Commissioning during COVID-19: Understanding local needs
Informing good commissioning
To develop a full picture of what is needed, commissioners must gather and make sense of information from a range of sources including recent responses and impacts of COVID-19. Understanding local aspirations, experiences and needs is vital to deliver support or approaches that will make a difference. Understanding supply – what is available and how it is used – is an essential commissioning task. This includes provision that’s off the radar because it is not commissioned by the local authority, or because it is small scale or not described as care. Commissioners also need to look beyond their own area to see what is working well elsewhere.
Most people with care and support needs put their own arrangements and solutions in place. It is up to commissioners to understand how people are supported or co-supported by their own networks, how people with direct payments are utilising their budgets and what self-funders are doing. ‘Understanding the impact of COVID-19 and responses on citizens' describes their experiences during the pandemic and how these may shape thinking about what’s needed both as an immediate response and for the future.
A more detailed understanding will shape the right support and responses. This must enable analysis about equalities and different needs, and identify gaps and opportunities. Good quality individual assessments – whilst many of these may currently be phone based – should be enabling and record the rich detail to help understand specific needs, diversity, aspirations and barriers. Aggregating intelligence from assessments will help to inform planning and messages to providers on needs, outcomes and preferences. Wider links with individuals, community groups and providers are needed to gather information from and about self-funders.
Co-production and commissioning
Relevant approaches and provision can only be developed when truly shaped by the people who will use them. The pandemic has meant urgent action being developed quickly but it is more important than ever to build ongoing and future responses with people. Building relationships and platforms offers valued and efficient ways of communicating and understanding people’s views. That is absolutely vital during COVID-19 and beyond to understand current impacts and to shape responses that work. Areas with established approaches to co-producing will find this easier: a position of ‘this is how we do things’ with residents at the heart of decision making.
See Nothing about Disabled people without Disabled people practice example from London Borough of Hammersmith & Fulham.
Tips for good co-production Open
- Develop co-production approaches with people – ask what works for them. COVID-19 will mean doing some things differently. Be flexible using a range of approaches so people can be involved in ways that suit them. Use established groups but don’t make that the only way. Some people who usually struggle to get to physical events have been able to engage virtually. Others have been excluded due to lack of accessible digital connection.
- Invest in peer support and DPOs (disabled people’s organisations). Peer support can give confidence and a shared voice. Ensure there is active communication with user-led organisations and DPOs during COVID-19 and beyond. They are invested in their local communities and help ensure citizens are at the heart of decision making.
- Build capacity for co-production and share leadership – invest in training delivered by people with lived experience, resource co-production and support the development of a shared understanding. That’s as important for staff, councillors as it is for local people and can continue to be built during the COVID-19 pandemic.
- Engage with people at different times and in different ways: at weekends, via phone calls and webinars. Use social media, information boards at shops, pharmacies or GP surgeries. Without this, you may miss key voices or particular groups. What has been the feedback via mutual aid groups?
- Equality and diversity. Co-production must be inclusive. Some communities are seldom heard, so they may be reluctant to engage with statutory services or existing approaches might not work for them. Can you link through other channels such as advocacy or carer organisations, faith groups or community groups that people trust? Are you missing people?
- Understand the context. People fear losing what they have even if it isn’t perfect. It needs to be safe for people to give their views. What is available will shape what people say they want and ultimately what they choose. You can help broaden horizons by enabling people to share their stories.
- Respect and value people’s views. Ask people if you have the questions right. Engage people with meaningful questions that will make a difference. What barriers are people experiencing? What would good support look like?
- Be clear how information will be used – what difference it will make and by when. Show and ask people what has changed as a result of their work.
- Reward and recognition is a key strand of co-production so be clear how this will work and continue to co-produce agreed ways of doing this. Whether that’s paying for involvement in developing specifications, payment for co-delivering training or refreshments for people giving their time at an event. Is there a way of doing this for virtual meetings too?
- Discuss existing co-produced values, for example, TLAP’s I statements that people might want to adapt and adopt locally as core principles.
Empowering people and building capacity
In order to facilitate choice and control, people need to be empowered; they need to understand what is available, what might work for them, how to access support, how to fund it and feel confident to do so.
The approach to commissioning needs to promote equality and be responsive to the diversity of people and their situations. Information and advice are significant enablers: the provision of such is a duty under the Care Act. Access to relevant information about local practical support, financial advice and benefits has been vital during COVID-19. Videos and stories can have a real impact. Peer support can be powerful at building trust and confidence. Advocacy is essential for some people to be involved in decisions about their own lives and must continue to be available to those who need it during COVID-19.
Effective commissioning cannot be achieved in isolation. It needs to be co-produced with local people and by close collaboration with adults and children services, public health, housing, NHS partners, and the wider community. Broader engagement can help tackle the barriers people face that could make a real difference in their lives. For example, accessing leisure services, sustaining work, education, shops and community services.
Stakeholders may be interested in different outcomes, so it is important to be clear about the respective benefits and measures. Knowing partners’ plans and priorities will help identify opportunities across a wider platform and support, where needed, cross system working. This is really important to ensure that collaborative approaches to immediate issues translate in to more effective long-term work. As outlined above, building in a strategic approach to co-production will ensure citizens are shaping the decisions that affect them.
Identifying relevant reporting mechanisms and outcomes measures may help. How does this work contribute to the local Adult Social Care Outcomes Framework (ASCOF) and the Public Health Outcomes Framework (PHOF)? What reporting is of interest to the local clinical commissioning group (CCG) and mental health trust? Are there other measures related to employment, for example, that provide a focus?
Local authorities and health services have legal duties to develop integrated approaches for the benefit of individuals. People should not have to navigate multiple and complicated ‘customer journeys’, nor be subject to multiple assessments requiring the same information to be given over and over again. Integrated approaches should maximise outcomes and make the best use of everyone’s time and resources.
Working together – engagement and partnerships
Engagement helps foster collaboration and enables a broad picture of needs and potential solutions. It enables us to understand respective skills – what each partner brings to the table, so we can respond more appropriately.
This has been demonstrated during COVID-19 and needs to inform next steps. Providers, along with the voluntary and community sector and mutual aid groups, are essential partners. Commissioners need to know when to take a facilitative or fixing role: when they should lead or co-ordinate and when to stand back. Commissioners need to ensure stakeholders can feed in and value their ideas across wider agendas. Some approaches to support engagement are as follows:
- Bring stakeholders together. It’s important for providers, commissioners and decision makers to hear from people – their stories are powerful. Find digital ways to do this during COVID-19. Providers can showcase good practice and innovation can be shared. This will help stimulate new discussions and change power dynamics.
- Regular supportive communication with providers has been highly valued during COVID-19.
- Is there a forum to meet with providers and community groups? Does that engage different types of organisations – community enterprises as well as traditional services?
- Gather information and get views from GPs and pharmacists. They are seeing people regularly and may also have feedback from social prescribing.
- Are elected members involved? As well as shaping decisions, they will have a view and represent the needs of their constituents.
- Are there shared agendas through the health and wellbeing board?
- Engage with local community plans, housing plans and equalities plans to address employment, ageing well, access to leisure, community engagement, or tackling isolation and loneliness.
- Link with your local Healthwatch as the independent champion for people using health and social care services to shape and improve services.
- Connect with (and fund) disabled people’s organisations (DPOs), carers groups and needs-specific groups. Community organisations and faith groups will also have a view and may be able to offer creative solutions. Disabled, older people and carers are part of that community, too.
- Local businesses often want to contribute to their community. People who work or own companies are also carers, Disabled people, family members. They may want to develop corporate social responsibility (CSR) plans.