Innovative “Commissioning For Outcomes” – Adult Social Care in Slough Leads The Way

Before eWorld Procurement and Supply, we mentioned in our preview a session on adult social care procurement from Craig Brewin, Head of Commissioning at Slough Council and said the topic “is not glamourous but is as important an issue for the UK as any”.

“Not glamourous”? responded Brewin in a comment. “Our life is a blur of film premiers, glitzy award ceremonies, and Downing Street receptions”!

A very good response, and he mentioned our comment at the beginning of his session at eWorld and said “thanks for the mention” (somewhat ironically)!  But I was sincere in saying this is one of the most important topics around for local government, taxpayers and citizens. Almost all of us will personally or through close family have exposure to social care issues in years to come, so how it is bought, managed and provided is a huge issue, with many current challenges.

Anyway, Brewin in his eWorld session did not disappoint us. This was a very interesting and thought-provoking 30 minutes for many reasons. Fundamentally, this was an explanation of how “commissioning for outcomes” could and should work, based on the Slough experience to date.  We have heard a lot of talk about this approach in government over the years, but less evidence of it really working. It is not easy to make it happen, and when time, money or expertise is short, public bodies tend to slip back into specifying what they want suppliers to do, rather than defining the outputs and outcomes they want provided.

Slough is really embracing the concept, and Brewin highlighted what it takes to follow those principles through the procurement process. Health and social care fall under the EU “light touch” procurement regime, so as long as authorities adhere to the fundamental treaty principles (transparency, fairness etc) you can design your own procurement process.

But there was a sharp intake of breath moment from the audience when Brewin explained that for several tenders in this field, Slough has told the market exactly what the budget is, which goes against a fundamental procurement “belief”. Tenders are then evaluated tenders purely on the expected outcomes from the proposals that suppliers make based on that budget. There is no price evaluation in the selection process at all.

While it is unusual for buyers to use this approach, it seems very sensible here. The fact is that money is limited and defined for many contracts of this nature. It is no good a supplier putting in a technically wonderful bid if it is simply unaffordable. Now you could set a maximum cost and allow suppliers to bid less (and score points for that), but such an approach complicates the evaluation process again. This seems a very elegant solution; and the EU regulations do allow it of course.

The specification is also not what most procurement professionals are used to; basically, it lays out those desired outputs and outcomes, and lets the supplier define how they will achieve those goals, what services will be delivered, and what resources they will use. The Council only gets into detail on inputs if there are legal or compliance issues e.g. around safeguarding.

This process has been used for tenders in areas such as drug and alcohol treatment and services for people with learning disabilities. These are difficult contracts from a procurement point of view in several ways. Markets are limited; often councils will only have one bidder for this sort of service, and as Brewin said, “if we get three credible bidders we get very excited”.

So far, Slough has found that competition has been healthy using this approach, and some potential providers are genuinely coming up with new and innovative ways of delivering services, focusing on the outputs rather than following previously established ways of doing things.

One factor that Brewin emphasised is the need under this approach for true expertise to be applied by the authority at the evaluation stage. Internal service experts must be involved as they are really assessing the credibility of the proposal and the likelihood that it will indeed achieve the predicted outcomes, such as improving wellbeing outcomes for Slough.

But while the process draws on this expertise, is also very structured. For instance, the team uses a matrix to map how each stage in the bidders’ conversion of resources into outcomes impacts on the next. (That is followed though into the contract monitoring stage). So this is about as far as you can get from a “tick in the box” evaluation process based on yes / no questions and scoring on a price basis.

Will the providers achieve the outcomes needed and expected by Slough, at an affordable price?  Only time will tell whether this approach is really delivering. But as budgets remain squeezed in the public sector, citizens and councils need innovation as well as professionalism from providers. This sort of process, with genuine contracting for outcomes, seems to give the best chance of achieving those challenging goals.

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First Voice

  1. Dan:

    Well done to Slough for doing something more innovative and taking a risk.

    Anyone want to guess if the procurement people involved are still judged on savings?

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