Report on the Open Policy Debate on Commissioning 23 ... · PDF fileensure that commissioning works in practice. ... Data is often a snapshot ... Managing expectations

Report on the Open Policy Debate on Commissioning

23rd October 2015

Dublin Castle

Summary of notable themes:

The most prevalent theme to emerge throughout the Open Policy Debate, and was shared by most

if not all participants, was the need for an Irish Commissioning process to be driven primarily by the

needs of the service user.

The need for a common understanding and definition of what exactly is (and is not) meant by

‘commissioning’ was frequently raised by participants.

Collaboration in needs assessment, identification of outcomes, measurement of outcomes, service

design and delivery, monitoring, assessment and evaluation was cited as a fundamental key to

ensure that commissioning works in practice. Care should be taken when collaborating and

consulting not to create any false senses of expectation that are unrealistic.

There were many calls for openness and transparency to be a central and abiding feature in the

application of any commissioning process. Additionally there were a number of calls for an appeals

mechanism as part of any commissioning processes.

The pace of transition was clearly an issue for both service providers and commissioners; with a

general feeling that this process is better being done right than rapidly. There was some criticism of

a ‘push’ from Central Government Departments when it was felt that neither the Departments

themselves or the providers and end-users were yet fully or even partially ready for transition.

There were also stated concerns about the potential effects on continuity of care that could arise

through improper, rushed or badly planned transitioning.

The need to address inequalities in service provision should be tackled when designing

commissioning systems.

It was generally agreed by participants that funding models for interventions should fit the service

provided and not the other way around.

Investment in the ‘infrastructure’ around commissioning was also cited as something that must be

addressed, especially if we are to succeed in fostering good interrogable, reusable and coherent

datasets.

The requirement to build capacity, skills and knowledge on all sides of the commissioning spectrum

featured prominently amongst participants.

When considering principles to underpin commissioning in an Irish context, some participants felt

that a human rights based approach should be considered.

Again, when considering principles, the centrality of the user in needs assessment, outcomes

determination, monitoring and evaluation was considered paramount.

Caution was offered during feedback not to confuse principles with steps in, or iterations of, the

commissioning process. It was felt that some of the draft principles offered could be confused with

process. Principles should instil values from which rules can follow.

The Operation of the Breakout Sessions at the Open Policy Debate:

At breakout session one, participants were asked to examine the strengths, weaknesses,

opportunities and threats (“SWOT analysis”) posed by introducing a commissioning approach under

a number of topic headings. Each topic heading was considered by three groups to ensure as much

of a plurality of views as time allowed.

During Breakout session two, participants were asked to consider a set of draft principles and give

their views on these principles to underpin a commissioning approach in Ireland.

Below is a copy of:

Open Policy Debate Agenda

Topic headings for “SWOT analysis” by the groups of participants (breakout session one)

Draft principles that issued to participants to stimulate discussion (breakout session two)

Feedback of the groups from the breakout sessions

If you have any further queries on this Open Policy Debate please contact the Reform and Delivery

Office of the Department of Public Expenditure & Reform at 01-6045089.

Open Policy Debate Commissioning for Better Outcomes

Friday 23rd October 2015 Bedford Hall Suite, Dublin Castle, Dublin 2

09.45-10.10 Registration

10.10-10.20 Welcome and introduction (Dr.John Sweeney, Moderator) Opening address Robert Watt, Secretary General, Department of Public Expenditure & Reform Fergal Lynch, Secretary General, Department of Children & Youth Affairs

10.20-10.40 Key Findings of the Literature Review Anne Colgan, Centre for Effective Services

10.40-11.20 Four Perspectives ‘How do the findings presented in the Literature Review relate to/reflect your experiences to date?’

A Policy Maker’s Perspective A Provider’s Perspective and a Service Recipient’s Perspective A Funder’s Perspective

11.20-11.30 Coffee Break

11.30-11.50 The opportunities and challenges of introducing commissioning in Ireland & Draft Principles for Commissioning in Ireland Elizabeth Canavan, Assistant Secretary, Department of Children & Youth Affairs

11.50-13:10 Breakout Session 1

13.10-14.00 Lunch

14.00-14.15 Feedback from Breakout Session 1

14.15-15.15 Breakout Session 2

15.15-15.45 Feedback from Breakout Session 2 This will be followed by a moderator-led discussion

15.45-16.00 Next steps and close

Open Policy Debate

Commissioning for Better Outcomes

Table 1

Assessing Needs

Understanding and describing users’ needs

Shortcomings in current methods of provision

Engaging stakeholders and providers early

Conducting the needs analysis

Other issues around needs analyses

Open Policy Debate

Commissioning for Better Outcomes

Table 2

Designing Services

Understanding outcomes

Inputs and outputs versus outcomes

Attribution and causality

Metrics to accommodate service design

Other issues around service design

Open Policy Debate

Commissioning for Better Outcomes

Table 3

Funding Arrangements

Appropriate payment models

Inappropriate payment models

When to use, when not to use

Full cost recovery

Other issues around funding arrangements

Open Policy Debate

Commissioning for Better Outcomes

Table 4

Sourcing Providers

Ensuring a ‘level playing field’

Understanding the heterogeneity of the NGO sector

Potential legal implications in provider selection

Other issues around provider selection

Open Policy Debate

Commissioning for Better Outcomes

Table 5

Delivery to users

Understanding risk in delivery

Managing risk

Delivery from new providers

Embedding and improving delivery

Other issues around service delivery

Open Policy Debate

Commissioning for Better Outcomes

Table 6

Monitoring and evaluation

Data requirements

Monitoring for performance versus monitoring of performance

Tackling decommissioning

Other issues monitoring and evaluation

Open Policy Debate

Draft Commissioning Principles

Principle 1

Understand the needs of users consulting potential provider organisations well in advance of commissioning new services

Principle 2

Putting outcomes for users at the heart of the strategic planning process

Principle 3

Mapping the fullest practical range of providers, with a view to understanding their respective contributions

to delivering outcome, and considering investing in the capacity of those working with particularly hard-to-

reach groups

Principle 4

Ensuring contracting processes are transparent and fair, facilitating the involvement of the broadest range of suppliers, including considering sub-contracting and consortia building, where appropriate

Principle 5

Ensuring long-term contracts and risk sharing, wherever appropriate, as ways of achieving efficiency and effectiveness;

Principle 6

Seeking feedback from service users, communities and providers in order to review the effectiveness of the commissioning process in meeting local needs.

Group Feedback:

Group 1

Topic: Assessing Need

Assessing needs is key to the Commissioning process – it provides the evidence base and underpins

transparency

Demographic profiling and datasets required

Analysis of profiles required

Needs assessments will be have to be broken into sub-sets of need

Acquiring comparative data can help ensure consistency

Needs assessment requires comprehensive data sets to identify and target needs

Capacity to analyse data and connect data on need is a big issue

Cognisance that needs can be individual, community and general public need

There is a need to use existing data /build on existing data

Data is often a snapshot – have to understand the ‘story behind’ the data and gather data iteratively

to ensure evolving needs are captured

Planning and assessing needs to take account of the locality

Managing expectations – when assessing need it is important not to create unrealistic expectations

amongst service-users

Needs should be conceptualised in relation to the outcome required by the user

Challenge around raising the expectations of what can be delivered while conducting the needs

assessment

Tackling silos of data is very important – more collaboration required, involving all stakeholders.

Often the data are not consistent or comparable, or access is not available. There is a need to

develop shared indicators

Often easy to measure data is used over more qualitative data

Connecting providers to assessed needs is a challenge

The identification of needs must involve all the people affected (in particular service-users) and

understand what their priorities are (understanding bias of need)

Commissioning process should recognise that assessment of needs should be iterative and ongoing

Political dimension is a risk (risk that need is not the primary factor that determines service provision

but lobbying and influence, legacy issues)– there is a nexus here to the need for transparency

Better access for Civil Society to Government Departments would help this

When does assessment start?

Care required not to ‘put the cart before the horse’

Needs assessment must be evidence based

Expertise in needs assessment required from civil society

Joint needs assessment are important, but also a challenging process given the diversity of the

stakeholders – how is this to be addressed? What is the role of Central Government? Can pre-

existing data be used/built upon?

Using pilot schemes and then scaling up

Needs assessment process should be iterative, continual and take account of continuity of service;

rather than reactionary interventions

Need for Systematic Consultation

Principles:

Users should drive the strategic planning process and be integral to the identification of their needs

and desired outcomes (principles 1&2 combined)

The Commissioning processes will be honest, open and transparent and include and independent

appeals process (principle 4)

Needs assessment needs to be evidence-based and involve consultation but be cognisant of those

who don’t engage and those who over-engage (same voices)

Commissioning process will be underpinned by a rights-based approach

Principle 3 is not considered to be an actual principle but more of a step in the process

Investment in infrastructure and building capacity (Suppliers and users) should be an inherent part

of any commissioning process

Commissioning as a term shall be agreed by all

An agreed set of outcomes for the citizen shall underpin all commissioning processes

Obs: having an agreed set of principles does not make much of a difference – how will an agreed set

of principles affect commissioning in Ireland? How can we develop an adequate degree of trust in

the commissioning process?

Concepts that must be reflected in the principles:

o Collaboration and co-production

o Shaping the pool of providers and suppliers (‘market-making’)

o An external and independent appeals process

o Honesty, openness and transparency

o Long term contracts/funding commitments and realistic funding levels for services and

providers

o Quality services should be the goal

o Good governance structures – what role for the Charities Regulator?

o Users should drive the commissioning process

Group 2

Topic: Service Design

Need to understand the process of designing commissioning and using that to decide whether to do it ourselves or outsource. What is commissioning? Central point in the literature review.

We need to debate commissioning as a way forward. Is it just ‘more of the same’, effectively moving the deckchairs, change for change sake.

It could be the ‘silver bullet’, but the evidence from the review doesn’t support that yet.

If the process is cyclical, you have to start at what commissioning is.

Need to be careful not to end up moving central problems out into the system.

Key point made: The literature review has a complete absence of mention of human rights. The UK takes a human rights approach to commissioning. Commissioning based on needs is not necessarily the right way.

The language of outcomes is easier when it’s informed by the language of rights.

There is no mention of rights in the Disability Act (other than the ‘right’ to an assessment of need, which has not been fully implemented).

Need to guard against taking us further away from the rights agenda.

If a service is commissioned, it can be required to ‘wear the commissioner’s jersey’.

Focus must be on end-user outcomes not outputs.

This is an opportunity to orient Departmental focus to outcomes and work backwards from there. There is no point in instigating a commissioning approach without starting from there.

DCYA has focussed on outcomes, where possible, for children.

First principle should be one of rights for children and adults – this is paramount.

DPER does not come from a position of focussing on the kind of society we want. Problem of service providers being able to trust that this is not just a new way of cutting back.

The difference between outcomes and outputs is crucial. Everything can be measured, quantitative and qualitative. To measure outcomes often a combination of these two things is required.

If this is to be more than words, then communities and individuals should be setting out the outcomes that they want.

A holistic idea/approach needs to be adopted.

There is a lot for everyone to learn from the disability sector which is further advanced on individual choice than others.

One principle should be that if you commission, the financial cost should not be more than current service provision as this would be wasteful.

There is a problem in moving from assessment of need to designing of services. This is both a difficulty because of the structure of organisations and because of funding models.

Rigidity in funding patterns is a problem. There should be some scope for flexibility at the margins to allow for tailored responses.

It is hard to put a uniform response in place if we don’t have appropriate funding.

It would be helpful to have a shared interest in nobody failing. This is a feature of the Area Based Childcare (ABC) initiative where it is built in. There is a shared interest in success.

It is difficult to make changes when you’re trying to keep the show on the road.

Service design is required at individual level and at organisational level.

Issue of budgets vs funding allocations.

Capacity building of providers is required.

There is a huge range of commissioners/funders. How can we design commissioning for an individual outcome or response in those circumstances?

If a number of commissioners fund a specific NGO to provide services, who ensures coherence in the system for end-users? Is this problem outsourced to the NGO?

Need to get service providers and funders to agree an evidence-informed pathway/package.

Design responses not services (and involve NGOs and users in this).

Trust is a huge issue. We need to trust service providers and service users and recognise their expertise.

In designing services, people who are being ‘served’ should be consulted.

Policy-makers have often not been in the shoes of those who use services. This is a role for the NGO.

Positive feelings about the co-design/alliance approach in designing services set out in the evidence review.

There is no knowledge of how services actually work at the centre.

Consortia idea is interesting (but is there a risk that is could eliminate choice).

Need to build in room for flexibility when commissioning services.

Issue is getting people in to social care services. It needs to be built into communities, role of ‘word of mouth’ should be harnessed. State has destroyed that through cutbacks.

Organisations such as Headstrong have done a lot of work on outcomes.

Genio – dementia project which was more flexible. It involved identifying the existing resources/services and any gaps. Gaps are filled with additional funding.

Look at what works? What could be copied? Share learning. What should be copied or should not? (Issue of de-commissioning in an orderly fashion).

There is a lack of capacity in leadership and facilitation at a community level.

We are good at collecting statistical data, but not at recording qualitative measures.

Services need to be designed locally.

Commissioning contract – governance should be appropriate to the size of the organisation. It is unfair to apply the same burden on smaller organisations.

Key lesson: Sometimes those involved in a project have very low expectations. They love the efforts made in projects but actual outcomes for those they are intended to support are not good.

A framework for commissioned services is required, but flexibility in a meaningful margin is required.

Principles

Need to understand needs – not just consult but involve people more deeply.

Need to involve service users at the start.

‘Feedback’ – what does it mean? It’s not the same thing as evaluation.

This shouldn’t just be about new services. What about existing services?

Something is missing regarding commissioning for social value, involving communities.

Different perspectives were expressed about the inclusion of rights. The terminology of ‘better’ outcomes was preferred, as outcomes on its own does not require an improvement.

Second principle should be made the first principle.

Number three – change terminology to ‘services and providers’. Mapping is key. Invest in capacity of those with the greatest need and include those with unmet need.

Number four should be deleted. It’s not a principle and in fact is a requirement of EU law.

Number 5 – consider use of ‘longer-term’ or ‘multi-annual’.

Sustainability is a key issue. Continuity of service for people is very important and uncertainty in annual funding allocations is very difficult. The models needs to provide for sustained, slower services over time.

The word ‘contract’ should be considered. This should be underpinned by good governance which gives you efficiency and effectiveness.

Number 6 – Change language to include government with a ‘small g’. Use evaluating the service and the commissioning process.

Group 3 Topic: Funding Arrangements

Attendees had differing views on what commissioning is. This led to agreement among participants of the

need for further clarity on the differences between the concepts of commissioning and competitive

tendering. [Some respondents seemed to conflate the two terms while others thought that

commissioning meant that competitive tendering could not take place.]

Some pointed out that commissioning was a process for determining needs and allocation of resources

and that new funding arrangements will need to be developed to support the process.

There was strong resistance from respondents to the widespread use of competitive tendering with

particular concerns voiced in relation to the viability of smaller organisations should this approach be

advanced. However, there was recognition from a small number of respondents that it can work in some

areas.

Different contracting and funding arrangements will be required across the different sectors as well as

among organisations of different sizes/scales.

The funding approach should be dictated by the needs of the services and service users, not the other way

around.

The requirement for engagement with service users to better understand their needs was emphasised.

A respondent suggested that a rights based approach to service delivery should be implemented.

There was strong consensus on the need for any new funding model to support collaboration, service

integration and good relationships. Two examples of where good collaboration is currently taking place

are the Area Based Childhood Initiatives and Meitheal Programme.

The impact of changes to the funding model on relationships “on the ground” must be considered prior

to implementation.

It was suggested that the potential of “Alliance Contracting” approaches be explored.

All funding decisions as well as decommissioning decisions need to be based on a properly constituted

performance management process.

There is a need for a multi-annual approach to funding in order to support strategic planning. The current

annual funding approach leads to providers guessing about what resources they will have from year to

year, hinders effective planning and leads to firefighting.

The funding approach needs to allow for and support service innovation at a local level.

The system could be a mix of grants (to fund capital, IT, equipment costs, etc) and outcomes linked

funding.

Significant deficits in management capacity, IT and analytics would have to be addressed before a

commissioning approach would be effective.

It was suggested that many organisations do not currently have the necessary data and information to

implement commissioning.

It was also suggested that any changes to funding arrangements be tested in a small area prior to any

radical changes being implemented on a wider scale.

Funders need to work with providers as opposed to being entirely separate from them.

Summary Points from Group 3 – Draft Commissioning Principles

The draft principles as they currently stand do not read as principles and instead appear more as tasks or

goals. It was suggested that principles should be more “value laden”.

It was suggested that the principles as currently drafted “epitomise the confusion about what is really

wanted from commissioning” because they do not clarify what it is about.

There is a need for a vision statement to inform the principles for commissioning.

Principle 1 should be broken into two parts because understanding the needs of users is different to talking

to provider organisations.

The principles could possibly be sequenced differently. Principles 1, 2 and 6 focus on the needs of the

service user and should therefore be at the core of the process. Principles 3, 4 and 5 are more about the

system.

Principle 2 is one of the better principles as they currently stand. The key is that the user should be at the

centre of the process. As such, the process should be “needs driven”.

Principle 6 – effectiveness should be based on rigorous evaluation as opposed to solely feedback. This

process should incorporate qualitative and quantitative data. It is crucial that evaluation feeds back into

new service design.

A principle should be included to the effect that the commissioning process will be independent and not

politically driven.

It was suggested that consideration be given to not numbering the principles to avoid them appearing to

be “ranked”.

It was suggested that the requirements of the funder, ie value for money should be embedded in the

principles.

The principles should also incorporate references to the need for good corporate governance and

evidence based design of services.

It is essential that the right outcome is defined. However, there are huge difficulties associated with

identifying appropriate outcomes as well as measuring those outcomes.

Once the principles are agreed, there will be a need for the strategy to show how the principles will be

translated into reality.

Group 4:

Topic: Sourcing service providers1

Discussion points:

Commissioning needs an accurate definition, that is nuanced for Ireland.

Most participants agreed that the starting point for the process of sourcing service providers is the actual

outcome(s) to be achieved as this dictates what kind of services may be sourced to achieve those outcomes.

There has to be a clear definition of outcomes which can then inform the process of determining the type of

services needed. It was added that to determine actual outcomes both current and future needs need to be

assessed.

It was stated that prior to sourcing providers existing service provision should be analysed. The diversity and

complexity of the community and voluntary sector needs to be recognised and properly understood. As one

person put it, the State (or other commissioner) need to understand the whole “service provider

landscape”; the scale and scope of services provided. When assessing service providers one has to examine

hard skills and expertise as well soft skills and qualities such as motivation and personal commitment,

relationships and local knowledge. There is often a focus on quantitative results but qualitative outputs and

outcomes are equally important (i.e. service users perceive services as person-centred). It was felt that

assessment of provision should include both monetary (cost and prices) as well as added value provided by

services.

It was further added that mapping should encompass funding provided by the commissioner/purchaser as

well as additional funding used for service provision. Many services receive funding from different sources

and only by looking at the totality of resources that a good understanding of the current service provision

can be established. In addition, there was a consensus among several participants that multiple needs

should be considered along with the suite of services to meet those needs, including the relationship and

collaboration among them. Over-arching reforms such as the recent re-alignment of local authorities can

provide impetus for such exercise. It was also noted that some fields are crowded with plenty of providers

whereas some others only have a few providers; this particularly applies to areas of specialisation. It is

important to recognise the need for both high-end (technical) and low-end (relationship-based) services;

both of which are necessary.

It was discussed that commissioning needs to be an all embracing process that is not limited to contracting:

this also affects how service providers are selected. It may involve tendering in some situation while in

others commissioning may be done through grants or some collaborative framework. There appeared to be

an overall view in regard to the process that centres around rationality and proportionality. Some concrete

mechanisms from health services were brought up as examples such as the voucher system – whereby

customers/clients/users can shop around, and the Home Care Package system. In the latter care is provided

for older people over and above normal community services and may be delivered by HSE, voluntary or

private providers. The emerging view was that the further discussion to define mechanisms to implement

commissioning would be beneficial. There seems to be a consensus that commissioning at its heart involves

a strategic cyclical approach to planning and implementation that is beneficial but further examination is

needed about its actual content and implementation.

1 The following is the summary combined notes of the three separate group discussions.

It was agreed that the consequence of potential decommissioning and switching providers needs to be

analysed. One concern raised in the discussion was the possible fragmentation of services. A further

difficulty in re-configuring services or changing providers is to deal with expectations, particularly in regard

to longer-running services, namely that they remain available. Added to that, a key question is to address

the hierarchy of services: in some areas one service may be both provided directly by the state and voluntary

(or private) providers. This leads to the difficulty in commissioning only the service provided by voluntary (or

private) providers. Related to that is the consequence of commissioning in terms of industrial relations:

employment may be protected within some services where in others people may be laid off or terms and

conditions changes to adapt to changing circumstances. Enforcing different sets of standards can cause

tension in the same area of service provision but to integrate them is not without its challenges.

Group participants agreed that there is a need to build capacity for commissioning including sourcing service

providers that concerns change management, application process and tendering (where appropriate) as well

as cost-benefit analysis. It was felt that the process is developmental and clearly needs initial investment.

Furthermore, there is inherent challenge in comparing profit and non-profit organisations, which need to be

addressed. The example was taken that a profit organisation aims to fill up all bed in a care home for

children whereas a non-profit organisation may examine what will the impact of taking that last child on the

existing group of children. Added to that, it was recognised that smaller organisations face more difficulty in

applying for contracts or operating an infrastructure that allows them to assess needs and their own

performance on a continual basis. Therefore they need more support.

What further emerged from the discussions is the role of information sharing and administrative systems

underpinning the commissioning process and in particular, sourcing service providers. Infrastructural

support is also relevant in that context; one highlighted that in the UK there are intermediary organisations

whose task is to build capacity among the community and voluntary sector and assist in the process of

changing providers. One participant noted his organisation often worked with existing providers by building

their capacity. In their context (development work abroad) this was also necessitated by lack of alternatives;

however, this is an important consideration even when there are more alternatives available.

The discussion also touched upon the question of risks involved in commissioning services. It was

underscored that providers should not bear risks alone but in conjunction with commissioners. That also

helps maintaining a positive relationship where parties trust each other. It was noted that trust between the

community and voluntary sector and the state and indeed among C&V organisations is a critical building

block for the process of commissioning and within that sourcing service providers. Several NGO

representatives felt that damage was caused by austerity measures and how they were implemented.

Restoration of relationship is an important pre-condition to the introduction of a commissioning process.

A key conclusion of the discussions was that the primary consideration has to be service

users/clients/consumers/citizens. When commissioning services, efforts should be made to ensure a positive

relationship with them – this is particularly relevant when changing service providers.

Group 4 - Key principles of commissioning in Ireland

The emerging consensus from the group was that needs of people should be the primary consideration. The

importance of assessing needs and consulting with people follows from that. It was suggested the key

principle should be to improve outcomes predicated on their need (principle 2). An important question in

that context is whose needs one focuses on and who defines that need; there could be conflicting

perspectives that have to be unpacked and reconciled.

It was proposed that rights of the people should be explicitly mentioned when setting out principles for

commissioning. Several thought the principles were couched as operational propositions and less so as key

principles that are closer to values such as rights, relationship (between users, providers and commissioner),

innovation and transparency. It was further noted that a mission statement would be beneficial to add to

key principles.

When it comes to the process, it was put forward that commissioning has to be a total process and should

include sound planning and implementation, with an emphasis on its developmental aspect. It was also

stressed that all stakeholders need to engage in the process which should be free from political interference

and pressure. In that context it is necessary to have a well-functioning platform for the State to engage with

the community and voluntary sector. It was added that the process has to be incremental, transparent and

should include an option to appeal decisions. Evaluation should be an integral part against criteria which

were already decided upon the outset and which can then inform assessments leading to potential re-

configuration or de-commissioning.

It was also highlighted that skills need to be developed for both the commissioner and commissionee. It was

proposed that a fund to incentivise professionalization and rationalisation should be made available; an

example from the UK was taken where there was a community and voluntary sector merger fund. Further,

the collection and analysing of good data is a key tool to implement commissioning effectively.

It was suggested that there is potential for learning from operating service level agreements by the HSE (or

indeed other agencies) with voluntary (or private) providers. This includes both looking at over-arching

frameworks for using SLAs as well as monitoring their implementation through audits and evaluations.

Discussion then further explored the role of audits and their focus on governance issues. It was noted that

audit can be a right tool for achieving sound service delivery or provide base for service reconfiguration

provided it is proportionate, is not overly focused on small details and quantitative outputs – the latter was

seen to be sole, or least major, focus of audits in recent years. To sum it up, continual assessment of services

is seen as an important operating principle of commissioning provided that it is proportionate and gives

strong consideration to both qualitative and quantitative outcomes.

It was also felt that the value created by community and voluntary sectors should be recognised in defining

principles for commissioning considering the sector’s impact on communities, its involvement of volunteers

and its capacity to raise funds. In doing so, the value of advocacy work should also be acknowledged and

legitimised – an approach that first may not seem natural in a commissioning context.

In conclusion, the agreement was that before discussing its operation there needs to be a step back to

determine key objectives and values of the commissioning process along with a possible mission statement.

It was also suggested that perhaps the term “commissioning” should be revised to put more emphasis on its

developmental aspect and reduce any potential misunderstanding (e.g. tendering) or negative connotation

associated with it.

Group 5

Topic: Delivery to Users

Need to define what Commissioning is / isn’t.

Strengths:

Must have the ability to catch people falling through gaps in the system

Have the capacity to deal with multiple funders

Delivery has to be person-centric, user-driven

Delivery options need to build in future need projections that are realistic and ambitious

Delivery decisions have to be evidence-based and based on realistic future needs projections

(Principles should be future-proofed)

Further Education and Training sector appears suitable for commissioning (and decommissioning)

Weaknesses:

Reality of delivery is messy – requires flexibility and ease of response

Skimping, cherrypicking, short-termism, bureaucracy could be costly

Continuity of care needs to be upfront and centre

Capacity to deliver – on both sides needs to be focussed on (and needs funding)

Opportunities:

Build in outcomes – not just outputs

Formalise integration of services (if done well)

Need public service, private sector and C&V to be able to work well together (Tusla has shown a lead

in this area)

Could foster collaboration and co-production if done well

[for the above to be done properly the criteria for service delivery to users need to be clear and users need

to be involved in planning stage]

Threats/Risks:

It is a complex operating environment

Risk of fragmentation of delivery/ ”Gaps”

Value of good working relationships could be lost

Risk to planning for episodic/complex needs (and loss of the ability to respond to these)

Potential to lose goodwill and solidarity that exists in sector

Timing and pace of commissioning

Might limit risk taking/innovation and flexibility.

Group 5 – Observations on Draft Principles:

Re-ordered/amended and augmented as follows:

1. Putting outcomes for those who use services at the heart of the planning process

2. Outcomes should be agreed by stakeholders and widely supported

3. Value and respect contributions of existing providers and harness and build capacity, where possible

and appropriate

4. Ensuring commissioning processes are transparent and fair, facilitating the involvement of the broadest range of suppliers, including considering sub-commissioning and consortia building, where appropriate (words in bold substituted in place of ‘contracting’)

5. Ensuring long-term contracts, risk sharing and gain-sharing, wherever appropriate, as ways of

achieving efficiency and effectiveness (words in bold added to original principle)

6. Seeking feedback from service users, communities and providers in order to review the effectiveness of the commissioning process in meeting local needs.

7. Needs assessment must be evidence-based

8. Value the voluntary contribution of family members, carers, friends and community.

9. ]Commissioning should seek to improve the quality and effectiveness of service provision

10. Make the best use of available facilities, people and other resources

11. The commissioning process should be accountable to public, communities and clients.

Group 6 – Monitoring and Evaluating

Commissioning will require a value to be placed on good data collection, especially if it is widely

disseminated

Commissioning will require knowledge and understanding of what the capacity is to actually provide

the desired outcome

Being able to measure and evaluate what changes in people’s lives may present challenges

The capacity to translate the academic, abstract or conceptual into real needs-based projects will be

a challenge

There needs to be a balance in evaluation

Models can vary; numbers –v- social value

Political interference can threaten a good commissioning model

There is temptation to invest additional money in more services rather than data infrastructure and

people to deliver new model

There are difficulties in securing new funding

There is no perfect commissioning model

Data is currently not used effectively as evidence for funding decisions.

The monitoring function is underfunded, often appropriate data skills are missing from the public

sector side

Need to recognise the life-cycles of organisations – and how that impacts on Commissioning cycle

Legacy issues, such as programs, culture and systems, must be recognised and dealt with, including

public sector bodies.

There are issues when dealing with ‘cross-over’ in projects

How will decision-makers deal with data that tells them something they do not wish to hear?

How do we monitor performance – should monitoring be independently executed?

There is a need to build local capacity in order to effectively monitor and evaluate

Consolidation (and collaboration?) within the sector needs to be driven by the sector itself rather

than being imposed by the agenda to introduce commissioning

For a Commissioning model to actually work all parts must function coherently i.e. poor monitoring

will lead to failure

The Commissioner may focus too much on financials (rather than outcomes) as these are easy to

measure

The Commissioners may be poor at recognising the value of relationships.

There is an overall risk that a change (to Commissioner) may be started and then abandoned or that

the approach may be piecemeal and inconsistent.

The C&V sector are developing new capacities in the area, can this be spread to the Public Sector.

New cheaper IT (online tools, etc) might make data/information management easier

Many academics are willing to engage / assist

A measured approach is recommended

Public sector should collaborate with service providers and recipients going forward

Key message for all is that data collection and monitoring are not ‘administrative’ tasks lacking in

real value. They are core tasks.

Group 6 - Observations on Principles:

Understand the needs of users by consulting with them

Develop an understanding of users through listening to them and their service providers to inform

decision making