SUMMARY Plymouth City Council has developed a systems-based approach to supporting people with complex needs through the use of an Alliance Contract – with many benefits resulting. Gary Wallace introduces the Alliance in this short film (case study continues below). Traditionally, contracts had been commissioned in separate silos, often resulting in duplication, inefficiencies and poor outcomes for the person using multiple services. Twenty five contracts spanning substance misuse and homelessness were aligned under the co-produced Alliance model. Using an Alliance model, the focus is on creating systemic change to support a new relational way of working that really meets human needs. Partners share responsibility for achieving outcomes and are mutually supportive, making decisions based on the best outcome for the service user. The Alliance was awarded a single contract by Plymouth City Council for the provision of support for people who have needs in relation to homelessness and may also have support needs around substance misuse, mental health, offending and risk of exploitation. The Plymouth Alliance has made significant progress in process of transformation during its first year of operation and has been fundamental in providing support during the Covid-19 crisis. BACKGROUND The Plymouth Alliance contract focuses specifically on supporting people with complex needs. These are adults who experience several problems at the same time: for example, mental health problems, substance misuse, homelessness and offending, resulting in them living chaotic lives. In turn, there will also be a negative impact on families and communities and very often there is ineffective contact with the services there to support such people. A review of how support had previously been provided demonstrated uncomfortable truths for commissioners and services. Commissioning had been seen as a top-down, opaque and disempowering process, with a master servant relationship rather than an inclusive partnership between commissioners, services and people using services, as well as their families and communities. Commissioning was carried out in silos with little regard to what other silos were doing. It was commissioning for near horizons rather than as part of a long-term strategy and commissioning was seen as a problem setter, rather than a problem solver. Service users often felt done to, rather than worked with, and as a result, felt disempowered and marginalised. There was a mismatch between what workers valued about their work and what consumers valued: specialism and expertise versus authenticity, warmth and persistence. Services were largely unaware of the detail of what other services provided. The services collaborated by exception not by default. This work challenged commissioners and services to work together and in collaboration with people using the services. It showed there was a need for an iterative process to develop a new approach and for checking back with stakeholders regularly through the commissioning process. It opened the way for the prospect of a whole system of service, designed around the needs of people, rather than a fragmented market built around the needs of commissioners and services. Video presentation (case study continues below) – Rachel Silcock, Strategic Commissioning Manager at Plymouth City Council, describes the journey towards the successful Alliance contract, how challenges on the journey were overcome, and some of the impact and better outcomes which have resulted: Developing a new partnership approach Initially a year of systems leadership work took place with lots of appreciative enquiry, based on personal story telling. Commissioners, the voluntary and community sector collaborated and cooperated with a view to transformation. They participated in themed group activities, learning labs, and worked alongside one another in a sharing environment. Structures were only set up that could support a new culture. The Decision: an ALLIANCE CONTRACT The new complex needs model was co-designed by people who use the services, commissioners, the voluntary and community sector. It enables people to be supported flexibly, receiving the right care, at the right time, in the right place. Its focus is on creating systemic change: changes to culture, funding structures, commissioning and policy that will support a new way of working. The Plymouth Alliance has eight member organisations including the Council and seven other social enterprises and charities. All share responsibility for achieving outcomes and are mutually supportive, making decisions based on the best outcome for the service user. The Alliance can be viewed as a virtual organisation, where partners work collectively to create a collaborative environment without the need for a new organisational form. All parties are working to the same outcomes and are signed up to the same success measures. It is a relationship based on trust, transparency and collective accountability and the Local Authority is a member of the leadership team, enabling it to have an active role in the development of the Alliance. The Alliance Contract had a first year budget of £7.7m. The initial contract was for five years (from 2019) with a potential for extension to ten. FORMAL PROCESS Having decided to go down the route of an Alliance contract, the process took about year. A competitive procurement was run as a one stage process incorporating a Supplier Questionnaire (SQ) and Invitation to submit Initial Tenders (ISIT) followed by an Invitation to submit Final Tenders (ISFT). The SQ included both mandatory (pass or fail) and evaluated questions. One SQ was received from each member of the Plymouth Alliance. All of them exceeded the minimum requirements and therefore the Plymouth Alliance proceeded to have their ISIT evaluated. The submitted tender was evaluated by a team of individuals with various skill sets from across Plymouth City Council and NEW Devon CCG, in order to ensure both transparency and robustness. The tender process determined that the Alliance members had the critical knowledge and experience to provide the service and the considering all evaluation criteria they offered the ‘most economically advantageous tender.’ THE ALLIANCE IS NOT A LEGAL ENTITY – SO HOW DOES THE CONTRACT WORK? The contract covers: all substance misuse services,all services supporting homeless people contracted by the council,defined offers and asks with mental health servicesand a wider group of 20 other services either subcontracted by the alliance or part of the system group. The alliance is a vehicle to share risks, responsibilities and opportunities. It is a way of working based on alignment around the outcomes and commitment to principles and behaviours. It’s not a legal entity. Participants retain their own identity and internal controls. Alliance principles All of the Alliance members commit to working to Alliance Principles: to assume collective responsibility for all of the risks involved in providing services under the Agreementto make decisions on a ‘Best for People using Services’ basisto commit to unanimous, principle and value based-decision making on all key issuesto adopt a culture of ‘no fault, no blame’ between the Alliance Participants and to seek to avoid all disputes and litigation (except in very limited cases of wilful default)to adopt open book accounting and transparency in all mattersto appoint and select key roles on a best person basisto act in accordance with the Alliance Values and Behaviours at all times. There are other key principles embedded in the Alliance’s service offer. You can download them (pdf format) here. Alliance Governance and Finance There are four levels of governance of the alliance: Commissioner as ‘owner’; the Alliance leadership team; the Alliance management team; the Alliance manager. All of the annual budget of £7.7 million is devolved into the Alliance. This includes some demand-led projects such as prescribing and bed and breakfast accommodation. The alliance is free to decide how it spends the money. Over time other budgets (which are currently aligned with the Alliance, but retained by budget holders) will also be devolved. GovernanceFinanceCommissioner as ownerSets the mandate outcomes and risk strategySets the financial envelopeAlliance leadership teamSenior members from the different organisations involved, including the commissioner, each with authority to commit on behalf of their organisationsDecide how funds are to be spent with the financial plan, monitor spend overall and report to the commissioner as ownerAlliance management teamKey people with subject expertise from each of the participating organisations (they link to a wider integrated team for delivery)Deliver within the funding available and compile financial reportsAlliance managerRuns the AlliancePresents composite financial reports to the Alliance leadership team Key changes A no wrong door approach, where someone can present at multiple points into the system and still receive the same high quality, consistent offerA system of complex needs workers who deliver support wrapped around the personA reduction in duplication and inefficiencySystem decisions being made collectively about resources using a ‘best for people using services’ principle and the ability to respond flexibly to need. Some initial results: Alcohol outreach prototype has delivered 44% reduction in admissions and 33% reduction in bed daysMany hostel residents are now in their own accommodation, which has reduced bed and breakfast spending by around £1/2 million.To respond with urgency to the Covid-19 Crisis the Alliance has made decisions according to two key principles – Is it legal? and Is it safe?Prevention of Covid-19 outbreaks among people supported by the AllianceLess than 10% no shows for drug addiction service Key Learning Change was based on an honest review of underperforming servicesThere was real engagement at different levels with techniques like appreciative enquiryThe alliance was born out of a process of collaboration – organisations working together (many for several years) before it was set-upThere were parallel processes of systems leadership work with local organisations and the formal procurementSenior sponsorship of the project was crucialOfficers and partners were able to draw on experience of other alliance contractsIt’s important to get the legal and procurement teams on board earlyIt’s important that partner organisation fully understand what they are signing up to in terms of jointly held financial riskIt takes a lot of people resources – from commissioners and partners What next? For further information contact: Rachel Silcock Strategic Commissioning Manager, Plymouth City Council (email or tel 01752 307 176). 5 Fundamental Correctives for Public Service Reform Read about the Five Correctives here or click the buttons below for descriptions of the outcomes of, process behind, underlying principles, and evidence for each corrective. 9 Key Principles for working with purpose-aligned partners Component principles for effective partnership working. Click here. Tools, Resources and Model Documents Example documentation, contracts, processes and agreements you can access – or use as a checklist as you progress your partnerships. These practical models and outlines include a set of social value imperatives. Case studies of purpose-aligned partnerships Examples of successful public service community partnerships delivering a variety of public services. See them here. Toolkit menu Back to the main menu of the Toolkit.
SUMMARY Plymouth City Council has developed a systems-based approach to supporting people with complex needs through the use of an Alliance Contract – with many benefits resulting. Gary Wallace introduces the Alliance in this short film (case study continues below). Traditionally, contracts had been commissioned in separate silos, often resulting in duplication, inefficiencies and poor outcomes for the person using multiple services. Twenty five contracts spanning substance misuse and homelessness were aligned under the co-produced Alliance model. Using an Alliance model, the focus is on creating systemic change to support a new relational way of working that really meets human needs. Partners share responsibility for achieving outcomes and are mutually supportive, making decisions based on the best outcome for the service user. The Alliance was awarded a single contract by Plymouth City Council for the provision of support for people who have needs in relation to homelessness and may also have support needs around substance misuse, mental health, offending and risk of exploitation. The Plymouth Alliance has made significant progress in process of transformation during its first year of operation and has been fundamental in providing support during the Covid-19 crisis. BACKGROUND The Plymouth Alliance contract focuses specifically on supporting people with complex needs. These are adults who experience several problems at the same time: for example, mental health problems, substance misuse, homelessness and offending, resulting in them living chaotic lives. In turn, there will also be a negative impact on families and communities and very often there is ineffective contact with the services there to support such people. A review of how support had previously been provided demonstrated uncomfortable truths for commissioners and services. Commissioning had been seen as a top-down, opaque and disempowering process, with a master servant relationship rather than an inclusive partnership between commissioners, services and people using services, as well as their families and communities. Commissioning was carried out in silos with little regard to what other silos were doing. It was commissioning for near horizons rather than as part of a long-term strategy and commissioning was seen as a problem setter, rather than a problem solver. Service users often felt done to, rather than worked with, and as a result, felt disempowered and marginalised. There was a mismatch between what workers valued about their work and what consumers valued: specialism and expertise versus authenticity, warmth and persistence. Services were largely unaware of the detail of what other services provided. The services collaborated by exception not by default. This work challenged commissioners and services to work together and in collaboration with people using the services. It showed there was a need for an iterative process to develop a new approach and for checking back with stakeholders regularly through the commissioning process. It opened the way for the prospect of a whole system of service, designed around the needs of people, rather than a fragmented market built around the needs of commissioners and services. Video presentation (case study continues below) – Rachel Silcock, Strategic Commissioning Manager at Plymouth City Council, describes the journey towards the successful Alliance contract, how challenges on the journey were overcome, and some of the impact and better outcomes which have resulted: Developing a new partnership approach Initially a year of systems leadership work took place with lots of appreciative enquiry, based on personal story telling. Commissioners, the voluntary and community sector collaborated and cooperated with a view to transformation. They participated in themed group activities, learning labs, and worked alongside one another in a sharing environment. Structures were only set up that could support a new culture. The Decision: an ALLIANCE CONTRACT The new complex needs model was co-designed by people who use the services, commissioners, the voluntary and community sector. It enables people to be supported flexibly, receiving the right care, at the right time, in the right place. Its focus is on creating systemic change: changes to culture, funding structures, commissioning and policy that will support a new way of working. The Plymouth Alliance has eight member organisations including the Council and seven other social enterprises and charities. All share responsibility for achieving outcomes and are mutually supportive, making decisions based on the best outcome for the service user. The Alliance can be viewed as a virtual organisation, where partners work collectively to create a collaborative environment without the need for a new organisational form. All parties are working to the same outcomes and are signed up to the same success measures. It is a relationship based on trust, transparency and collective accountability and the Local Authority is a member of the leadership team, enabling it to have an active role in the development of the Alliance. The Alliance Contract had a first year budget of £7.7m. The initial contract was for five years (from 2019) with a potential for extension to ten. FORMAL PROCESS Having decided to go down the route of an Alliance contract, the process took about year. A competitive procurement was run as a one stage process incorporating a Supplier Questionnaire (SQ) and Invitation to submit Initial Tenders (ISIT) followed by an Invitation to submit Final Tenders (ISFT). The SQ included both mandatory (pass or fail) and evaluated questions. One SQ was received from each member of the Plymouth Alliance. All of them exceeded the minimum requirements and therefore the Plymouth Alliance proceeded to have their ISIT evaluated. The submitted tender was evaluated by a team of individuals with various skill sets from across Plymouth City Council and NEW Devon CCG, in order to ensure both transparency and robustness. The tender process determined that the Alliance members had the critical knowledge and experience to provide the service and the considering all evaluation criteria they offered the ‘most economically advantageous tender.’ THE ALLIANCE IS NOT A LEGAL ENTITY – SO HOW DOES THE CONTRACT WORK? The contract covers: all substance misuse services,all services supporting homeless people contracted by the council,defined offers and asks with mental health servicesand a wider group of 20 other services either subcontracted by the alliance or part of the system group. The alliance is a vehicle to share risks, responsibilities and opportunities. It is a way of working based on alignment around the outcomes and commitment to principles and behaviours. It’s not a legal entity. Participants retain their own identity and internal controls. Alliance principles All of the Alliance members commit to working to Alliance Principles: to assume collective responsibility for all of the risks involved in providing services under the Agreementto make decisions on a ‘Best for People using Services’ basisto commit to unanimous, principle and value based-decision making on all key issuesto adopt a culture of ‘no fault, no blame’ between the Alliance Participants and to seek to avoid all disputes and litigation (except in very limited cases of wilful default)to adopt open book accounting and transparency in all mattersto appoint and select key roles on a best person basisto act in accordance with the Alliance Values and Behaviours at all times. There are other key principles embedded in the Alliance’s service offer. You can download them (pdf format) here. Alliance Governance and Finance There are four levels of governance of the alliance: Commissioner as ‘owner’; the Alliance leadership team; the Alliance management team; the Alliance manager. All of the annual budget of £7.7 million is devolved into the Alliance. This includes some demand-led projects such as prescribing and bed and breakfast accommodation. The alliance is free to decide how it spends the money. Over time other budgets (which are currently aligned with the Alliance, but retained by budget holders) will also be devolved. GovernanceFinanceCommissioner as ownerSets the mandate outcomes and risk strategySets the financial envelopeAlliance leadership teamSenior members from the different organisations involved, including the commissioner, each with authority to commit on behalf of their organisationsDecide how funds are to be spent with the financial plan, monitor spend overall and report to the commissioner as ownerAlliance management teamKey people with subject expertise from each of the participating organisations (they link to a wider integrated team for delivery)Deliver within the funding available and compile financial reportsAlliance managerRuns the AlliancePresents composite financial reports to the Alliance leadership team Key changes A no wrong door approach, where someone can present at multiple points into the system and still receive the same high quality, consistent offerA system of complex needs workers who deliver support wrapped around the personA reduction in duplication and inefficiencySystem decisions being made collectively about resources using a ‘best for people using services’ principle and the ability to respond flexibly to need. Some initial results: Alcohol outreach prototype has delivered 44% reduction in admissions and 33% reduction in bed daysMany hostel residents are now in their own accommodation, which has reduced bed and breakfast spending by around £1/2 million.To respond with urgency to the Covid-19 Crisis the Alliance has made decisions according to two key principles – Is it legal? and Is it safe?Prevention of Covid-19 outbreaks among people supported by the AllianceLess than 10% no shows for drug addiction service Key Learning Change was based on an honest review of underperforming servicesThere was real engagement at different levels with techniques like appreciative enquiryThe alliance was born out of a process of collaboration – organisations working together (many for several years) before it was set-upThere were parallel processes of systems leadership work with local organisations and the formal procurementSenior sponsorship of the project was crucialOfficers and partners were able to draw on experience of other alliance contractsIt’s important to get the legal and procurement teams on board earlyIt’s important that partner organisation fully understand what they are signing up to in terms of jointly held financial riskIt takes a lot of people resources – from commissioners and partners What next? For further information contact: Rachel Silcock Strategic Commissioning Manager, Plymouth City Council (email or tel 01752 307 176). 5 Fundamental Correctives for Public Service Reform Read about the Five Correctives here or click the buttons below for descriptions of the outcomes of, process behind, underlying principles, and evidence for each corrective. 9 Key Principles for working with purpose-aligned partners Component principles for effective partnership working. Click here. Tools, Resources and Model Documents Example documentation, contracts, processes and agreements you can access – or use as a checklist as you progress your partnerships. These practical models and outlines include a set of social value imperatives. Case studies of purpose-aligned partnerships Examples of successful public service community partnerships delivering a variety of public services. See them here. Toolkit menu Back to the main menu of the Toolkit.