Outcomes-Based Commissioning for The South London SEN Commissioning Group | adam HTT

During the NCCTC 2017 Children’s Conference we were joined by Rakhee Dave-Shah from the South London SEN Commissioning Group (SLC) for a workshop about how they have transformed their approach to commissioning services for children and young adults with SEN.

Here, we pick out the key themes from that Q&A and invite you to continue the conversation on our joint LinkedIn Group with Rakhee called the ‘SEN Commissioning Group’.

The Q&A was hosted by Richard Boddington of adam and Rakhee Dave-Shah of The South London SEN Commissioning Group (SLC).

Rich: “Thanks to so many of you who have turned up today, the plan for the next hour or so is to let Rakhee talk to you all about the multi award winning SLC around changing the way they commission SEN placements.”

Rakhee: “My name is Rakhee Dave-Shah, I’m the Strategic Programme Lead for the South London Commissioning Programme, that is a 10-borough partnership for SEN commissioning and a 7-borough partnership for commissioning for placements for looked after children and young people, which we have just found out we have DFE Innovation funding for, so the looked after children side.”

Question 1: Going back 18-24 months, why did you think there was a need to change?

Rakhee: “So, the way the programme works is that all boroughs contribute a nominal amount towards shared resource to manage the market. The boroughs were experiencing a rise in demand for children with special educational needs and increasing cost, the boroughs were spending £76m per annum with very little contract management in place or contracts in place even. As well as spot purchasing, so Cathy was talking about ‘going out shopping’ for placements rather than actually commissioning placements and that was very much true for us.

We’re using 250 Schools and Colleges, specialist Schools and Colleges, independent or maintained but the majority of our spend was with 10 School and Colleges. The top few were venture capitalists and a couple of charities. So, the question that I had for the boroughs when we did this data analysis was ‘is that because they’re the best at meeting the outcomes for our children, they’re preparing our children for adulthood because if that is the case then it’s job done, we’ll block purchase with those ten and it’s sorted and we’ve shared the risk across 10 boroughs so no one borough is taking the risk of a block purchase’, because block purchasing is traditionally thought of as risky.

But actually, there wasn’t a confident yes across the room and in my naivety, I asked ‘why are we using them so much?’ The answer was, the boroughs were picking up the phone to the providers that they knew and those they had built relationships with over time. Now that was not working in two ways, it was not working because the boroughs, if we’re talking about how each child’s needs are unique and outcomes being unique, the boroughs were not picking up the phone to the best providers in mind, they were picking up the phone to the provider they could think of first. And the providers, who had spent all this time and energy building a relationship with the borough officers, because of attrition if the borough officer left, they would lose that relationship.

So, relationships are great but if people leave that relationship and people move jobs, how do you maintain that? I have some examples of providers who actually stopped getting phone calls and couldn’t understand why that was the case.

So overall, the Children’s and Families Act which has been the largest overhaul of SEN Services in a generation, Public Contract Regulations which we talked about a bit downstairs, , rising demand and funding from DFE not keeping up with the rising demand, so the same amount of funding but more children because of the population growth but also Early Years and Post 16 up to the age of 25 to place with the same amount of money and overspent budgets. And also quite honestly, if I’m being very blunt a tradition of ‘containment’ of children, instead of progress and moving them on to a successful adulthood whatever that might be for that child.

Question 2: What was the spark for change? Did it come from within the councils or within the provider base or from an individual?

Rakhee: “So the spark for working in partnership to manage this common problem, because it was common across the boroughs came from Croydon who contacted neighbouring boroughs saying ‘we’ve got this problem, do you have the same problem?’ It was a bit like a eureka moment where we get these people together in a room and they say ‘yes exactly!, how are we going to do this?’. Children’s and families act was a big driver in terms of the lack of resource within boroughs, the conversion to EHC plans, parent preference and tribunals. So, there was a real mixture of issues faced by the boroughs but they were dealing with them internally by themselves and feeling quite isolated in doing that. So, that was the spark for thinking let’s put our heads together because there’s a way that we can deal with this together. The market was also a driver.”

Question 3: What would you say the markets opinion of the programme was?

Rakhee: “So, the market had a mixed opinion, when we started I stood in front of the providers for the very first time and the accusation quite rightly was this is just about driving down costs. We had to be honest about the budgetary situation the boroughs were in and it would have been wrong of us not to be honest about that and put that on the table.

However, they also valued having that person, that contact point, for 10 local authorities, the one person they could ask in terms of building a relationship with them and they would have access to 10 local authorities. There was a real understanding from the market of the fact that they weren’t getting the referrals and the more places they had filled, the more economies of scale they have and the more savings they were able to transfer back to the local authorities. So, there was a sense of that too in terms of how do we get those phone calls and how do we get a fair chance at being able to offer placements because the sector is very passionate about delivering outcomes for children.”

Question 4: The decision to make a change, how did you come up with the model you wanted to put in place, what kind of options and process did you go through?

Rakhee: “OK in typical local government fashion, an options appraisal! The good thing is we had the governance set up so we have a Board which is set up of the Heads of Services and Budget Holders in all 10 boroughs, they’re the decision makers and we have an Operational Group which is made up of Team Leaders in all the boroughs. There are differences in the way the boroughs work, but actually there were also similarities. So, we had the governance in place and once we had that governance established it was a good point at which I could ask some naïve questions like ‘why and curious and what’ questions, those sorts of things which generates some discussions.

So, we did an options appraisal and I think the sense I got back from the boroughs was that they wanted to stick and didn’t want change, there was too much change already and they really didn’t want any more. Added to that, as much as possible, they wanted to stick to the spot purchasing style of working but without it being spot purchasing and there were good reasons for that. Also apart from the change, the parent preference means that you have to place with Schools that might not be on a Framework or a Block Purchase arrangement, tribunals mean you have to do that, to keeping children local they were key drivers to why they wanted to stick to something different that was in between a framework agreement, block purchasing and spot purchasing.

Which is where we thought about an integrated commissioning, dynamic purchasing solution and we spoke to Newham actually who were already using adam for their dynamic purchasing solution for Short-Breaks, which was really really helpful. I think the people I’ve got to thank most in this journey are people who haven’t had professional ego and have been willing to share. So, a big shout-out to Newham, to Birmingham and all those boroughs who actually have shared their experience and West Sussex. As well as those that didn’t do what we did but have shared their lessons learned from what they’d done, so we could actually use that to inform our thinking. So, a huge shout-out goes to them really, because it wouldn’t have been possible to think about a solution without actually speaking to those people and sharing their learnings.”

Question 5: Picking up a couple of things there, I think two of the most important things and challenges I have in what I do is around the access to that governance and that decision-making process and you seem to have a direct line into that and also the collaboration and engagement across multiple councils, who like you say, may be doing very different things but ultimately are willing to share, engage and talk and I don’t know how common that is?

Rakhee: “It has been incredibly tough to establish that so my first couple of Board meetings were therapy sessions essentially, boroughs getting together talking about all the different issues, and there were a lot, which was really valuable to them, it was very important. But at the end of the Board meetings I was thinking ‘I’ve got no decisions and no direction so how do I move forward?’ So, I think the ask was two-fold, I had to step up so I made sure that I had all the information and I had clearly outlined what decision I needed from them for every step of the way, the decision sheet was circulated, the terms of reference were updated to make it very clear that the Boards remit was decision making, it wasn’t just talking about a subject at a high level.

It takes discipline and I agree, I’ve worked with a number of local authorities and consortium arrangements and that’s the thing, if you can crack that, you will be able to do what you need to achieve, the change you need. I wouldn’t even venture on a change programme without actually having that in place first.”

Question 6: When you got to the point where ultimately the change had been approved, what was the expectations of the end result?

Rakhee: “The expectations were that the change would be cost neutral, it shouldn’t cost us more than what we’re paying right now, it should have the child at the centre of whatever we do and make things better for the child or the young person with special needs. It should help the market, I’m using the word ‘market’ but I’m trying to avoid it after this morning, but it can help them understand what is being required of them, because under the old mechanism., the schools and colleges would say to us ‘we would like to build in your area but we don’t know what your needs are or what your demand is’, and we would just say that Croydon has got that need and Sutton has got that need, but very anecdotal but we didn’t actually have the birds-eye view across the boroughs.

So, it should help the sector to build their capabilities in terms of growing and building locally but also in terms of what we’re expecting of them for our children and young people. So, making it very clear with one voice what our expectation is for these children and young people. So, they were the high-level requirements, I mean they wanted an off-the-shelf end-to-end IT Solution but they had also been scared by IT solutions in the past! So, they wanted me to do all the work to make sure that they weren’t going to have any regrets having procured an IT solution.”

Question 7: Yes it’s not uncommon is it! So, you’ve got to a point where there’s agreement to make a change you understand what the key drivers and what outcomes you’re looking to achieve are. So now talk us through how you went back and implemented that change. I’m thinking about it from two areas, you have the internal change in terms of how you engage with the key stakeholders internally and then how you engage with the providers and how that journey went.

Rakhee: “Yes so we had already identified a number of mechanisms for engaging with schools and colleges at provider events and progressively, they became much more solution focused. Which is normal, change, no-one likes change, the boroughs don’t like change, the schools don’t like change, they’re doing important work, it’s just an added complication in the whole scheme of things.

So, the initial reaction from the sector was, ‘no way you can’t do this’, the children’s and families act won’t allow you to do this but gradually we chipped away at that and actually ‘why’, let’s talk a bit more about why? So, keeping an eye on the prize was really helpful in terms of how is that good for the child or young person? You know, how is the current arrangement working for them and how can we be confident in the way that we’re doing it?

I can confidently say that when we implemented our integrated commissioning solution I had a couple of emails from providers that I have saved to date, from schools and providers who have congratulated me, which I’m quite proud of.

So, that was the work with the sector really, newsletters, keeping them aware, we held focus groups to make sure they were involved in how we would score quality in our integrated commissioning solution, that was a big one. We involved them in the contracts that we used, so we went with the national contract, we were thinking about a 10-borough contract and actually we said no, we did an exercise with our boroughs and laid out what we wanted in the contract that isn’t in the national contract for school and colleges and most of it was in the contract we just weren’t monitoring it well enough!

Which was a realisation for us and the sector to us that if we have our own contract, it’ll cost us more because we’ll have legal costs and they’ll transfer those costs over to us which no one wants. So, we went with the national contract 2013 Schools and Colleges Contract making a variation in terms of, and I’ll hold my hands up to this, in the use of technology to procure placements.

So, we did a fair bit of work with the sector, we’ve spoken to people like Jonathan Fingerhut who goes out and talks to schools and colleges a lot doing a bit of myth busting because there are a few myths around. We’ve spoken to Claire Dorer to try and form our thinking, the CEO of NASS. So yes, it was a resource intensive piece of work with the sector and we needed buy-in from them and we were very aware that we could put together a very jazzy wrapper of what we’re doing but actually if we don’t have the schools on it, it’s pointless. So, we worked really hard with them.

With the boroughs, we did a fair bit of process mapping, so yeah 10 boroughs, 10 processes! It was really torturous, we did a fair amount of what lots do we need and the amount of hours we spent on the lots that we needed and they use autism, SEMH, and speech, language and communication so the big ones they don’t actually really use the ones they suggested they were going to use which is a lesson learnt for me. Because we spent hours discussing those and how they were absolutely necessary. So, a fair bit of work with the boroughs too.”

Question 8: I think that struck me that the decision-making process was relatively lengthy, not that it’s ever quick but, the engagement from all the boroughs in that process is sometimes a poison challis which was hopefully a benefit in the end?

Rakhee: “Yes of course, you sat in on a number of those meetings, I sat in all of them and have the scars to prove I’ve been in all of them. But yes, it was necessary to get engagement from both sides. And co-production is a word that is used often, it takes time but it’s worth it in the end because they feel like they’re part of that solution.

Question 9: I think another thing that struck me from a number of meetings that we had, around children’s and families act and PCR that you were addressing those through the decision-making process and when you were engaging with people at the right time, you almost had the answers to hand and I think that’s something that struck me when you talk about the governance process and knowing what the answer and having the answer to present that.

Rakhee: “That is very true, if you go to the board and say what do you want to do about this and you’ll get ten different answers. I went to the board and I changed tact and said ‘this is the issue, this is my recommendation and have the evidence in hand if I’m questioned on it’ and say ‘do you agree with my recommendation?’. So, it sounds so simple but actually it’s not.”

Question 10: And having frequent meetings with those decision-makers came in handy throughout the implementation process because there are decisions to make as you find out something new that you didn’t know at the start.

Rakhee: “Right yes, so when we had the tender for the IT platform and we wanted to award, we actually held an extraordinary board meeting; so our board cycles every two months, works with the Head of Services, and we do things outside of that virtually, but at key points in the project we had extraordinary board meetings and called people in and did what we needed to do.

A big point to mention is around, we were the first to do this and there was no one we could find who has actually done this across ten boroughs. So, it needed to be de-risked somewhat for the boroughs because the Heads of Services felt a bit vulnerable, especially in the context of overspent budgets because they can’t put a lot of time and energy into something when they don’t have any proof that it’s going to work. So, a big challenge for me was trying to find funding and we were fortunate that we applied for DCLG Grant Funding, Transformation Challenge Funding which de-risked the change programme and it gave us a clear focus for delivery within a financial envelope”.

Question 11: How would you say the journey was from the providers’ side? From this is what we’re looking to do, to the month of implementation and engagement with them. How was that?

Rakhee: “So if you put yourself in the school’s shoes, there are the top ten or so who are getting business and there’s the fear that we won’t get any business if they go down this change path. There were the smaller schools who were thinking this is going to be administratively burdensome and it’s just another procurement vehicle and it’s not going to achieve anything, we’ll still be spot purchasing and we’ll still work with the parent and we’ll encourage the parent to challenge the local authority. So, there was a fair amount of actually getting everybody to see the benefits of open, fair and transparent competition. I use that a lot in my discussions with them indicating that they will have sight of everything in our business and it was really important to also say and highlight to them that we are 12% of the national market share so if you want access to that 12%, you need to work with us.

We worked with them actually and conceded on a number of things to make it work for both parties and we did try to keep it as less burdensome as possible, we went back to the children’s and families act to see what we needed to deliver as statutory under the legislation and make sure that that was in there, anything over and above was a bonus. We have other things in there but we absolutely needed those four things in there from the children’s and families act in our quality and assurance.”

Question 12: We have probably touched on these anyway and as these people in the room may be looking to go on a change journey themselves, whatever that is, the key challenges, 10 boroughs working together, strikes me as being the top of the list or challenges. Changing thinking within 10, so what were the 4 or 5 of the biggest issues and hurdles that you hit throughout the process that you knew about or weren’t aware of at the time?

Rakhee: “So I think in terms of reflections, I personally underestimated how much time and energy is required in change management from the start of the process until now, we’ve been live for one year, over one year and there has been a lot of attrition in boroughs so we are continuously reminding boroughs that ‘this is what we have agreed to do, these were the reasons’, and it’s brilliant when you have people involved in the designing and developing the solution, still there and then you get new people that come in and think what’s the point of all of this, why can’t I just pick up the phone to the school that I know will be able to deliver the needs and meet the outcomes.

So, it’s reminding those messages and not underestimating that change takes time and people move backwards and forwards. I think the thing that we did particularly well was having a narrative on the benefits for all parties. So yes, there were differences across the boroughs in the way they are structured, the way their processes are. There are differences across providers, school, in the way they deliver services, but actually keeping in mind that we’ve got to tell them what the benefits of any change are and remind them again and again and keeping focus on that child’s needs and meeting their outcomes”.

Question 13: I think there’s a balance when you’re going through change, especially with 10 boroughs in that you don’t want to water down the change. So, there’s the common denominator across everybody, so there has to be that give and take across everybody because you have to change that and we’re not going to achieve those outcomes if we don’t, if you water it down to a level, you’re not going to achieve those outcomes. So, if you had your time again, what would you have done differently?

Rakhee: “I would have asked for more funding it’s always about more money! No, if we had our time again I think I would be more cautious of using the word co-production. I think it’s absolutely necessary, but it takes time and it takes a lot of resource to be quite honest.

Most of the local authorities that I’ve worked with don’t understand the difference between co-production and co-design and if we’re co-designing let’s just be honest that we are co-designing. It’s the way things are working, there’s not enough of us to go around, we had to deliver this project in one year, we did a little bit of co-production and we did a little bit of co-design but I would be very clear from the outset, with everybody involved that this is a co-production piece and this is a co-design piece because I think it manages expectations. And that’s where we ended up with various lots that we didn’t need and that was part of co-production and that was part of making everybody come together and own the solution. Where-as that could have been done through co-design so just differentiating between the two. We use these buzzwords all the time don’t we and they become a thing so it’s just being conscious of taking a step back and being honest about actually what are we doing”.

Question 14: Yes some things do lose their meaning they just get overused. So, you’ve already said, you’re a year in. How are results? I ask with a due sense of trepidation and baited breath!

Rakhee: “OK the good news is we’ve got over 100 schools and colleges on our integrated commissioning solution. We’ve already made savings of over a million pounds through jointly procuring the IT platform and streamlining our processes. The time taken to make placements is less than it was before.

On two occasions we haven’t chosen the top ranking school and we’ve justified that with parents preference. What we have done, has not yet been trialled in tribunal but the hypothesis is actually in tribunal we’ll be in a better position to say not that that school isn’t the right school for the child but actually we have five other schools that can meet the needs and deliver the outcomes and this is the price that they’re quoting. Which hopefully gives us a bit more information that we can take back to tribunal, but it hasn’t been tested so we don’t know, so we need to wait for that to be tested.

All 10 boroughs are using the system and 100 schools is beyond what we had imagined if I’m honest. The closest model we looked at was the West Sussex model which had been operating for 4 years and they had 40 something schools on there over the 4-year period.

Schools can join at any time; we have also suspended a school on the basis of safeguarding issues so it gives us that level of control and command type arrangement with the schools as and when required. We have a very good working relationship with schools and a key success for me is actually we’ve got a phone call from a school at the beginning of last year, a local school catering for social, emotional and mental health needs, good with outstanding features from Ofsted and phoned us up and said we’ve only got one child in the school and unless we get more placements, we need up to 20 to be sustainable, we’ll close down.

This school was not on any of the boroughs radars at all, it had dropped off. They had been contacting one of the operational leads at one of the boroughs and that operational lead had been on long-term sickness, they were trying to arrange a meeting to discuss that they have had children from us before, can we please get some more children. They also admit that they could have been more proactive and could have found out other ways of getting in contact with us and the programme and this was the first time I’d heard of this school.

It wasn’t even on the list of schools that the boroughs had supplied us for. We worked with the school and got them onto the integrated commissioning solution and they are hoping to open again in September, they now see all of our referrals, they had actually handed out P45’s to their staff it was that stark. I went to the building and there were bin bags everywhere, they owned the building, we have a high need for SEN placements in South London and they are in South London.

It’s bonkers, I could not believe what I was seeing and I had a sense of failure on my part because I thought I should have picked this up and how is a school hidden like this from the programme? So, we supported them, there was an issue with IT knowledge, you know, working with an IT system so we actually sat with them and worked through it to take them through the process of becoming an approved supplier step by step. I remember getting a phone call saying I’ve submitted can you just look at it and I said have you pressed the submit button? And they hadn’t pressed the submit button! So, I asked them to do that and said I would get them approved straightaway so they can see the referrals. That to me is something I am particularly proud of.

We want the sector to grow, we’ve also got two new schools opening in the area and we’re able to confidently be able to say to them, these are the number of referrals that have gone out and we’ve got over 100 referrals that have gone out in the last year and these are the ones that haven’t yielded and these are the ones we haven’t been able to fill places for. That knowledge is priceless to the sector. To be able to give that to the sector, they can then build their understanding of what our needs and demands are and build their package in that way, it feels like a win.”

Question 15: So, considering that change is always an ongoing thing, what do you see your programme looking like in 12 months’ time?

Rakhee: “Wow OK so, I’d quite like to slow down but that’s not happening! The difficulty with this programme, the 10-borough programme is that the 10 boroughs have seen it work and they have talked to their colleagues in the borough. We were contacted by the short break team in the boroughs and SEN transport teams in the boroughs, residential care, fostering and we really had to think about where do we expand and explore the temptation is to spread out too quickly across multiple categories but we have learnt from other consortia that this can be dangerous.

If we tried to do lots of things and the worry was that we would lose focus on what matters. So, the clear thing for me was let’s get one thing right and then move on to something else. We’re one year down the line in SEN and in January we did the business case, transferring the blue-print to residential care and fostering, directors of the children’s services in 7 of the 10 local authorities have signed up to that principle. It’s the same operating model of sharing resource to look at an options appraisal. The output might not be an integrated commissioning DPS we don’t know what it is and we’re being very cautious because SEN started with what are we going to do about this and the residential and fostering started with we want exactly that!

What you’ve done in SEN we want exactly that! So, we took a step back and said no actually, let’s just think about this it might not be the solution. The SEN market is very different to residential care and fostering, there are similarities and there are differences. So, what we need to do is an options appraisal and we’ve just heard about DFE funding, grant funding which is really helpful. So, it’s more money and mutualising the risk across the boroughs because this a cohort that is very very vulnerable, we don’t want to make mistakes, we can’t get it wrong. So yes, in a years time we will have an integrated commissioning solution be that a DPS or a framework or a block contract across 7 local authorities which will enable us to commission based on outcomes and build the capabilities of the sector to deliver those outcomes.”

We would like to thank Rakhee once again for her time at NCCTC this year and for sharing so openly the SLC journey so far. If you have questions for Rakhee, we would like to invite you to continue the conversation on our joint LinkedIn Group: SEN Commissioning.


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