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Brighton and Hove City Council

08 October 2021

adam has been working with Brighton and Hove City Council to help them commission person-centred care. In this interview, we speak to Andy Witham, Head of Commissioning for Adult Social Care, about why the Council have decided to change the way they commission services for Learning Disabilities and Home Support and the key parts that behaviour and culture play in innovating procurement practices.

What does your current process look like?

We had an existing framework agreement set up – the complex needs framework – and the majority of those suppliers will have transferred to the new adam category development system. Although the framework was in place, we weren’t sure people were using it as it was first intended when it was established. I think there was still a lot of picking up the phone to just one Provider to see if they could take the person on. That may be fine; there may only be one Provider who can supply the package. But how are we demonstrating that and where is the scrutiny over how it’s been done?

Since then, adam have worked closely with Brighton to provide detailed reports to demonstrate their market activity which shows exactly how packages have been commissioned. The system has allowed for a more streamline compliant process, from Framework to DPS on the system and has ultimately saved the council money. During spot purchasing, BHCC was buying around £2 above the Framework ceiling price, since implementing SProc.Net, they have matched and sometimes saved on majority of their packages.

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Caregiver supporting an elderly person

What about Supplier Engagement?

We’ve got some gaps where we know we need more suppliers in certain areas. For instance, some of the support for people with acquired brain injuries – we rely on a sole Provider for that, so anything we can do to expand that would be great. We’ve got some new suppliers coming through for enrolment. The services are high-cost, and if we can try and get some competition in the market, that can only be a good thing, both for us and the individuals. The suppliers seem to have bought into the process and have been engaged. It does come back to the review, though, because they told us their challenges and problems with the process, and implementing adam is us trying to improve those challenges.

What do you think the challenges are with managing a dynamic supply base?

I think it’s good in that adam allows new entrants to come on board. So rather than us saying, ‘I’m sorry. It’s a four-year framework. You can’t join it’, as long as they can satisfy the entry criteria, they can join at any point; we’re not shutting the door on any new suppliers. So I think it can only be a good thing, can’t it? I’m not saying we’re going to be inundated with new suppliers, because it’s a niche market, but as new suppliers become available, they can join.

And what will more dynamic suppliers mean for the Learning Disabilities category?

From our point of view, when we’re setting out the requirements for the individuals, we need to be cleverer about how we’re putting those requirements to the market. In the past, we may have stated ‘this person needs X hours of care’; it’s now more about ‘what are the outcomes’. If those outcomes are ‘this person wants to be able to travel around the city’, we need to be asking the Providers how they’re going to help that person do that. We need to start thinking in a different way. It’s not going to happen overnight, but we need to be changing the way we think about services and the way the requirements are out together. It’ll help us move towards a more outcomes focused way of commissioning. We will be using a 60/40 rating – 60% quality, 40% value – for suppliers, but we are looking to tailor the ratings based on individual care packages.

Brighton had around 10 providers engaging with them and picking up their packages. Since then, Brighton and adam have collaborated to engage more than 30 providers on the system, giving Brighton the choice and competition within their market.

What do people with Learning Disabilities want and need from the marketplace?

The independent review did a number of visits, speaking to staff, Providers and Service Users. People came back and were quite clear what they wanted in the review. They want services to be person-centred and focused on them. They also mentioned about travelling independently around the city. They want to be able to work… they want to do all those ‘normal’ things. Hopefully through the services we’re going to commission, we’re going to be able to take people on that journey to where they can do those things.

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Man laughing in an office

What are the expectations for the Learning Disability category moving forward?

More person-centred, more transparency, increased competition in the market, better processes, more efficiencies… increased value for money. But it’s not all about saving money. Yes, from our point of view, we obviously want to make sure we’re getting value-formoney from packages, but it’s not the main reason we’re doing it – we’re quite clear about that. The outcomes will be about moving people on, about making them more independent, which is what they’ve told us they want to do. So it’s not about saying, ‘here you go; you can have this person for the next twenty years’. It’s going to be more about, ‘what are you going to do for them?

adam has since developed the system further to facilitate outcome-based commissioning. The system allows the individual’s wellbeing to the be the driving force for the service provided. The requirement comes equipped with a set of outcomes that must be achieved. The provider then has the ability to demonstrate through the system how they plan to meet said outcomes. The Service User journey can be tracked on the system through Service reviews and provider quality questionnaires and assessments.

Can you describe for us how you think the marketplace is going to change?

We’ve tried to break-down the barriers for Providers to get accredited on the system, so we’ve taken a lot of process from the front-end and moved it to the back. Yes, there are certain criteria Providers have to satisfy. There are certain policies they have to have and they have to be a financially stable organisation, but we have tried to strip out any onerous requirements. It was quite key at the beginning, because we wanted to broaden our marketplace without putting anyone at risk. We needed to decide what we could remove from the front end to give suppliers the opportunity to get onto the system. We realised a lot of the specifics about the Provider’s ability to deliver services for the person can be captured within the requirements stage. Yes, we’ve broken down a lot of barriers to make it easy to get onto our system, but actually they’ll have to demonstrate it through the requirements’ end.

During the onboarding process on the system, BHCC providers are required to load certain proof of insurances, training certificates and CQC registration and/or certificate. There is also the option to ask a set of quality questions during this onboarding process. These quality questions are then fed into a Provider Quality Score which can impact commissioning decisions if necessary. The main success here is the fact that Brighton have a compliant and selected market of trusted providers; ultimately making filling packages that much more streamlined and efficient and in turn aiding BHCC to avoid provider failures and packages being handed back.

There has been a lot of support from adam and the whole process has been smooth. The system went live on the 4th of April 2015 for us. There’s been a clear message from the Director of Social services that any new packages will have to go through the system. Now, it’s about making that happen and facilitating it. It’ll be a learning as we go situation, so it’ll be interesting to see how it progresses. For us, it’s a lot about behaviour and culture and how we use the adam Social Care tool to help change some of that. There’s also a big-push to get current packages reviewed and then put them back through the adam system.

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