Commissioning and delivering person-led and -centred services: key event reflections

Fulfilling Lives Lambeth Southwark and Lewisham (LSL) recently hosted an event with Research and Learning partners NPC, Groundswell, and The Centre for Regional Economic and Social Research at Sheffield Hallam University (CRESR).

It focused on commissioning and best practice for person-led, and person-centred services. It also explored some of the measures that commissioners and service providers can put into place to help achieve better outcomes for people experiencing multiple disadvantage (this includes homelessness, mental ill-health, interaction with the criminal justice system and drug and alcohol use).

The event was linked to research conducted by the partnership and these recent outputs – for commissioners and for services.

Panellists at the event included Ian Street (Commissioning Manager at Leeds City Council), Lucy Holmes (Creating Change Director at Groundswell) Helen Henriques (Quality & Development Partner at Fulfilling Lives LSL) and Sarah Hough (Research Officer at Groundswell).

This blog summaries the key ‘take-aways’ from the event.

Partnership Working

• No one provider has all the answers and organisations must work together to meet the needs of people accessing support. Multi-agency partnership working is critical to address the interconnecting needs of people experiencing multiple disadvantage who may require support from multiple services. Navigator roles and multi-agency contracts and meetings can help to foster partnership working.

Timeframes/flexibility

• Longer contracts, as opposed to short commissioning cycles (often driven by central government), allow providers to build relationships and partnership working.
• Competition between services can create perverse incentives where services feel they have to offer unattainable outcomes to be successful in tendering. Such competition can also mean providers are protective of their outcome measurement techniques. Changes of providers where staff are TUPEd (Transfer of Undertakings Protection of Employment). This means staff move from one organisation to another in a change of contract which can be disruptive, stressful and result in high staff turnover. Multi-agency commissioning encourages partnership working and can help to prevent this.
• Time limited services/outcomes may not be helpful to people with interconnecting needs who experience periods of progress and setbacks.

Outcomes

• Support is often based around a service’s or commissioner’s agenda rather than the wishes of people seeking support. This means people’s needs are not recognised, acted upon or reported which can lead to further disadvantage and/or poor outcomes. Sarah described how this can “set people up to fail and further disadvantage them”.
• Helena talked about the need to start with the principle of “what is important to the individual” and the idea that “we don’t really know anything about a person’s journey or their hopes and desires”. We need to start the relationship on this basis and this way we can change the system.
• Over-reliance on ‘hard’ outcome measures hides the huge amount of work that people and support services must do to get to that point. Lucy explained; “achieving soft outcomes, like trust and motivation to change, can take longer than a delivery contract or commissioning cycle, so if you’re not monitoring those things, you might find yourself making decisions without the full picture.”

Relationships

• Building trusting, unconditional professional relationships is key. Ian explained; “we are all people.  The starting point is always relationships – with the provider and with the people the provider is supporting.”
• People experiencing multiple disadvantage are unlikely to become involved with support unless their needs are being met and they feel supported/heard. Sarah shared this quote from a person accessing support;

“I went through a long period where I was passed from one worker to another. Constantly having to restart a relationship and go through traumatic memories. The new workers just picked up the info the previous worker left and made their own mind up from that.”

• Professionals’ hands can be tied in terms of the support they can offer, causing friction between the person being supported and the practitioner. This affects relationships and the ability to build trust.

Culture and language

• Panellists described how these ways of working should be incorporated into the culture of commissioning and delivering services. Ian described how the “overarching vision for Leeds to be the best city to live in, to be a compassionate city and place for people to be able to fulfil their potential”. This idea of people being able to fulfil their potential is at the very core of the Fulfilling Lives programme.
• Fostering a culture of trust in services and in people who use services can lead to better outcomes. Lucy told us; “we need to trust clients to make decisions about their own goals, and to trust providers to find the right way to support them.”
• There should be cultures developed which include mechanisms for co-production and meaningful consultation of people who use services. This includes in the commissioning process itself. Ian explained; “I’d love a situation where people with lived experience can be part of the process in an ongoing basis including the management of contracts.”
• Language is paramount – take, for example, the term ‘soft’ outcomes as Helena described “the ‘soft’ outcomes can be the ‘hardest’ to achieve.”

The event ended with a final question from the audience: ‘are we saying it is okay for people to make bad choices?’ Sarah Hough responded:

“No of course not, but you have got to understand when people experiencing multiple disadvantage they may have very few options.

For me, as a care leaver I didn’t have that family backing or support network so that left me at a disadvantage…When people have gone through trauma, they might make bad choices by your standards but by their standards that might seem like a reasonable choice… that might be survival to that person.

It is wrong to put assumptions of ‘right’ or ‘wrong’ if you do not understand that person’s situation”

This quote brilliantly articulates why services cannot make value judgments on people’s choices, their needs and the consequent outcomes.