Case Study Provider and commissioner collaboration – Positive outcomes for people with learning disabilities

Mixing together commissioners and providers could be considered unusual ingredients for an action learning set – throw into the mix a competitive procurement market and it looks like a recipe for failure.  But a recent pilot action learning set hosted by the Local Government Association (LGA) proves that commissioners and competing providers can work together to improve cross sector communication, develop new ways of working and improved working practices for the benefit of service users.

Part of the Department of Health Grant funded “Finding Common Purpose” project which is chaired by the Co-Chair of the Association of Directors of Adult Social Care Learning Disability Network, the LGA set up a pilot action learning set bringing together commissioners and providers of services for people with learning disability in the London Borough of Newham.  Finding Common Purpose is overseen by a consortium of stakeholders including Skills for Care, the Care Provider Alliance, the LGA, service users and their representatives, the National Valuing Families Forum and local commissioners.

The action learning set, which met between February and April 2015 brought together those providing services, commissioning services and those representing vulnerable service users.

The unusual make-up of the action learning set presented some specific facilitation issues so careful management of the set was essential. This included establishing explicit contracting regarding confidential information, taking a principle practice approach, using a theme-based approach and agreeing in advance which outputs could be used externally.  Themes which the set tackled included how to improve the commissioning role for those with learning disability, how to retain front line quality of care given substantial change for providers, how to move towards integrated working for Health and Social care, responding as well as possible to behaviour that challenges and how best to hold to the principle and practice of personalisation.

At the conclusion of four meetings participants reported a significant improvement in communication between providers and commissioners as well as improved relationships.  Comments included; “ We started to develop a mutual understanding of the challenges” and there was “momentum for driving things forward and feeling of engagement and a will to work together from most to the providers involved”.

Participants also acknowledged improvement in their approaches to developing creative solutions to problems – but the outputs from the set reflect a greater shift than the participants may have appreciated.

Learning, which will impact significantly on service users in the Borough, included:

  • Sharing of local best practice
  • Challenge for all involved generating new ideas for provision or improvement of care
  • Looking outward at other resources
  • Developing an action plan to continue shared commissioner and provider communication for those working with learning disability in Newham.

Some of the main outcomes included:

  • Providers sharing best practice:
    •  for example setting up an internal WhatsApp so a provider could share images of great practice
    • surgeries to determine the needs of families
    • innovative ideas included family forums, transitional work and cross fertilisation with boroughs and families
    • providers to be more involved in care planning, outcome planning etc
    • to support people to make personal choice –  increase advocacy, develop self advocacy in users’ best interests
  • Maintaining excellent front line care despite pressures of organisational change :
    • increasing routes for recruiting front line staff e.g. young people, apprentices, graduates
    • improving recruitment by taking potential staff out with service users for half a day to test for values and motivation e.g. swimming so they know they may need to dress service users
  • Establishing realistic goal setting for service users e.g. able to live independently versus ability to go to the shops alone

One outcome highlighted as important for moving towards integrated care was the need for joint reviews which would reduce effort and get support onto the agenda.  They also advocated developing a person-centred protocol which could include the use of media – for example enabling service users to talk about their own experiences.

As this was a pilot approach the action learning set spent time specifically on practical steps to share the learning across the borough to reach all those involved in the provision and commissioning of social care for those with learning disability.  They believed that the learning created was of real value to the borough, and it also established an agenda for future partnership working and events.