I have noticwed that some recent discussions talked about PCTs and commissioning. You might this artice of interest.

http://www.hsj.co.uk/news/2008/10/concern_as_pcts_stick...dHbf2M4ICzVqUH-IKI6$

Interesting article to flush out any more commissioning managers lurking in the forum (there must be more!)
I'm trying to avoid getting into a big discussion about decommissioning as I'm moving to a different DAAT in 2 weeks and don't want to set the hares running unnecessarily! (Which is also why I've been able to find a little breathing space to make a few posts-before disappearing again behind piles of performance reports, service specs and budget sheets-but having dipped a toe in a few times hopefully I can still chip in on relevant threads)
Obviously decommissioning is necessary sometimes-eg. persistent under-performance, treatment system redesign etc-but isn't always a magical solution-with TUPE it can be the same people delivering and managing the service only accountable to a different board.
having read the article, I do hope commissioning managers aren't going to be performance managed on the amount of de-commissioning they do!
I had a really interesting meeting with a service user last week going through my job description as she will be sitting on the panel to recruit my replacement. From her perspective the key things required are someone with some background knowledge of substance misuse issues, communication skills (with an emphasis on listening, not just talking and making presentations) and some kind of "quality assurance" role-ie acting on user feedback and taking issues to servie providers.
Another comment that sticks in my mind is a reply from Tony Birt to a question I asked about what makes good commissioning at a local conference-which was about "taking risks"-I'm not sure the PCT Director of Commissioning would agree but I think there's some truth in it.Any other thoughts on what makes a good commissioner/commissioning?
Final question-where will get good commissioning managers from in the future to work in the field? Should we be "growing our own" as it were, so that they will have some experience in the field rather than importing them from other fields-so that, for example, they won't be fobbed off by nurses saying "clinical governance"-can't do that! and will have creative ideas on what can go in the "other structured interventions" box?
Maybe we need our own forum too?!
tony

I share your concern Tony that from the tone of the article it looks like decommissioning is set to become the 'next big thing' as a crude measure of 'world class commissioning', and there is a suggestion in the article that it may be politically motivated by a desire to increase plurality of provider types - is sufficient attention being paid to improved quality? Decommissioning for the sake of it smacks of machismo and could even be seen as vindictive. Naming no names, I have witnessed recurrent recommissioning processes in one area which have naturally expended a great deal of time, effort and expense. Whilst there have been gains, there have also been losses, not least of morale and valuable expertise. I can't help asking myself, if I was working as a local provider, how much faith would I have that it would last this time? Or would I prefer not to wait and see, but to seek pastures new whilst going is good?

This message has been edited. Last edited by: susi,

Interesting replies. Tony hits one of the many nails right on the head - TUPE. These four letters haunt the re-commissioning process. That said, we have had some very productive service re-design and re-commissioning in the North West. We have had many permutations. Contracts have gone from one NHS Trust to another. From NHS trust to 3rd sector. From 3rd Sector to NHS. From one 3rd sector provider to another. Interesting times. Mark Gilman

Does that mean TUPE stands for Transfering Underperforming Projects Elsewhere

One recurring theme coming out of our current needs assessment and consultations locally is local delivery of treatment services, responding to the needs of different neighbourhoods etc-does anyone know of any areas where Practice Based Commissioning has enabled this-particularly devolving some budgets to be used more flexibly locally-and if so any locqal contacts from whom I could get more information?
thanks
tony

quote:

Originally posted by will-C:
Does that mean TUPE stands for Transfering Underperforming Projects Elsewhere

To most NHS staff it means losing your NHS pension that you might have paid into for many years.

I think huge benefits can come from recommissioning when its done well and for the right reasons. However having worked for both large and small providers I'd have to say that there is nothing more soul destroying that spending weeks working on a tender when you know the provider is just going to leave the contract with the incumbent ..... or opening a specification to find that instead of respecifying the service the commissioner has just written down the things the current provider does in no particular order and then added a couple of lines from Models of Care or the Orange Guidelines to make it look new ... or when you get to page 156 and you find a paragraph about boiler maintenance in the new building and realise the commissioner has done a cut and paste from a social services contract from 1987 for old people's homes and suddenly all those references to walking frames begin to make sense ... or getting to interview and finding that pretty much everyone on the interview panel wants to conduct the process in welsh ... or getting a set of TUPE information that suggests you might be asked to take over between a half and two thirds of 8 different consultant psychiatrists, 12 senior nurses and a small poodle called Henry all without hitting a "cash envelope" in the region of £78k pa.

The best tendering experience I've had has been when commissioenrs use a framework agreement and look for a series of collaborative bids from a number of local providers. This actually gives providers some room for creativity and stops commissioners from having to pretend they know everything.

Sara

The last post made me laugh- I inherited a few “cut and paste” specs produced by a consultant in my current post and had to work through them replacing “Walsall” with “Wolverhampton” and having lived and worked in Cardiff for nearly 20 years I know all about the challenges of the Welsh language legislation!
I think the key activity is writing the service specs-this is where the commissioner has to focus all their knowledge and skills-bringing together their knowledge of national policy (MoC, orange book etc), local needs assessment, consultations with providers, work collaboratively with service users etc—maybe this is why we have to pretend that we know everything?! Also there has to be a decision about what type of spec it will be-at one end of the spectrum there are “outcome” based specs, with just a few output targets but which leave the service provider to be innovative and at the other end the more “controlling” types of spec which specify inputs in great detail-eg. what posts there should be etc.
Most importantly I think the specs are the final point in a process-treatment system redesign needs to be collaborative and transparent and culminates in spec writing-maybe commissioners don’t need to know everything-just a little about lots of things?
tony

quote:

Originally posted by Simon Greasley:

quote:

Originally posted by will-C:
Does that mean TUPE stands for Transfering Underperforming Projects Elsewhere

To most NHS staff it means losing your NHS pension that you might have paid into for many years.

Might be interesting to link this thread with this:

http://wiredin.org.uk/practitioners/community/blog/entr...-sector-environment/

Sorry but I would rather lifes where saved from improving performance/s than saving peoples pensions. I know that might sound cold hearted but sacrifices have to be made and for too long the service users have been that lamb...

quote:

Originally posted by will-C:
Sorry but I would rather lifes where saved from improving performance/s than saving peoples pensions. I know that might sound cold hearted but sacrifices have to be made and for too long the service users have been that lamb...

Will,
TUPE means a new service have to take over the old staff, so problem staff if not managed properly will remain in place and performing badly.
I wonder sometimes whether we need to be pushing more services that aren't doing so well or providing better training.
I guess for some services re-commissioning and going to the cheapest bidder - if a commissioner did that could mean services get worse.
To have highly motivated and educated staff, there needs to be plenty of training, opportunities to develop a service for the better and a good reward package.
I imagine NHS Nurses - myself included would not be happy to lose many years of a final salary pension scheme and in fact I couldn't afford to do it.

Hi Simon, please excuse my naiveness, when it comes to decomissioning and the TUPE process. (Sounds like a wig, probably why the extremes) I can be guilty on line of snapping at things I don't fully understand. I have seen what you described a few times where the organisation losing the contract and new bid winner takes on the old providers staff either untill they can change them for the better or force them out over time, through changes in employment contracts.
Oddly today, I was looking through the Barnsley process maps of service provision;specifically GP prescribing as a model of simple to best practise, as my area is about 8 years behind you all out there.
My experience, has mainly been in working with charities with the Trusts as superior partner/leaders in clinical governance.

I think your bang on the nail, to many service who could benefit from a change in leadersip and out come performance targets are thrown aside for cheaper bidders, when a dose of stringent coaching and staff shifts could make the world of difference. I personally think the drug sector is infected with too many bullies and it doesnt matter how many organisations you yoyo the contract to, your gonna find the same narcisstic approaches. Its a bit like seeing the same old actors on the TV screen, program after program.

I had the privilege last week of hearing Steve Martin talk about influencing people. I was obviously thinking of influencing people to make positive choices around their drug use. Hopefully, they will want to 'recover' from their problems and move on. Anyway, Steve Martin of Influence at Work UK (I think thats right) was talking abou the unnisersal truths of influence. These include things like Reciprocity - you invite me to dinner at your house and I'll invite you to mine etc. But it also included Liking the person trying to influence you. I cant stop thinking how crucial this is in our line of work. I find it hard to like people I dont respect and I find it hard to respect people who dont tell the truth - who I dont experience as being authentic. I think this might be one of the reasons why one addict talking to another is such powerful medicine. It is so much harder to lie to someone you like. Someone who is like you.

By way of illustration Steve Martin talked about an experiment done on Halloween. Children knocking on a house door Trick or Treating were told "there is a box of sweets over there, help yourself but only take one please." Over 30% took more than one. The experiment was repeated only this time a mirror was strategically placed so that the childrne had to look in the mirror as they took the sweets. Less than 9% took more than one sweet.

There's discussion at present on other threads on this site (notably about Lighthouse closing) and on other sites like The Alliance's which touches on possible unintended consequences of retendering.

I think this lead article from Scanbites is also worth reading:
http://www.scan.uk.net/docstore/scanBites20.pdf

Cheers
Simon

I've got to the point of hearing just about enough of re-tendering.
Who is this going to benefit? Who is pushing it?
I'm sorry I only hear the bad things and I can't recall hearing anything good, is there anything good to hear?

All I see is a watering down of the professions to save money and I predict a worse patient experience.
People working in drug services who have no professional body are more easily pushed.
I'm predicting worse times ahead, the patient's will suffer and many good profesionals will be lost.

I wonder why there has not been any industrial action?

quote:

<snip>
I wonder why there has not been any industrial action?

Hmmm. What would such industrial action look like?

Probably because as professionals we do not want to bring a country already on the edge to its knees.

I was thinking about this issue on the way to the shops this morning, after watching the news since 4.00am due to my daughter propensity to be an early riser.
The Tories have said they would like to curb/cut public spending if they come into power, focusing their attention on the NHS. The head of the TUC was saying this is ludicrous in this current economic and financial climate as front line services need to be bolstered and not slashed to support any recovery from the recession.

Anyway my thoughts surrounded the mass inequalities faced by drug workers/services in the care field repetitively held ransom to whimsical funding streams and juggled tenders. The Police, Prison, Nurses, teachers, social workers and probation officers etc all walk out on strike, never have I ever heard of drug workers uniting and picketing a service or county council. We are like the dogs of war. The Liverpool Lighthouse is another victim along with the many more services who have been swallowed up over the past 3 years by loss of key tenders, over growth and faulty management.