“A chance to do things differently”

CCPS has a longstanding commitment to leading culture change in commissioning and procurement, with a focus on embedding rights-based approaches and increasing collaboration, writes Policy Manager Alison Christie. In 2023-24, our work in this area included running a test-of-change of model outcomes-based contract template documents and related terms and conditions. We were pleased to collaborate with Scottish Borders Council and law firm Morton Fraser Macroberts as part of the project.

Background

The aim was to provide local authorities with a set of template documents to use and adapt when contracting for social care support services and to ensure that the contractual process focuses on the person’s outcomes. The Model Contract is three-way agreement between the supported person, the provider and the local authority. It is an Option 3 Self-directed Support (SDS) contract, meaning it can be used for all types of social care services.

The test-of-change was a small-scale project to assess how the Model Contract and Ts & Cs could work in practice and be adapted for use locally. By the end of the project, it was in readiness for use with one individual and support provider contracted through Scottish Borders Council (SBC), with an outcomes-based social work assessment, individual outcomes-based support plan and signed legal agreements all in progress.

In his blog below, Bryan Davies, Chief Officer – Strategic Commissioning and Performance at SBC, reflects on his experience of sharing the work and the learning gained.

“Part of my role at SBC focuses on developing our approach to commissioning, including looking at how we establish new governance arrangements for commissioning decision-making.

Currently in development are an early draft commissioning strategy within which there are 11 commissioning principles we will be committing to upon completion of the engagement process.

The developing approach also includes exercises such as the mapping of all our longstanding commissioning arrangements and the modelling of a capacity versus demand whole system profile across all health and social care settings. This Commissioning Framework will set out a new approach to existing commissioning in the Scottish Borders with a focus on ethical commissioning and collaboration.

One of the first areas of review in the Borders is Care at Home provision. CCPS’s test of change was of particular interest because it allowed us to look at the potential for doing things differently in terms of three-way contracts between the commissioner, the provider and the individual with that focus on the individual’s outcomes.

Trialling ideas

As a small test of change, we felt it was a useful exercise to begin to think through how the model contract might be implemented. However, one of the things that came through clearly was the need for more time. This proved to be a frustration throughout the project in terms of working towards a very imminent deadline.

Very quickly we pulled together legal experts, social work practitioners, partner agencies and other disciplines to look at the detail. But despite an excellent collaborative approach, unfortunately we didn’t have the time to go ‘live’ with a contract and involvement of a service user within the timeframe given.

In scoping a new way of working, lots of questions were raised for us about, for example, distinguishing between self-directed support option two and this specific option three piece of work. This test of change was within the context of option 3 (social work provided care through the means of a framework), and as a result the issue of scale became important.

The real value of any further test of change would be linked to scaling up. However, it was an interesting exercise in terms of the process that stakeholders might go through to get to this new three-way contractual arrangement.

Question time

SBC currently does assess individuals for outcomes but has historically set budgets around time and task provision of care at home rather than outcomes. So there is continued development in this aspect.

The capacity of the provider to deliver on the individuals’ outcomes while also delivering on a large-scale traditional volume of Care at Home provision on a time and task basis also provided a challenge. Questions were raised from the provider’s perspective about how they would manage the capacity to achieve this.

We highlighted other questions around evidencing progress against the achievement of the person’s outcomes.

There was an acknowledgement that there are tools that already exist and are in use by SBC and providers, but questions as to how SBC and stakeholders would agree suitable tools for the evidencing of those outcomes.

SBC also weren’t clear about managing a person’s expectations in terms of how open to be about this being a test of change when getting to testing stage with a service user.

Steps in the right direction

There was also a suggestion to better sequence the steps that needed to be taken. For example, the contract’s function could have been brought in earlier.

There was a significant focus on the legal input, and it was felt that in addition, there was a need for input from the contracts and procurement team to help the group understand where progress needed to be made in practically applying the new contract.

The experience has informed wider working for SBC in developing commissioning approaches, and we feel that it will be important to revisit much of what was experimented with during the project.

Overall, I felt that, despite it being a very small-scale test of change, a great deal of value had been learnt by the project group in a short period of time.”