Waltham Forest: Commissioning Domiciliary Care

In this interview, Darren Newman, Head of Service Design and Contract Management at the London Borough of Waltham Forest Council, talks to us about what the local marketplace looked like before Waltham Forest started using Digital Commissioning technology and what a stable process and diverse Providers mean for the people who need the services they commission.

What did Domiciliary Care look like in Waltham Forest before?

When the framework came into place four or five years ago, there were a number of organisations that signalled they wanted to work with the authority. But they weren’t all active, they weren’t all engaging with us in provider forums, they weren’t responding to calls from the brokerage team to take on service requirements, etc. So on the face of it, we had a good number of providers but we weren’t really fully utilising the full capacity. That created a very static provider base, which we were working with for four or five years. There was certainly nobody new coming on board; all we’d done was lost providers along the way. And what that meant was, when the framework finished in October, we actually had 45% of our business with two providers. There was real risk there; it wasn’t a strategic choice.

        Since we’ve gone live with the DPS, we’ve now got 34 providers. There are a further 45 who have applied to register but don’t meet our enrolment criteria. But because it’s dynamic, we have been able to give some feedback to them in terms of where they’ve failed to meet the standard, and they will have another opportunity to reapply. It still shows to me that there’s a gap between the interest that’s out there and where we’re pitching our quality standards.

What prompted you to look at procuring Domiciliary Care differently?

We were in a corner, which I think was good, as every extension had been used possible, so we had to do something different. But it was also about wanting to take a very different tactic to the traditional approach: time and task. We did have an outcomes based specification, but that wasn’t making any difference to the way we were commissioning individual packages or the way we were monitoring.


"Suppliers' problems are our problems at the end of the day."


What were your processes like before?

Our brokering team was dedicated to Domiciliary Care, and it was very much a broker picking up the phone and phoning the Provider to see if they could take the requirement. Whichever Provider they’d called decided if they could take that package, and there was no method to it. It meant the market wasn’t aware what the demand was and what the need was. Whereas now, the requirement will go out to the whole market, provided they’ve shown an interest in providing for that care category. Even if they don’t win it, at least they have visibility of what’s out there.


What has changed with your Provider market?

From my perspective, I don’t think we had done enough to engage with the market, in terms of having real dialogue with them or where some of the costs are in the system, to actually see what it is that’s creating those costs and what we can do to reduce some of them. As I say, we’re really clear going forward now, with our new contract arrangements from last October, that we really want to start having more of a conversation around where the real issues are because basically their problems are our problems at the end of the day. We really have to be clear where those issues are in the system and come up with an agenda for how we address some of those, accepting it’s not going to be easy.

What about your level of engagement with Providers now?

We did launch a new provider forum in January, very much around how we wanted to make a dialogue going forward. For me, it’s around wanting to start reinvigorating that relationship with our market. We want to take the service offer on a journey and we can only do that if we’re working hand in glove with providers. We’re looking to pilot outcomes based commissioning and a results approach; for us, that was one of the attractions of opting for the adam platform because it gives you that flexibility. What we started off with in October is not what we’re stuck with for the next four or five years. We can change our requirements as we go on. It gives us the opportunity to carry on that development journey and engage providers, so we will be running some pilots around outcome based commissioning, and we will be able to co-produce that approach with the market.

What has the new process meant internally?

The process is now all automated. Right from the initial requirement that comes through, it goes out to the full marketplace. Providers can then respond to the requirement if they can meet the person’s needs. We have a 60/40 evaluation: 60% of the scoring criteria is quality. The offers will come back – we’re averaging four offers per requirement – from which the brokers will then do the scoring. At the moment, it’s based on their enrolment quality score, but as we move on and we start to do performance and contract management of the providers, the scoring will be updated. So our initial quality score is informed by what they said they can do, and then as they go on, it’s basically formed on whether they’re actually doing what they said they can do.                       

      The real strength of it being automated is the management information that comes through. You’ve got a much clearer idea around the number of offers and what’s happening in each category of care, which is helpful. It’s enabling us to change practises within our brokering service, as you can see whether there is consistency, in terms of how we’re actually commissioning those packages of care.