coverage requirements may beunclear or change mid term, undermining transparency andconfidence providers have in commissioning generally. This is often

characterised by what is known as zero-sum gaming and is theheart of the Audit Commission concerns of 2004. Adopting theframework processes shown in diagrams one and three mitigatesthe integration of national programmes for commissioning,procurement and social protection.

Internal Stakeholder EngagementQ: How will the various stakeholders respond to the introduction ofnew processes?

A: The NECE recently reported that collaborative sourcingprogrammes for health and social care, across the NHS and localauthorities are difficult to engage. Commonly difficult to manage asresponsibility for procurement is devolved to Partnership specificcommissioning teams, social care contracts teams or out sourced toanother NHS body. Stakeholders are often concerned about losingcontrol and harbour worries that they wont have input intosourcing decisions impacting on their joint arrangements for

decision making for setting and delivering local priorities.

It is often felt that Partnership working is difficult enough withoutthe added complication of trying to collaborate with one or moreauthorities. This is often the sole reason given for opting out ofcollaborative sourcing projects.

The Sunderland approach mitigates these concerns by adopting aframework approach to commissioning in a specialised market

category i.e. substance use. The merger of the three NHS PCTs ofSunderland, Gateshead and South of Tyne into the South of TyneNHS PCT adds further support to collaborative sourcing in theStrategic Category retaining local ownership in the Bottleneck andRoutine categories and, depending on local need and marketconditions, the leverage category.

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Lack of Expertise and ResourcesQ: Most local Partnerships have dedicated teams handling theseprocesses, so why do it differently?

A: Subjective views about the credibility, expertise and competency

of those handling contracting, procurement and commissioningprocesses can have a devastating impact on the people involvedand in worst case scenarios result in legal challenge. Adoptingframework approaches mitigates staff burnout, provides a cleanand transparent platform for action and enablement, buildscapacity and identifies cashable savings in backroom andoperational settings. The Sunderland approach, once agreed, waslargely reliant on the confidence and capabilities of front lineadministrative staff in document handling, making use of existing

clinical, operational and strategic expert groups that already metand existed. The Sunderland approach has an embedded Leanmethodology and is compatible with models of public servicetransformation.

Sustainable ResourcingQ: Lessons from the eighties and nineties, that saw an increasedrole for voluntary organisations, were reliant on close workingrelationships with LA staff which were costly and ineffective,

interfered with competition and resulted in conflicts of interests.How is this different?

A: The operating and policy environment is significantly different tothe contract culture of the eighties and nineties. Some localauthorities and local NHS PCTs have cited a lack of, and fear of,already scarce resources being drawn into provider enablementthat is not apart of their long term strategic financial plans, is timeconsuming and has historically been poorly managed. This is a

major barrier to overcome and successful category sourcing isdependant on agreed areas of collaboration.

The balance between locally determined planning and sub-regionalplanning is best understood and rationalised by using the categorysourcing framework and attributing lead commissioning roles, withBottleneck and Routine categories best suited to local area planningand leverage and strategic categories suited to sub-regionalplanning.

Also, sine the eighties and nineties the legislative and policyframework has seen a significant shift with increased emphasis on

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Partners and performance in one area is not a real measure forelsewhere. Also, JCMs for drug and alcohol services have a goodtrack record in taking ownership and asserting their authority tomeet stakeholder, regulator and performance managementexpectations and letting go or sharing these responsibilities will be

unfamiliar territory and maybe outside their comfort zone. Theformation of sub regional managementmeetings for this expert group mitigate support for change.

The Sunderland approach adopted a Provider EnablementApproach and where the competency assessment showed a solidoverall organisational track record and poor local delivery or viceversa remedial action plans were used to mitigate the differential.The provider enablement programme has also been used to

harness otherwise isolated pockets of service provision to ensurestrategic relevance.

The adoption of the category sourcing framework at a sub regionallevel will mitigate a commitment to a sub-regional picture. Anyfailure to do so may result in sub-optimal results, jeopardises localPartnership performance ratings and undermine wider NHS reformand Local Government modernisation agendas. This critical areawill need full buy-in from this expert group.

Part Four: The Programme - Scope of the

decision making for a sub-regional

concordat

This programme aspires to the development of a sustainable Sub-

Regional collaborative specialist category sourcing programme for

substance misuse to:

Deliver a better deal for Strategic Partnerships and the South

of Tyne NHS PCT by understanding, managing and leveraging

the xxxxx identified annual spend on bought in substance

misuse services currently bought separately but provided sub-

regionally

Deliver co-ordinated, intelligent and efficient local and sub-

regional approaches to market management, releasing xxx,over 3 years to support front line delivery in tacking substance

misuse problems

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Drive forward the adoption of Excellence Models by the

provider market in order to realise the back office process

efficiencies and satisfy the requirements of World Class

Commissioning

Deliver consistently high calibre, value for money and worldclass contracts for everyone

Optimise procurement activities into a collaborative,

performance management framework, removing duplication

and reducing resource requirements by as much as two-thirds

for non-lead commissioners

Offer a strategic approach, driving forward world class

commissioning transforming local delivery and delivering the

Public Sector Transformation agendas.

Embedded collaborative procurement and World Class

Commissioning, sharing expertise and knowledge with a public

service and performance management ethos

Shape procurement sourcing requirements into a strategic

forward plan to maximise opportunity to stimulate the sub-regional delivery of broad policies; drive innovation and

market shaping, supporting local regeneration, addressing

inequality and promoting social protection.

Optimise cashable savings and mitigate the risks of sustaining

the savings ensuring Third and Fourth Sector providers with a

commitment to world class commissioning and predicated

outcomes that are truly designed for demand and meet patient

and customer need.

In the medium term, having harnessed the category sourcing into a

cyclical programme, the opportunity will present itself to review the

organisation of procurement and commissioning skills and capacity

across the sub-region and transform this activity into a fit for

purpose structure for world class commissioning of future delivery

in substance misuse services.

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Adoption of a framework approach

To achieve a sub-regional category sourcing programme the South

of Tyne NHS PCT, the three participating local authorities and theirPartners would need to adopt, in whole or part, the framework

approaches of the Sunderland Approach.

This is not the adoption of the findings of the Sunderland APPS

process but rather the adoption of the framework process for

category sourcing and the application of a specialised exercise

targeting the development of a high level strategic category of third

party provider partners.

The feasibility appraisal, detailed above, does not support the

adoption of sub-regional activity within the service areas

characterised as Bottleneck or Routine categories, the leverage

category will, having identified those suitable for inclusion in the

Strategic category, have increased importance in future years as

the use competition and population need may necessitate

movement between the categories and a re-freshed standing list

developed in meet new market conditions and population need.Based on the feasibility of a sub-regional approach bringing the

intended benefits in the Strategic Category the following is

recommended:

Recommendation One

Adopt the framework process of the Sunderland approach for

category sourcing for the Strategic Category, using Article 81(3)

exemptions to ensure cashable savings are realised.

Recommendation Two

Develop a Sub-Regional (Strategic Category) standing list owned by

the South of Tyne NHS PCT

Recommendation Three

Take advantage of the Strategic Category programme, building on

the Sunderland approach, to agree the form and content of a sub-regional concordat. Using in whole or in part the Sunderland

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approach to total quality management.

This is shown in Diagram Four below:

Adapted from The National Procurement strategy/NECE/Duncan Olive June 2007 and re-used in Using P4 Methods to

Establish Strategic Control of Commissioning Process, Ale Fraher 2008

Strategic Category Sourcing - The Process

This process will include a comprehensive and systematic market

category review of prioritised Providers demonstrating core

competencies for inclusion on the Strategic Category standing listof providers.

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Each expert group review will include:

Spend baseline review

Assessment of current area commitments

Assessment of available contract options, transition or

migration arrangements

Assessment and risk appraisal of the category sourcing

benefits, impact on current arrangements and provider

suitability

The Approach

This will be a strategic commissioning activity, with the newlyconfigured sub-regional meeting of JCMs and Head of Service

acting as the expert group, for the market identified as Strategic

Category. The focus will shift from the day to day and year by year

management of existing contractual and procurement

arrangements to managing markets and optimising outcomes. In

the short term the approach is concerned with leveraging spend

and optimising sub-regional delivery, with all the benefits that this

will deliver.

The approach will make available information from the Sunderland

APPS, aggregating other standing lists and inviting providers to

update or re-fresh their portfolios against set criteria. The criteria

set will concentrate on the providers ability to demonstrate:




Excellence in customer/patient care, treatment and

management

Diagram Five shows the steps in this process:

Diagram Five

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Recommendation FourThe evaluation and assessment criteria of Strategic Categoryproviders is as follows:




Excellence in customer/patient care, treatment andmanagement

The master score system (balance scorecard) from the SunderlandAPPS is available or can be adapted for use.

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Recommendation FiveThe sub-regional meetings of the Head of Service and JCMs couldserve as the Expert Group, with representatives from the three local

Joint Commissioning Groups nominating one local governmentrepresentative, a clinical specialist and nominated provider siderepresentative to form the Quality Assurance group. Procurementexpertise will be sought from City Hospital procurement team.

NB The omission of user/carer representation is a reflection of the shift in statutoryobligations arising from the Local Government and Public Involvement in Health Act2007, the local government representative, it would seem now has theseresponsibilities.

Part Five : Project management

GovernanceEffective project and subsequent category programme governancewill be accomplished by addressing the following as an embeddedpart of the project implementation:

Project/category programme management and controlProject/programme assuranceQuality managementStakeholder managementIssue Resolution and Risk managementPerformance managementBenefits management

Programme OrganisationThe stakeholders and people involved in the Project Board(s),

Quality Assurance Group and Expert Group are all embeddedfeatures of the existing structures, placing minimal demands ontime but maximising their respective executive roles.

The value offered by City Hospitals procurement expertise andguidance was fully recognised through out the Sunderland APPS,providing the legitimate body for approving and safeguarding fairplay through out. The procurement team at City Hospital is centralto the delivery of the programme.

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The organisation of this project and future running of theprogramme has been designed to make efficient use of currentgovernance arrangements and resources.

Stakeholder Engagement and Communication Strategy

To optimise the effectiveness of this project it will be vital to put inplace effective communication to all stakeholders. Goodcommunication from JCMs within their local area will becomplimented by provider briefing sessions, followed by a categorysourcing white paper and application for inclusion.

Project ControlThis project will managed in accordance with the PRINCE 2 projectmanagement guidelines.

Project MethodologyThe project implementation is in accordance with PRINCE 2 projectmanagement guidelines

Project Review MeetingsThe project will be reviewed by the Project Board (the sub regionalmeeting with JCMs) with day to day back up offered by the JCM for

Sunderland, administrative support will be offered by the SaferCommunities Team. Quality Assurance Reports will be provided viathe Project Board to local Joint Commissioning Groups at plannedintervals.

Change ControlShould there exist a need for a significant change to the project, aChange Request will be raised and reported to the Project Board.

Part Six: Approval and Permission

This Project Initiation Document has been read and signed off bythe following signatories:

Head of Service for South of Tyne NHS PCTHead of Strategic Finance for South of Tyne NHS PCTHead of Procurement City HospitalsJoint Commissioning Managers for each participating local area.

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Part Seven: About Alec Fraher andAssociates Ltd

Alec is an experienced associate consultant who has worked

effectively across all client groups and in both voluntary and

statutory provider services, more recently his working focusing on

the purchase of both social care, housing and health services He

has been involved in a number of Authorities with a brief to analyse

existing service provision, lead on the procurement and

commissioning of services from various sources internal and

external to organisations.

He has strong background in Partnership working across Health,Social Care and Housing, and safeguarding experience dating back

to the mid nineties when Alec held a number of honorary hospital

manager posts as the head of advocacy services in a range of

secure psychiatric settings and more recently handling the transfer

of and divestment of public sector services to the independent

sector. He is a registered social worker and holds a graduateship in,

Public Service Performance Management and Transformation and is

an accredited Cipfa performance manager. .

Key Achievements

Author and Architect of Better, Brighter Futures, atransformational tool used in the redesign of drug and alcoholservices.

Process mapping and service redesign for homecare servicesto Older People ,Learning and Physical and Disabilities,including Sensory Impairment

Design and setting up of Approved Provider schemes for OlderPeople, People with Learning Disabilities and Adults withMental Ill Health

Safe transfer of 5000hrs of home care services to theindependent sector and market alignment

Validation by National Institute for excellence in Mental Healthin England and Wales for the design of an inclusiveaccreditation tool.

Co-author of Models of Excellence for Care Home Management Author of P4 A Transformational Method for Whole System

Improvement

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Alecs associates for this assignment are Dr Phil Barden, a worldrenowned Performance Management expert. Phil will provideexternal validation of the methods and processes used in this

exercise.

Geoff Beacon, Beacon-Dodsworth. Geoff is a soft waredeveloper and demographics expert, he and his colleagues have asolid track record in the analysis of large data sets, havingundertaken work in North West England examining the linksbetween geographic deprivation and health inequality. Geoff has along standing concern about health inequality among thealcohol/drug misusing population and those with metal health

problems.

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