Changing commissioning practice through building relationships
To truly deliver on the vision of self-directed support in Scotland, we need to change the way we commission health and social care services: we must empower individuals and communities by giving them real choices in how their health and care needs are met.
The purpose of self-directed support is to reshape the delivery of social care support in Scotland and empower people to be equal partners in their care. The Social Care Support reform programme builds on this vision, while recognising that system changes are necessary to attain it. A key requirement is a culture change in commissioning practice, with a shift towards innovation, flexibility and collaboration across the statutory, independent and third sectors.
Relationships over processes
Often, systems and processes can be barriers to doing things differently. The ihub’s Collaborative Communities team works with Integration Authorities across Scotland to explore commissioning systems and processes. We support change in practice to one that is:
- Based on collaboration, rather than competition.
- An enabler to promote choice and control for individuals and communities.
In the short term, this work aims to raise awareness and knowledge of local systems and processes and build the skills and confidence to enable a change in commissioning conversations across sectors. Our longer-term aim is to change commissioning practice and behaviour through the development of collaborative commissioning relationships.
Delivering knowledge, connections and support
Over the past 12 months, the team has delivered a range of activities with key stakeholders including senior managers, commissioners, and operational managers within Integration Authorities, as well as independent and third sector providers. These activities include:
- Providing subject matter expert knowledge around commissioning
- Highlighting innovative models of practice
- Creating connections between those working on common issues
- Giving practical support through bespoke workshops
- Providing independent facilitation at local meetings and events
- Giving ‘critical friend’ advice and support.
Seeing “an exciting future”
As a result of the enthusiasm and commitment demonstrated by the services we’ve been working with, we are already starting to see impact:
Orkney Health and Care
Orkney Health and Care is exploring how to put co-production into action through working with third sector organisations and communities to develop alternative solutions to traditional social care support with third and independent sector organisations and communities.
The ihub delivered workshops focused on ‘Co-production, Workforce and Regulation’ that were well attended by staff across health, social care, education and community organisations. Opportunities were identified around sharing training resources, the generic worker role and community capacity building.
A participant summed up the day by saying, “The session set the scene for an exciting future with our community based services. I have a sense that the movement towards culture change has now begun.”
East Ayrshire Health and Social Care Partnership (HSCP)
East Ayrshire HSCP is working with care and support providers to develop a sustainable approach to commissioning that is built on collaboration, rather than competition. The ihub provided expert knowledge and critical friend advice to senior managers. We delivered bespoke workshops with commissioners and key independent and third sector providers to explore current practice. We aim to identify a common future vision to create a Partnership Provider Statement.
A workshop attendee observed, “That is what I like about these events – we are really allowed to speak…. I think external facilitators can develop a more constructive conversation.”
In 2017, Inverclyde HSCP worked with senior managers and third sector providers to explore commissioning culture and attitudes. The aim was to break down barriers to enable practice that is outcome-focused rather than target-driven.
The ihub delivered a series of bespoke workshops to explore current practice, including enablers and barriers to change, and relationships with independent and third sector providers.
One participant reflected, “I have come away with ideas for the year ahead for my teams and our local services in mental health.”
We revisited Inverclyde HSCP in April 2019 and there was clear evidence that they had continued to build on the initial work to deliver a more person centred approach to commissioning services. We plan to revisit each Integration Authority we have supported to capture their learning about how to ensure the approaches are embedded into day to day practice.
A senior manager from Inverclyde HSCP reported that, “We’re taking steps towards being able to do outcome based commissioning. We have seen a change in behaviour and the way people work together, as instead of heads being down looking at paperwork, heads are up looking around and staff are more confident to try new things.”