Transcript Procurement Phase: 1

INTEGRATION AND
EXTERNALISATION
RE-COMMISSIONING INTEGRATED
CHILDREN’S SERVICES IN DEVON
Jenny Connelly
Jon Richards
What did we re-commission?
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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
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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?
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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
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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 Team
Service around the
Child (Children in
care)
Physical, Sensory &
Learning Disability
Joint agency multidisciplinary teams for
children with disabilities,
including children’s
community nursing
Specialist Child Assessment
Centres
Community Equipment
Service
Speech & Language
Therapy Service
Family support services,
including short breaks units
Public Health
Nursing
Health Visiting
School Nursing
Immunisation
Service
Newborn hearing
screening service
Health service for
children in care
Apr 11
Develop
the
model
• Mapping
• Gather
views
• Market
Sep 11
Procure
the
service
Jul 12
• Dialogue
• Tenders
• Evaluation
Transfer to
new
provider(s)
Ongoing engagement
Mar 13
• Staff
• Contracts
• Finance
Co-production Phase: 1
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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
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Information gathered influenced our decisions
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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
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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
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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
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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
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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
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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
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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
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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
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Judicial Review Phase: 1
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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
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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
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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
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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
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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
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Challenge of doing this cross-agency
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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
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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?