Allowing the third sector a greater input in shaping local services can make for better results, argue Paul Hopley and colleagues
Strategic commissioning with the third sector can present a number of difficulties. However, a partnership in the North West is working to overcome these challenges, engaging the third sector in commissioning new crisis and respite mental health services.
The service providers are represented through the Lancashire Mental Health and Social Care Partnership, a task force charged with improving care in these areas across the county. Other partners are the Lancashire Voluntary Sector Consortium and Central Lancashire University. This tripartite route for planning services has allowed a strategic and integrated approach to commissioning.
A central part of the strategy is to develop new adult crisis and respite services to reduce inappropriate hospital admissions. Currently, the range of choices of services for those experiencing crisis is limited, with the only alternative often being hospital admission.
The consortium provides an excellent opportunity for both established and more locally driven voluntary sector organisations to work co-operatively and strategically. However, a real challenge is to turn the commitment of partner voluntary organisations in the consortium into 'readiness for commissioning' in the sector.
Lack of both long-term funding and short-term contracts mean many third-sector organisations have to invest disproportionately large amounts of resources to secure funding. Contracting processes are often too costly for smaller organisations and withdrawal of funding can lead to service closure.
Service users and carers repeatedly complain that they are unaware what services are available. Commissioners may also lack information on third-sector capacity, partly due to a lack of meaningful engagement with the sector.
We have supported collaboration between voluntary-sector organisations through the consortium so they can share knowledge and, potentially, infrastructure and risk. The consortium can communicate with commissioners with one voice.
The consortium is open to all social enterprise organisations willing to sign up to the common standards, values and shared governance arrangements. It has started to consider how commissioners relate to the voluntary sector in the development of mental health services and to explore what commissioners require from them.
Our next aim is to develop a comprehensive commissioning framework for use with the consortium. The framework will increase the diversity of services available from the voluntary sector, providing alternatives to admission. We anticipate this will generate savings which can be invested in new, value-added services.
The development of the commissioning framework is underpinned with key standards, processes and outcomes for service delivery. A key component is a clear service model fully integrated with a workforce and organisational development strategy, specifically addressing 'readiness for commissioning'.
A prototype commissioning framework will be evaluated as voluntary-sector organisations tender for NHS contracts. The framework will be refined through application in two primary care trusts, and will end with roll-out to other PCTs in Lancashire. It is hoped the work will have a wider impact regionally and inspire further innovation in third-sector commissioning.