How crucial was it for the council to create a new ambition and framework to shift to outcomes-based collaborative commissioning?
We needed to move away from a traditional, transactional commissioner-provider approach to being more about collaboration, working together to achieve the best outcomes for the people we are caring for. That's what the shift has allowed us to do.
It's about getting beyond conversations about fees and talking about the outcomes we are trying to achieve and how we do that within an affordable model.
Until we did this piece of work, we didn't really get out there and ask what people wanted. They were told ‘this is what you are going to get'. Individual care homes and agencies would obviously have care plans that reflect a person's needs, but we weren't really working to understand what people want. That's now changing.
What changes have you seen in commissioning behaviours and is it likely that other areas of the council will adopt the new way of working?
The biggest difference is that across children's, adults and public health we've got a laser focus on building lived experience into our commissioning cycle. It's embedded in our joint strategic needs assessments and informs commissioning priorities.
We spend time finding out what people want from services – not only those using them now but those who may use them in the future.
We've also seen a shift in mindset across commissioning teams. We want to work with providers, not just commission them to deliver a service. It's actually improved our ability to challenge providers when there are issues because conversations are less adversarial thanks to the relationships we've built up. Commissioners and providers can have a two-way conversation, talk things through and hold each other to account.
In terms of wider adoption, we have introduced a commissioning portal that was co-produced with the wider workforce to build greater awareness around commissioning and enable them to act when there's a part of the process that's not going well.
IMPOWER supported Wolverhampton and Walsall councils to co-develop, with staff, their commissioning toolkits. How useful have staff found it?
It's used across commissioning now and we've developed a checklist so we know it's being used consistently. Managers can check-in with commissioners and ask where they are in the toolkit so they're much more engaged in the process. We're now looking at how we embed the toolkit in other parts of the organisation so it's not just something that sits within commissioning.
How have things progressed since your work was captured in our joint report with The King's Fund, Friends doing what they love?
Our outcomes-based commissioning approach is progressing steadily. It's taken longer than we thought, but to do it well we would rather take time and have further engagement with residential and nursing care providers. We have agreed what good outcomes look like and are currently drawing up a service specification. Although this will be our first big commission that we have used the approach on, we've already adopted it for other existing areas of commissioned work.
Have commissioning colleagues continued to engage those using the services and what impact has that had?
It's part and parcel of their work and we're seeing the value of having those personal stories inform how we commission. For example, when our quality assessor officers go into settings they're not just looking at the records and charts, they are speaking to people about the experiences they are having and bringing that intelligence back. We've used it with technology enabled care commissioning to understand what people want from technology and the difference it makes.
We know from the direction of travel set by Government that local government is going to have to really step up in this space in terms of making sure the voices of people receiving care come through. It's not enough for councils to just say they've done a survey – you need a robust mechanism to get that feedback, which we now have.
What has been the biggest impact of changing the council's approach to commissioning?
It's given us a structure to build a shared understanding of how we want to commission in the city and the outcomes we want to achieve. It's changed our relationship with providers to one of genuine partnership while ensuring we work in way that constantly puts the voice of lived experience at the forefront.
Austin Macauley is a freelance reporter
• The report Friends doing what they love, is available here
