Integration and Externalisation Re-commissioning Integrated Children’s Services in Devon

1. Integration and ExternalisationRe-commissioning Integrated Children’s Services in Devon Jenny Connelly Jon Richards

2. What did we re-commission? • 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 • 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

3. What did we need to achieve & why? • 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

4. Programme objectives • 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

5. Integrated Children’s Services Public Health Nursing Health Visiting School Nursing Immunisation Service Newborn hearing screening service Health service for children in care 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 multi-disciplinary 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

6. Apr 11 Sep 11 Jul 12 Mar 13 Ongoing engagement

7. Co-production Phase: 1 • 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

8. Co-production Phase: 2 • Information gathered influenced our decisions • 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

9. Guiding principles • 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

10. Co-production Phase: 3 • 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

11. Procurement Phase: 1 • 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

12. Procurement Phase: 2 • 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

13. Procurement Phase: 3 • 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

14. Procurement Phase: 4 • 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

15. Procurement Phase: 5 • 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

16. Judicial Review Phase: 1 • 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!

17. Judicial Review Phase: 2 • 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!

18. Due Diligence and Mobilisation (DDM) Phase: 1 • 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

19. DDM Phase: 2 • 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

20. DDM Phase: 3 • 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!

21. Overall lessons: 1 • Challenge of doing this cross-agency • 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

22. Overall lessons: 2 • 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!

23. Any questions?