Market shaping and commissioning to meet local needs

Our commissioning service

As part of stabilising our service, a Commissioning Leadership Team, consisting of an Assistant Director and three Heads of Service is in place. This followed the completion of a wider re-organisation across commissioning teams to create a more adaptable structure with flexible roles, enabling individual key skills and strengths to be utilised across the service. We are now moving into a period of development to standardise and improve how services are commissioned and managed. The development work is focused on ensuring that the foundations are in place to enable continuous improvement in the commissioning of services with a focus on structures, people, skills, strategies, and planning. Alongside the structure and role changes completed, we have invested in a learning and development programme for all commissioning staff, to ensure that they have the skills and abilities to deliver excellent services for our residents.

Our approach to commissioning

The priorities in our Adult Social Care Strategy set the foundations for decision making, where we need to prioritise areas for improvement and how we spend money. It aligns with other strategies such as the Carers Strategy, and the Changing Futures Programme and informs future iterations of joint health and social care priorities in West Sussex.

The commitments set out in our Strategy have also set the context for the development of a strategic commissioning framework that has delivered a new Commissioning Strategy. The strategy outlines the current market position, demand, principles underpinning how we commission and our key commissioning objectives and intentions.

In addition a series of Market Position Statements (MPS) are in development, with Older Peoples residential and nursing care and Extra Care recently completed and published. Other market areas in development include care and support at home and a refreshed learning disability and autism MPS. The MPS documents give more detailed predictions on need and demand projections and set clear objectives for each market area to give a clear position to market providers and developers.  

In parallel with these planned strategies, we are also focusing on ensuring we have clear operational policies in place and have recently completed production of a formalised approach to contract management, which is now being implemented across adults commissioning. This will shortly be followed with a Provider Quality Assurance Framework. Both of these will provide clear mechanisms for managing our business, supporting the market and ensuring that residents of West Sussex have access to good quality services and solutions.

Across commissioning in Adult Social Care, we have identified a number of key areas in a Strategic Outline Case for internal consideration regarding capital investment and use of assets. This is an important step for us in focusing our commissioning intentions on future direction and ensuring the necessary investment to achieve our ambitions. These areas include extra care, lifelong services and mental health, Shaw healthcare services and directly provided services. 

Expanding on the development of these fundamental and enabling resources, we recognise there are areas that we want to improve in how we provide support to people. One of the key objectives of this work will be ensuring our commissioning standards are applied regularly across all activities to ensure that examples of current good practice are delivered more widely.

Person-centred and outcomes based services

All contracts for services have stated requirements around person centred approaches but we are not currently confident that all services are truly delivered in this way across our broad provider market. We want to develop approaches around procurement, oversight and monitoring contractual compliance that gives greater assurance that services are consistently delivered as intended and put the person at the centre.

We are currently re-commissioning the Community Reablement Service to start from April 2025 and are intending to grow the service significantly to support more people to remain independent for longer. To support the substantial growth required we are investing, in partnership with our current provider, to grow the workforce over the winter to support increased numbers of people accessing reablement, whilst also improving hospital discharge. We expect the service to grow in volume of reablement starts over the winter, and again in April 2025, with the start of the new service. We are planning for further increases over the course of the new service to enable anyone who may benefit from reablement to access the service and prevent, reduce or delay the need for longer term support and to enable people to retain or regain independence or remain at home. The ambition is to develop and commission a Community Reablement Service to achieve quality customer outcomes including:

• Increasing the level of customer independence in activities of daily living
• Reducing the number of people requiring formal, on-going care services
• Improving customer health and wellbeing  
• Supporting hospital admission avoidance
• Facilitating timely discharge from hospital and supporting flow through the system
• Support social care practitioners to promote wellbeing components that include dignity, daily living, and independence and which support people to live well at home and for longer.

The Adult Social Care Strategy was co-designed and co-produced and reflects the priorities of the individuals that the council is here to support.  Established groups like the Adults’ Services Customer and Carer Group, the Minorities Health & Social Care Group and Learning Disabilities and Autism Partnership Boards will continue to be key co-production partners, both as organisations and as a route to customers, carers and self-funders.  The Voluntary, Community and Social Enterprise (VCSE) Collaboration Board is strengthening strategic relationships with the VCSE sector with a co-production practitioners’ group formed to engage partners in projects and programmes. The Strategic Care Providers Forum chaired by the Director of Adults and Health with key adult social care providers ensures ongoing dialogue and partnership to support West Sussex’s provider market. Our ambition is to increase engagement and co-production through each stage of the commissioning cycle to ensure each service is best designed to meet our needs and objectives.  

The ability for customers to choose how they pay for any support they receive is important to us. To support a more flexible approach for customers in paying for their care, we have decided to investigate the use of Individual Service Funds (ISFs) as a first stage in finding new ways to join up customers with a developing market and increasing the range of more flexible options available from the very outset of someone wanting to access care and support.

We have conducted extensive research into the use of ISFs across the country and agreed to develop pilots to evaluate success. We are attracted by the potential for innovation both in achieving outcomes for customers and the new relationships with providers that this would entail. Following the research, we co-produced with market providers an ISF model which will be delivered during the pilots. We are currently engaged in detailed preparations for pilots which we envisage will commence in the new year, which will include a review of how ISFs impact on charging for care and support.

Addressing inequalities through pro-active approaches

We want to better understand how inclusion and diversity are reflected in service design and delivery phases, in particular removing barriers to service access. We want to improve our understanding about local communities and ensure that solutions and services are developed to consider the needs of all residents and communities of West Sussex and improve customer outcomes. Our partnership work with the NHS, district and borough councils, and the VCSE to develop Local Community Networks have created a strong partnership connection with communities to bring insight and deliver change at a neighbourhood level, allowing us to focus on our most affected communities. Throughout any new tendering of contracts, we are leveraging our influence as commissioners to reduce inequalities of access to services and inequality of opportunity and outcomes.  We are evaluating the impact on people with protected characteristics in the services we commission and reviewing access of services for people with these characteristics.

We will ensure that co-production, with customers and providers, is embedded throughout all parts of the commissioning cycle in all areas of our business. We have therefore identified co-production as one of our key areas of focus, learning to support commissioners with this aim and seeking to ensure that all of our commissioning embeds the approach that we can evidence now in several areas.

The County Council has in place a Social Value Framework which commits us to consider in any procurement how a contracted service will improve the social, environmental, and economic wellbeing of a relevant area. This approach focusses on outcomes and effecting long-term change in the community. Examples of delivering social value through our commissioning can include initiatives like:

• Active recruitment of staff from under-represented groups and people facing greater social or economic barriers
• Opportunities for young adults, students and or apprenticeships
• Making facilities available to groups that would otherwise struggle to access them
• Offering support and careers information to schools and colleges
• Offering volunteering opportunities to individuals seeking employment experience