What is commissioning?

Analyse

Understand the need, the numbers of people affected, the reasons for this, how we address this now (or identification of a gap if we don’t), how we might do this better in the future.

Plan

What changes do we want to bring about, what are the steps to doing this, who needs to be involved, what are the likely impacts and timescales?

Do

The implementation stage; making the plans real.  Sometimes this will involve buying new services or ending existing ones.  At other times the approach might be to do things differently or to hold different conversations.

Review

This stage is where we look at how we do things or a change that we made and ask whether it is the best way to achieve the results we want.  This could include an evaluation of a new service or a review of a whole area of provision.

By following this cyclical approach, agencies can gain a deeper understanding of the issues, plan for change that is most likely to have the desired impact, implement effective changes and monitor the impact on the person using a service, the service providers and wider partners.

Each of the partners use commissioning as a technique to improve outcomes currently.  This strategy provides an opportunity for agencies to join together and do this collectively with identified areas to work on over the next 3 years.

Joint Commissioning

When we talk about joint commissioning, this can cover a range of approaches to working together to analyse, plan, do and review.  Joint commissioning can include:

Aligning our services or funds

• This means working together as agencies to ensure our services create a seamless system. Each agency makes their own arrangements to provide the necessary services, but this will be worked through with partners to ensure it fits with the wider needs of the system and with the strategic plan of all partners. An example if this could be all agencies identify a growing number of children with SEND. They work together to understand the needs of these additional children and the services across the system that will be required.  They make plans together to increase the services they offer or to do things differently to meet this need in a new way.  They work together to make it happen.

Pooled budgets

• This means a shared fund set up by 2 or more partner agencies. An agreement is in place to define how much each party will put into the fund and what the funding can and can’t be used for. An example of this is the councils and CCG’s decide to create one ‘pot’ of money to fund placements for children whose needs cannot be met through mainstream services. This pot of money combines some spend from councils on social care and education and Continuing Care funding from the CCG.  All the partners agree the level of contribution they will make to the pot at the start of the year. The pot of money is used to fund the needs of children meeting the criteria for the fund throughout that year.

Lead agency

• This means one agency takes the lead on delivering or contracting out a service on behalf of another. There will be an agreement in place to set out what the lead agency should do and to cover the funding arrangements. This could be one council agrees to contract for all the short breaks provision on behalf of all three local authorities.  There is an agreement that states how this should be run and how much money will be paid to the council doing this on behalf of the others.

Integrated teams

• This means teams of people that are funded or employed by more than one agency but that work as a single team. They deliver services that meet the responsibilities of both agencies. For example, a team of speech and language therapists (funded by the CCG) are based in the same building and share the same manager as a team of specialist teachers for children with hearing and/or visual impairment (funded by the council).  They work as one team although their jobs are different.

Some joint commissioning will involve the local authorities working together, some will involve the CCG and local authorities.  Some will take place across the whole of Leicester, Leicestershire and Rutland area, others may cover just one locality. 

All of the overlapping areas in the diagram below represent areas of joint commissioning.

Current joint working

The four agencies commission a range of provision to support children, young people and families with SEND. Details of these services can be found at families.leicester.gov.uk. These services combine to offer a range of support and to improve outcomes for this group.  There are increasing amounts of joint commissioning and partnership working across the agencies, including:

• A Joint Planning and Transformation Group for Children has been established to identify and deliver on joint commissioning opportunities for children’s services across LLR
• The Joint Solutions Panels between each of the Council’s and CCG reviews the complex needs of children and young people where there is a need for joint co-ordination and personalised funding.
• Council and CCG representatives attend the monthly in-patient Mental Health bed management meeting working with case manager from specialised commissioning to plan and support discharge of vulnerable children who often have SEND.
• Joint CCG and Council senior officers have responsibilities across the Transforming Care (TCP) agenda, delivering service improvement for all age learning disability and autistic spectrum disorder services to ensure community care and reduce in-patient admissions
• LLR Future in Minds (FIM) Board having oversight of delivery of the Mental Health Transformation Plan
• The SEND improvement boards are multi-agency forums for Councils and CCG’s to improve provision, activity and outcomes. Two boards cover the Leicestershire and Rutland and Leicester with the Councils and the CCG present on each.  Robust plans to oversee change are monitored at the boards and these provide a regular, joint forum to discuss issues and barriers and to collaborate
• Local authorities and the CCG have also collaborated through work on supporting the transition to adulthood with examples of joint plans or governance arrangements to support this.
• The regional commissioning group for children and young people, bringing commissioners from Councils across the region together to discuss issues arising and the common market. The group has recently collaborated on establishing a regional dashboard of placements, giving access to data on where placements have been made and the cost of these amongst other data sets.  The group is currently working on sharing quality assurance information to improve the intelligence held by each Council on the quality of placements made.

Commissioned services across health, education, social care and public health

The list below details the provision that each agency is funding or directly delivering, correct as of August 2020.  These are services primarily focused on children with SEND but some reference is also made to universal provision for all children, young people and/or families. It should be noted that this does not include services directly commissioned by schools and colleges or by NHS England.

Services commissioned by councils

• Education placements - £116.9 million
• Education psychology - £2.7 million 
• Short breaks/respite - £2.3 million
• Specialist nursery provision - £2.4 million
• Assessment and support teams - £2.3 million 
• Specialist teaching service - £6.6 million 
• Domiciliary support - £444k
• Social work provision (for disabled children) - £1.1 million 
• 0-19 healthy child provision (health visitors, school nurses etc for all children) - £16.2 million 
• Early help (for all children) - £18.5 million

Services commissioned by the CCG's

• Child and Family Support Service (CAFSS) - £1.8 million
• Community Paediatric Medical Services - £4.3 million
• Children's Continuing Care 0-18 - £2.7 million
• Adult Continuing Health Care (CHC) 18+ - £200k
• Speech and Language Therapy - £1.5 million
• Children’s Physiotherapy - £1.25 million
• Children’s Occupational Therapy - £1 million
• Children's Community Nursing - £364k
• CAMHS Triage and Access - £200k
• CAMHS Eating Disorders - £868k
• CAMHS Outpatients City and County - £7.97 million
• CAMHS LD Team - £1.1 million
• CAMHS Crisis Team - £1.35 million
• CAMHS PBS - £108k
• Early Intervention - £380k

Community equipment loans across all organisations £195,000