Commissioning is at the heart of developing personalised approaches and services. Getting it right has a significant impact on the quality of people's lives and experiences. Commissioning also has some challenges for radically changing systems, processes and attitudes and for changing the balance of power to give people who use services the opportunity to set the agenda.
Commissioners will need to be willing to think imaginatively, innovate and take positive risks, working with people as equal partners to look beyond traditional health and social care services. They need to be fully supported by their organisations to ensure that people can direct their own support, and to develop co-production in commissioning in strategic locality based, area wide or regional commissioning. One of the key principles for personalisation is partnership - with individuals and their families, communities, commissioners and providers. (There is more detail on partnership working in the section on Partnership)
Making it happen- Lincolnshire
I can influence strategic planning of services as part of consultation or as a paid worker and as an equal partner.
The decisions and choices that I, and other people with mental health needs, make is captured and reflected in strategic planning.
Examples of things that help with this:
- When consulting: -Ensure and demonstrate that strategies for involving people who use services and public consultation impact on the way services are designed.
-Seek people's views on the best way to consult
-Make sure everyone is engaged - e.g. people with complex needs or who have difficulty expressing themselves, people with different ethnic or cultural backgrounds or language differences, travelling communities, gay and lesbian citizens
-Engage people from the start before any plans are written, and then throughout the implementation, monitoring and evaluation processes
Ensure that consultation is imaginative and sensitive to different situations, locations and cultures
Always complete the circle and let people know the outcome of consultations , monitoring and evaluation
- Commissioners work with partners to identify people's real needs and don't develop the market in a vacuum and for its own sake
- Commissioning is co-produced with people who use services and family and carers
- There is a system in place to ensure that what people have identified in their support plans is captured and used to ensure that the right supply of local services is available
- Experts by experience are members of planning boards and forums, locally, regionally and nationally - and they have the personal support (financial or other) they need to be effective contributors
- Training is available to give people the knowledge and skills needed to influence decision making and policy making
- Training is available for all board and forum members on disability, mental health and diversity
- Expert commissioners and advisors are employed • People who use or have used mental health services are engaged as expert commissioners
- Patient advisors are engaged to help re-design services, influence change and bring about local improvements
- Strategic plans are supported by action plans and financial plans and there is honesty about available resources and realistic timescales
- Commissioners plan with people for services they need over the course of their whole lives - and that all citizens will use, or potentially use, at some point
- Commissioners consider the needs of people that services are not currently meeting, for example, younger people and those from different cultural backgrounds
I am supported to take control, live more independently and have more choice through well supported self care.
Self care means having the opportunity to be responsible for your own health and to make the most of life and feel fulfilled. In order to support self-care approaches, commissioners and providers need to work in partnership with people to achieve the best possible outcomes. (For more detail see underInformation, Self-help and Advice section)
I have the opportunity to be in control of health resources for my recovery and well being.
Personal health budgets are a way of giving people more control over how money is spent on their health care. Primary Care Trusts already have powers to offer personal health budgets, either as a notional budget or held by a third party. However, as yet there has been a very limited use of these powers. A DH pilot programme is underway to enable PCTs and their partners to be innovative and explore opportunities offered by personal health budgets (DOH 2009)18 As part of the pilot programme, pilot sites will be able to offer direct payments for health care, where individuals are given the money.
Examples of things that help with this:
- Commissioners and providers:
- who are enthusiastic and motivated to support people to take up the opportunity for personal health budgets
-who experiment and are innovative and also look outside the scope of traditional NHS commissioning practice
-use learning from the personal health budgets pilot programme that is being set up by the Department of Health
-work together positively to focus on outcomes for people (not just on processes and inputs)
-have arrangements and contracts which allow for flexibility to respond to what people want
- Innovation and improvement in service design, with the full involvement of people with mental health needs
- Support and leadership from senior managers and clinicians to give commissioners and providers the confidence to boldly innovate
- Commissioners Learning Networks to share ideas, experiences and solutions to difficulties
- Personal health budgets seen as embodied in the context of practice based commissioning and world class commissioning - not as a separate initiative
There is a wide range of things available so that I can make real choices and barriers to access are removed.
(For more detail on a partnership approach to broader commissioning seePartnership section)
Examples of things that help with this:
- Commissioning for the whole community. This means local authorities commissioning for the well being of communities with an integrated approach to commissioning universal services (such as housing, transport, leisure, culture, adult learning, employment services etc) and care and support services - and taking action on how barriers to universal services can be overcome so that they are accessible and available to all
- Co-produced commissioning strategies, ensuring that people are able to directly influence what is commissioned
- Support for smaller providers and micro enterprises as a vital part of choice in a managed market. Support services and projects to offer advice, networking and marketing support to small providers to ensure that they can offer a viable alternative to larger providers
- Services directly provided by health and local authorities have strategic development plans to ensure that they have personalised approaches and are of good quality
- Joint commissioning - a joint strategic assessment of future needs with full community engagement - actively engaging with local communities, patients, people using services, carers and providers to develop a full understanding of needs to feed into commissioning - integrated local authority commissioning (universal and care and support services) and health commissioning - health and social care commissioners take the opportunity for a more personalised approach, working together in response to the Improving Access to Psychological Therapies programme (see link in Signposts below) - full advantage is taken of mechanisms for joint planning such as Local Area Agreements and Joint Strategic Partnerships (see link in Signposts section under Local Planning for further information)
- Ensuring that people still have the choice of group solutions e.g. in housing, social contact and activities, if that is what they want
- A sustainable financial model for a personalised service
- Using practice based commissioning creatively - so that teams can work with people as partners to design personalised support, improve the effectiveness of prevention and early intervention services, develop a wider range of local services being delivered at times that are convenient, and supporting people to manage and protect their own health and well-being to help avoid unnecessary admissions to hospital
- Voluntary organisations coming together to pool expertise and offer a whole system approach - so people can move flexibly between or through services
- Commissioners ensuring that they are planning for the needs of groups who are currently not well served, for example younger people and black and ethnic minorities with mental health needs
I have an opportunity to choose a user led service or be involved in running one.
A User-led organisation is one in which the people who the organisation represents or provides a service to, have the balance of power on the Management Committee or Board and are accountable to members and service users. user led organisations provide a range of services, for example, training, information and advice advocacy and peer support, support in using personal budgets, support to recruit and employ personal assistants, but their full potential is still being explored.
‘A key recommendation in the Improving Life Chances report (p91) states that: "By 2010, each locality (defined as that area covered by a Council with social services responsibilities) should have a user-led organisation modelled on existing CILs". DH established in 2006 the ULO project to address this recommendation. The organisations envisaged by this recommendation are seen as one of the key mechanisms for encouraging the participation of disabled people, carers and other people who use support in the design, delivery and monitoring of resources and services designed to support independent living.' (DH, 2007).
Putting People First outlines the aim for local authorities to ‘support at least one local user led organization and mainstream mechanisms to develop networks which ensure people using services and their families have a collective voice, influencing policy and provision'.
Examples of things that help with this:
- Commissioners, with the support of senior managers, who want to promote and encourage the development of user led organisations
- User led organisations as a clear part of commissioning strategies and plans for the development of the market
- Networks of user led organisations and those representing different groups of people that can support one another, share information and experience, collaborate in change and develop new ways of doing things
- Personal support, if needed, for people to be employed by or participate in user led organisations
I can see that services that I and my peers report are not good or not running in an appropriate style are supported to change, or are de-commissioned.
I can see that commissioners have listened to people reporting gaps in service provision and these are planned for.
People with mental health needs often find it frustrating that they have to use and put up with services that they do not find useful and which do not behave in ways that treat them with respect. This presents significant difficulties for people when no new resources are available for alternatives or to fill identified gaps.
Examples of things that help with this:
- Regular feedback from people with mental health needs through, for example, marketplace internet sites where people can rate services that they experience
- Involvement of people with mental health needs in designing and carrying out quality assurance activities (including inspection and service review), in a consultation role and as paid workers
- Inclusion of the involvement of people with mental health needs as a quality measure in inspection and audit
- Key individuals (such as clinicians, senior mangers and commissioners) should check for themselves what it is like, as a human experience, to get information, help or support from the organisations they work in and the systems they are responsible for. They should also routinely get feedback from people using those systems (service users and staff) about the nature of that experience and what changes could be made to improve it. This does not mean just dealing with complaints - but pro-actively seeking to improve the experiences people have by making the right changes
- Frameworks for measuring success that are designed to look at outcomes for people, not just outputs (e.g. not just the number of people with personal budgets)
- Using feedback to take action to improve or remove
- Data that is routinely collected and analysed to create an evidence base for successful provision that leads to the right outcomes for people and for decommissioning provision that does not
- There is a strategic understanding of gaps in services.
SIGNPOSTS
Projects and programmes
1. Personal Health Budgets: first steps Department of Health, 2009 Information about personal health budgets and a pilot to try them out. Contact: Personal Health Budgets Team personalhealthbudgets@dh.gsi. gov.uk
2. Improving Access to Psychological Therapies Programme National programme to provide improved access to psychological therapies for people with mental health needs. It also responds to service user's requests for more personalised services. www.iapt.nhs.uk/
mental health: commissioning vision
3. A new vision for mental health: Discussion Paper The Future Vision Coalition 2008 www.newvisionformentalhealth.org.uk The Future of Mental Health: A vision for 2015 The Sainsbury Centre for Mental Health 2006
4. www.scmh.org.uk Mental health into the mainstream ADASS 2008 Mental health, drugs and alcohol network. http://www.adass.org.uk/images/stories/Publications/Guidance/MHintoMainstream.pdf
5. Services for people with learning disabilities and challenging behaviour or mental health needs Guidance: Department of Health 2007 Mansell Report (rev ed) www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndguidance/dH_080129
6. Green Light Toolkit - for improving mental health support services for people with learning disabilities. www.learningdisabilities.org.uk/EasysiteWeb/getresource.axd?AssetId=14930&type=full&servicetype=Attachment
7. From segregation to inclusion: Commissioning guidance on day services for people with mental health problems CSIP, DH 2006. www.socialinclusion.org.uk/publications/day_Services_web.pdf
Involving people in commissioning
People who use services and carers
8. Working together for change: using person-centred information for commissioning, Department of Health, 2009. Looking at how commissioning can be co-produced at a strategic level and using aggregated information from person-centred reviews. www.dhcarenetworks.org.uk/Personalisation/Topics/browse/general/?parent=2734&child=5802
9. Involving people who use services in the commissioning process, Commissioning eBook Department of Health (2006). www.dhcarenetworks.org.uk/_library/Resources/bettercommissioning/bettercommissioning_ advice/chap3NWalker2.pdf
10. Having your say Tameside MBC has a Service user Involvement Team and a website that tells people how they can be involved and make their views known. www.tameside.gov.uk/tmbc2/haveyoursay.htm
11. Surrey users' Network (SuN) have produced ‘Involving Service Users and Carers in Local Services: guidelines for social services departments and others'. www.suntimes.btinternet.co.uk/info/invurcer.htm
Clinicians
12. Clinical leadership for NHS Commissioning: Exploring how allied health and other health professionals lead change through and beyond commissioning for a patient led NHS, NHS Alliance, 2007. www.nhsalliance.org/media.asp?display=press_release&press_release_id=259
The Community
13. Community Engagement to improve health: NICE Public Health Guidance 9, NICE, 2008. www.nice.org.uk/nicemedia/pdf/PH009guidance.pdf
14. Community engagement and community cohesion, Geraldine Blake, John Diamond, Jane Foot, Ben Gidley, Marjorie Mayo, Kalbir Shukra and Martin Yarnit, Joseph Rowntree Foundation, 2008. An exploration of the challenges of community engagement. www.jrf.org.uk/sites/files/jrf/2227-governance-community-engagement.pdf
15. Chapter 1: Community Engagement in Vision and Progress: Social inclusion and mental health. www.socialinclusion.org.uk/publications/NSIP_vision_ and_Progress.pdf
Commissioning and market management
16. Relentless Optimism: Creative Commissioning for Personalised Care CSIP, 2006
17. Commissioning for personalisation: A framework for Local Authority commissioners Department of Health, 2008 and Commissioning for Support Planning and Brokerage. Part of Putting People First Personalisation Toolkit. www.dhcarenetworks.org.uk/Personalisation/Topics/
18. Self-directed support: Financial sustainability model Part of the Personalisation Toolkit. Commissioning Framework for health and well being Department of Health, 2007. www.commissioning.csip.org.uk
19. Market Management: A guide for Local Authorities on creating a local system of self-directed support In Control: Part of Guides to Self-Directed Support series. www.in-control.org.uk
20. Joint Strategic Assessment , Department of Health, 2007 Guidance and tools for local partners. www.dh.gov.uk/en/Publicationsandstatistics/Publications/
21. About time: Commissioning to transform day and vocational services Lockett H, Seymour L, Pozner A Sainsbury Centre for Mental Health (2008). www.scmh.org.uk/publications/about_time.aspx?Id=580
Networking and action learning sets
22. North West Commissiong Road Map and joint commissioning development programme - to support personalisation and promote and link commissioners across the region. The website has some helpful general information and models to learn from. www.northwestroadmap.org.uk
23. The Commissioning e Book. Written by people who are actively involved in commissioning and want to share their knowledge and experience. Contributions reflect real challenges and concerns as well as exploring good practice in different aspects of the commissioning process. www.dhcarenetworks.org.uk/bettercommissioning/commissioninge-book
24. IDea Better Outcomes Community of Practice: Information about and support for outcomes based commissioning. www.communities.idea.gov.uk/comm/community-search.do?queryText=better+Outcomes&x=30&y=12
25. Answering the ‘So What?' question. Monitoring the outcomes for users of mental health service users Commissioning eBook, DH, 2006. www.dhcarenetworks.org.uk/bettercommissioning/commissioninge-book/chapt er10MonitoringandImprovement/10.21AnsweringtheSowhatquestionMonitoringoutcomesforusersofmentalhealthservices/?parent=2963&child=3009
Supporting smaller providers
26. NAAPS Micro Markets Project . Piloting a local agency model of support for existing and new micro markets in Oldham and kent. Also a practical guide to be published on how to set up an agency to support micro providers. Contact Sian Lockwood, NAAPS Chief Executive www.naaps.org.uk
User led organisations
27. What is a user led organisation? Department of Health link: www.dh.gov.uk/en/Socialcare/Socialcarereform/userledorganisations/dH_079592
28. Disability connects This is a network of disability related organisations in the London Borough of Ealing, including organisations for people with mental health needs that works together to share information and experience and create change. www.ecil.org/index.asp?pageId=58
29. User led organisations project policy, Department of Health, 2007. www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndguidance/dH_078804
World class commissioning
30. The World Class Commissioning programme is designed to transform the way in which services are commissioned in health services - with a focus on personalisation and improving outcomes. www.dh.gov.uk/en/ Managingyourorganisation/commissioning/Worldclasscommissioning/ index.htm
31. World class mental health commissioning: From vision to practice, Humana, 2008. http://www.humana.co.uk/pdfs/4620MentalHealth.pdf
Inspection
32. Experts by Experience: The benefit of experience: involving people who use services in inspections CSCI (2009). www.cqc.org.uk/_db/_documents/20080930%20ex%20by%20ex%20booklet%20final[1].pdf
Local planning
33. Department of Health link to information about Local Area Agreements and Local Public Service Agreements. www.dh.gov.uk/en/Socialcare/ Socialcarereform/Localareaagreements/dH_086691
34. IDeA website link to information about Local Area Agreements. www.idea.gov.uk/id/core/page.do?pageId=7532066
