Commissioning Workshop

1. Commissioning Workshop Rachel Wright Voluntary Sector Policy Manager

2. Shopping • Commissioning services from the voluntary sector through legal contracts. • Directorates will decide their Service Area objectives and make commissioning decisions based on their service priorities.

3. Investing • Investment Funding (a form of grant funding) is to enable organisations to develop their services to the point where GCC can meaningfully contract with them for future service provision. • Investment Funding will be offered on either a short or long term basis on the clear understanding that this is for the development of the service. • Directorates will make Investment Funding decisions that are directly linked to Service Area objectives

4. Giving • Small grant funding. • Directorates can continue to give small annual grants for new, innovative or short-term projects that meet funding priorities

5. The public health commissioning landscape Alice Walsh Deputy Director of Public Health

6. Health and Social care Bill – health care • establishes an independent NHS Board to allocate resources and provide commissioning guidance • increases GPs’ powers to commission services on behalf of their patients through GP consortia • strengthens the role of the Care Quality Commission • develops Monitor, the body that currently regulates NHS foundation trusts, into an economic regulator to oversee aspects of access and competition in the NHS • cuts the number of health bodies to help meet the Government’s commitment to cut NHS administration costs by a third, including abolishing Primary Care Trusts and Strategic Health Authorities

7. Health and Social care Bill –A new public health system • Public Health England – a national public health service • A return of Public Health leadership to Local Government • Professional leadership nationally and locally • Dedicated resources for public health at national and local levels • Focus on outcomes and evidence based practice supported by strong information and intelligence systems • Maintaining a strong relationship with the NHS, social care and civil society • All set out in the Health and Social Care Bill

8. The White Paper and consultation documents • Healthy Lives, Healthy People – our strategy for public health in England • Published 30 November 2010. The White Paper sets out the Government’s long-term vision for the future of public health in England. • Healthy Lives, Healthy People: transparency in outcomes - proposals for a public health outcomes framework. • Published: 20 December 2010. This consultation explores the proposed public health outcomes framework • Healthy Lives, Healthy People: consultation on the funding and commissioning routes for public health • Published 21 December 2010. This consultation explores the proposed funding and commissioning routes for Public Health England, including the ring-fenced budget provided to local authorities. • Healthy Lives, Healthy People: our health and wellbeing • Published 30 November 2010. This summary of evidence aims to set out the state of the nation’s health and wellbeing in 2010. • Review of public health professional regulation • Published: 30 November 2010. Dr Gabriel Scally, Regional Director of Public Health has prepared a report on the issue of professional regulation within public health.

9. What is public health about? • ‘ the science and art of promoting health and protecting wellbeing, preventing ill health and prolonging life through the organised efforts of society’.

10. What influences health & wellbeing? • Local authorities and voluntary and community organisations (VCOs) have a major role:

11. The Health Background • We have made good progress in tackling many of the major burdens of disease such as heart disease and cancer but there are still some significant challenges ahead: • Britain has amongst the worst levels of obesity in the world. • Smoking claims over 80,000 lives a year. • 1.6 million people are dependent on alcohol • . • Over 0.5 million new sexually transmitted infections were diagnosed last year, and 1 in 10 people getting an infection will be re-infected within a year. • Poor mental health is estimated to be responsible for nearly a quarter of the overall burden of long-standing poor health. • People in the poorest areas expect to live up to 7 years less than people in richer areas – inequalities remain entrenched

12. The new approach • responsive – owned by communities and shaped by their needs • resourced – with ring-fenced funding and incentives to improve • rigorous – professionally-led, focused on evidence, efficient and effective • resilient – strengthening protection against current and future threats to health.

13. The Nuffield Council on Bioethics’ ‘intervention ladder’ shows the range of potential approaches which could be used to promote positive lifestyle changes. The options range from the least intrusive to the most intrusive. Nuffield intervention ladder Greater levels of intervention

14. Public Health and local authorities • Local authorities will have a new statutory duty to take steps to improve the health of their population • A ring-fenced public health grant will be paid to local authorities • The DoH expects that the majority of services will be commissioned, given the opportunities that this would bring to engage local communities more widely in the provision of public health • To ensure joined up commissioning at a local level, local authorities and GP consortia will each have an equal and explicit obligation to prepare the Joint Strategic Needs Assessment (JSNA) and to do so through the health and wellbeing board • All health and wellbeing boards will develop a high level ‘joint health and wellbeing strategy’ that spans the NHS, social care and public health and which could potentially consider wider determinants of health such as housing or education

15. Public Health and the NHS • The NHS will commission some public health services, with funding passed from Public Health England. • In addition, the NHS will have an ongoing role in certain services with public health aspects -the Department expects that public health continues to be an integral part of primary care services. • Public health expertise will inform the commissioning of NHS funded services, facilitating integrated pathways of care for patients. • This will be underpinned: • locally by ensuring DsPH are able to advise the GP consortia; and • nationally via the relationship between the Secretary of State/ Public Health England and the NHS Commissioning Board.

16. Proposed role – the Director of Public Health • Will be jointly appointed by the relevant local authority and Public Health England and employed the local authority with accountability to locally elected members and through them to the public. • Will be the principal adviser on all health matters to the local authority, its elected members and officers, on the full range of local authority functions and their impact on the health of the local population • Will play a key role in the proposed new functions of local authorities in promoting integrated working • Jointly lead the development of the local Joint Strategic Needs Assessment (JSNA) and the joint health and wellbeing strategy (with Directors of Adult Social Services and Directors of Children’s Services) • Will continue to be an advocate for the public’s health within the community • Will produce an authoritative independent annual report on the health of their local population

17. Public Health funding and commissioning

18. Commissioning for outcomes:the new Public Health outcomes framework • Vision: to improve and protect the nation’s health and to improve the health of the poorest, fastest • Health Protection and Resilience: Protecting the population’s health from major emergencies and remain resilient to harm (PHE) • Tackling the wider determinants of health: Tackling factors which affect health and wellbeing and health inequalities (LHWB) • Health Improvement: Helping people to live healthy lifestyles, make healthy choices and reduce health inequalities (LA’s/LHWBs) • Prevention of ill health: Reducing the number of people living with preventable ill health and reduce health inequalities (LHWB) • Healthy life expectancy and preventable mortality: Preventing people from dying prematurely and reduce health inequalities (LHWB plus…) • The outcomes framework contains proposed indicators for each of the domains

19. Public Health outcomes framework – alignment with NHS and adult social care frameworks

20. Commissioning – the role of Health & Wellbeing Boards • By 2013: • Health & Wellbeing Boards will be in place in each (top tier) locality with effective communications mechanisms, introducing local democratic accountability to health care for the first time in almost 40 years • The HWB is the vehicle by which councils exercise their lead role in integrating the commissioning of health, social care and public health services to better meet the needs of individuals and families using the services. • New JSNAs and Joint Health and Well-being Strategies are key levers within this. • Genuine practical collaboration between Councillors, Directors from Public Health, Adult and Children’s Services, GP consortia, the NHS Commissioning Board and public and patient. Groups through HealthWatch will become the norm at every stage of the commissioning process so that needs and priorities are jointly assessed, to check they meet the needs of local people.

21. Membership of LHWB • Minimum membership of: • At least one elected representative (a local councillor) nominated by the leader or elected mayor, • A representative of each of the relevant GP Consortia (those within the local authority area) • Directors of public health, adult social services, children's services • Local HealthWatch representative • A representative oftheNHS Commissioning Board (in relation to their local commissioning responsibilities on request from the health and wellbeing board) • Other representatives can be appointed by the local authority and/or the health and wellbeing board

22. Summary national timetable

23. Summary • New NHS and Public Health commissioning landscape • Robust JSNA will be vital to underpin commissioning decisions for health, social care and public health • Health and Wellbeing strategy will inform commissioning intentions • Health and Wellbeing Board will have pivotal role in integrating the commissioning of health, social care and public health services • PH budget not yet allocated • Funding streams complex and further clarity awaited • GP consortia and Public Health will need to involve VCOs to ensure effective commissioning • NHS, PH & Adult Social Care Outcome frameworks will be used alongside JSNA to determine priorities

24. Local plans

25. Consultation • Healthy Lives, Healthy People – our strategy for public health in England • Role of GPs and GP practices in public health • Public health evidence • Professional regulation • Healthy Lives, Healthy People: transparency in outcomes - proposals for a public health outcomes framework • Healthy Lives, Healthy People: consultation on the funding and commissioning routes for public health • Find consultation documents at; • www.consultations.dh.gov.uk/healthy-people • Respond to consultations at; • publichealthengland@dh.gsi.gov.uk

26. 10 common mistakes made by tenderers! 17TH JANUARY 200

27. 1. Late Submission The return date and time are fixed. It is vital that you get your tender to the right location and on time.

28. 2. Open envelope Make sure your envelope is sealed. If It is opened it could be disqualified

29. 3. The wrong information on the envelope If the envelope isn’t clearly marked as a tender it may be opened at the wrong time or place, and can then be disqualified.

30. 4. Canvassing individuals in the tendering organisation The tender process has to be fair and transparent. If you try to influence staff or try to obtain information outside the process your bid could be disqualified.

31. 5. Alternative bids “We can’t do what you’re asking but we can do this…” Unless we specifically ask for alternatives we cannot accept them.

32. 6. Qualified bids “We can give you this price, but only if…..” Unless we specifically ask for qualified bids we cannot accept them

33. 7. Wrong information supplied Don’t tell us what you want us to know, tell us what we ask for, or anything that relates directly to the tender.

34. 8. Gaps in information We are not allowed to make it up or guess, so please make sure that all information needed is supplied

35. 9. Don’t assume we know you We have to assess you on the information that you supply for an individual tender, not on what we may know about you.

36. 10. Be realistic Be realistic about what you can actually achieve.

37. TenderingClaire SmartDirector Strategic ProcurementGloucestershire County Council

38. When is procurement not procurement? • Commissioning = the alignment of services to meet needs. • May or may NOT include procurement • Grants = Gifts • This is not procurement. • Procurement = buying goods or services from a 3rd party.

39. Rules – Internal • Each organisation is a statutory body and has rules which cover how it is set up, the delegation of authority or reservation of powers, and tendering levels and procedures to be followed. • Each organisation has set a level at which competitive quotes or competitive tendering takes place. An example may be £5,000 for quotes and £25,000 for tendering.

40. Rules – External (Regulations) • The Public Contracts Regulations 2006 (SI No 5) & The Public Contract (Amendments) Regulations 2009 (SI No 2992), derived from EU Directives • European threshold varies for different public sector organisations and for goods & services versus works contracts. It generally changes every 2 years and is based on the Euro. - NHS threshold is set at £101,323 - Councils’ threshold is at £156,442 - All “works” thresholds are set at £3,927,260.

41. What needs tendering? • The Value of contract must be considered over the life of the contract. This is the total spend for the organisation over a period usually of 3 - 5 years • Part A services, as stipulated in the regulations and would include services that could be provided across member states. • Part B services may be excluded from full EU tendering as they have special considerations for a country rather than the EU. e.g.: legal services/personnel placement

42. What exists already? • If a local contract already exists there is an expectation that the contracted supplier/suppliers would be used. • Buying Solutions (national, all public sector) or NHS Supply Chain (NHS only), frameworks are in place and could be utilised via call off or mini-competition • Some regional arrangements (e.g. PRO5 for councils) exist that organisations can choose to use, again either via call off or by mini-competitions. - Mini-competitions allow us to use the framework suppliers only to obtain tenders – hence “mini”

43. What if no arrangements exist? • If no current contract exists or is due to expire a full tendering process may be applicable, either locally for a lower level contract or via OJEU (Official Journal for the European Union) for higher values. • Set formats apply for OJEU tenders but often the same sets of forms will be used for local and OJEU tenders.

44. Tender process – Sourcing • Initially an advertisement is required to invite suppliers to express an interest. An OJEU ‘Contract notice’ as well as website notices may be issued. Other media could also be used to invite interest e.g. local newspaper or trade magazine. • A pre-qualification stage / short listing stage may be used to reduce the suppliers who have expressed an interest to a reasonable number to invite to tender.

45. Tender process - evaluation • The shortlisted suppliers are invited to submit an offer for the goods or service via an Invitation to Tender (ITT). • The returned bids will be evaluated, either by individuals or more usually by a team • Sometimes presentations, samples or trials, reference site visits, or further clarification is sought to evaluate or confirm evaluation.

46. Tender process - award • The preferred supplier is advised and all other bidders are advised of the details where their bid was lacking or valued less than the preferred supplier • Further debriefs may take place with suppliers to assist them to improve their bids for the future. • The award is made after a standstill period.

47. Tendering – Pre-qualificationHow to get your details across… • At Pre-Qualification stage each public sector organisation is trying to get details on how a potential supplier operates in general. • The more financially stable the supplier is and, the closer the requirement matches the supplier’s current work, the less risk for the public sector and the more likely the supplier will manage the requirement through the life of the contract period. • New National PQQ

48. Tendering – ITTHow good are you for what we need? • Answer each point as accurately as possible, with sufficient detail to explain each point without wandering off the question. • If you have supporting documentation please add this in where asked to do so, e.g. as appendices. • Send all of your responses back in the format requested and for the time needed. • Where does full cost recovery fit with tendering ?

49. MAX Technical (functional) control of goods/ Performance (outcome) services specified MIN max Time to create min max Performance risk min min Contractors innovations max Outcome Specifications

50. Reasons you can be ‘disqualified’ (before the ITT stage) • No evidence of capability to meet specification • Financial instability or where you are not deemed capable to perform a contract of the value envisaged • Misleading information provided or failure to disclose • Unpaid taxes or social security payments • Criminal offences relevant to the contract: e.g. security guard with an arson conviction; • Winding up order against supplier • Suspension from trading: e.g. bankruptcy of a director • Legal problems: e.g. patent rights • Found guilty of organised crime, corruption or fraud