Involving young people in the commissioning cycle, Dorset

Themes this local practice example relates to:

  • Youth
  • General resources

Basic details

Organisation submitting example

Dorset County Council – Children’s Services

Local authority/local area:

Dorset County Council


The context and rationale

Dorset County Council is working with young people to involve them fully in the commissioning cycle relating to specific services. This work aims to ensure that young people are as closely involved as possible in service planning and the commissioning cycle as a key element of service improvement. Three examples are given where young people have been involved in the commissioning process: the alternative education service, the sexual health strategy and the substance misuse service.

Background 

Dorset has made significant progress in capturing the views of children and young people, parents and carers and making sure these views are included in decision making; this ensures that services are better able to meet their needs. However, until recently, this work in Dorset has been limited to specific activity at particular points in the commissioning cycle. Even ‘though the work is at an early stage, piloting work is underway to engage with young people through a full commissioning cycle.

This work has been in two parts. 
Firstly,
• Development of a model of participation in the commissioning cycle.
• Working with both professionals and young people to map an eight stage model of commissioning against a range of activities which could take place. 
• Working with the contracts team within Children’s Services to embed participation within all services for children and young people.

Secondly, to pilot the model in specific work streams.

All Dorset County Council Children’s Services contracts now contain specific clauses around working to the Dorset Children’s Trust Participation Strategy. This includes providing opportunities where young people can be involved, workforce development, sharing of consultation information and completing a Participation Self-Assessment. This strong local commitment is reflected in the creation of a Strategic Participation Manager post within the Joint Commissioning Team.

Drivers for this work have included: 
• The premise that engagement with service users can ensure services are fit for purpose for those that use them. 
• The need to ensure value for money within the context of a challenging financial environment. 
• Continuous improvement within the wider participation agenda. Dorset has made significant progress on its Participation Strategy across Dorset’s services. 

This work has been recognised as ‘Outstanding’ for the area of “Making a Positive Contribution” for the full Ofsted safeguarding inspection which took place in September 2011. Ofsted was particularly impressed with Dorset’s Young Inspectors project (a team of young people trained and supported to inspect the services they use). The work around the commissioning cycle has been a logical next step.

The practice

Three examples where young people have been involved in the commissioning cycle are given below.

1. Commissioning an Alternative Education Service

Background
Dorset has provided alternative education through activities, for young people with a statement of special educational need. The contract with the existing provider was coming to an end and the service went out to tender. The initial phase was to ensure that the Service Specification reflected what young people needed from the service and four young people from a Pupil Referral Unit (PRU) were recruited to take part in a workshop. The workshop took place at a local youth centre, and was run by the Strategic Participation Manager with support from a member of the PRU staff and the Commissioning and Contracts Manager. 

Initial Workshop
The young people went through a step by step process of identifying their own needs, reflecting on the needs of their peers and then exploring how a service might respond to these needs. This concluded with a discussion about what knowledge and skills the successful organisation might need. (The session plan for the workshop is available from the C4EO team at C4EO team at the NFER). Using the notes from the session the young people made a short film which outlined what they wanted from an Alternative Education Service. The notes were written into the Service Specification in the words that young people had used. Those tendering for the service also received the film that the young people had made. They then had to respond to the young people’s specification by saying how they would meet young people’s expectations of the service.

Specification
This was done through a two hour planning workshop, again at the youth centre, with two of the young people from the first workshop and one young person new to the process, again from the PRU. The first activity of this session involved the young people grouping the key aspects of the service from their own specification into four different categories using a cards exercise. This enabled the young people to identify that the key aspect of their service specification was the ability of the successful organisation to build a relationship and this was used to set a presentation title for those tendering for the contract. They also used these categories to identify a set of questions to ask. The session also included information on being fair, objective and confidential. 

Tendering
All those tendering were invited to give a presentation to the young people about two weeks after the planning workshop, during a school day. This consisted of a ten minute presentation and a question and answer session. The sessions lasted about 45 minutes and were chaired by the young people themselves. These were observed by the Strategic Participation Manager and the Commissioning and Contracts Manager. The Young People’s Panel brought out some innovative presentation approaches involving films, animations, bright PowerPoint shows and handouts. One even brought along some farm yard animals! 

The young people fed back on all those tendering, identified their strengths and weaknesses and gave feedback on areas the adult panel might explore in more depth. They were also asked whether each of those tendering met with the young people’s original specification.

The feedback from the young people was passed on to the adult panel and informed their discussion at the end of the process. The contract was eventually awarded to an organisation that two of the three young people had said was the strongest. 

Contract Monitoring
In addition, it is planned that the Young Inspectors project will carry out an evaluation of this service twelve months into the contract. The service specification that was developed with the young people from the PRU will be used to form an inspection schedule against which the Young Inspectors can evaluate whether the service is providing what the young people stipulated.


2. Developing a Sexual Health Strategy

The Sexual Health Strategy brings together the activity of a number of different services and organisations and therefore the activity to involve young people was done in a number of different ways. 

Initial engagement
Through a number of professionals working with young people including the sexual health co-ordinators, young parents’ workers and school nurses, young people were consistently saying that there were changes needed to Sex and Relationships Education. This was reinforced through the Children’s Services Bi-Annual Survey and through the young people involved in the Teenage Pregnancy Strategy Group.

Sex and Relationships Conference
This enabled young people to identify the key issues for them around sexual health. A large number of organisations working with young people were invited to take part and the 25 young people who attended came from across the county and had a broad range of life experiences, including young travellers, young parents, those excluded from school and those Not in Employment, Education or Training. The event was positively reviewed by those attending and gave those responsible for producing a Sexual Health Strategy a number of areas to explore in more depth, including access to emergency contraception, provision of sex education, and the provision of information and literature. 

Young Inspectors
Young people have been involved in an inspection of sexual health clinics by the Young Inspectors. The Young Inspectors inspected three sites, all delivered in a slightly different way. The young people visited the three locations, completed an observational assessment and carried out interviews with staff. The feedback from young people provided a valuable insight into creating the right atmosphere, providing signage and access to the service and in making young people feel comfortable. 

Changes as a result of engaging with young people

• A single core Sex and Relationship Education (SRE) curriculum across Dorset
• Revised training programme with increased focus on working with young people
• Professional peer review of sexual health services for young people 
• Formal Standard Evaluation for SRE sessions (The Evaluation Form is available from the C4EO Team at NFER)
• Services are now Young People Friendly Accredited
• Extended the age range of those eligible for free Emergency Hormonal Contraception
• Involved young people in the development of new publicity materials and the website.

3. Commissioning a Substance Misuse Support Service

Two young people were recruited through an Information and Advice Centre. The young people took part in a preparation workshop to enable them to understand the commissioning process, the service specification, being fair and objective, and confidentiality. The young people were supported to identify what was important about the service for young people and to set questions accordingly. They then facilitated their own panel for the four organisations tendering to run the service. Again, the organisation that performed best with the young people was the one which was awarded the contract.

Whilst this piece of work did not involve young people throughout the commissioning cycle it was useful in developing an understanding of how to involve young people in specific parts of the cycle. The service will imminently be inspected by the Young Inspectors and the inspection schedule will be shaped by the information from the planning workshop and the questions that the young people asked during the tendering process. A key part of the inspection will be to establish from the service provider how the service has changed as a result of young people’s involvement.

Achievements so far

Clearly the focus of this work is to improve outcomes for young people from commissioned services, and where the involvement of young people led to a change to the service which improved outcomes. Tracking this is a difficult task. The value base used relies on the perspective of users; i.e., if they say a service works and is valuable, it increases the probability of getting good longer term outcomes.

Outcomes from the participation of young people with the Sexual Health Strategy

• Good quality and consistent SRE verified by positive feedback from young people
• More accessible services
• Increased hits to the website
• Increased take up of EHC.

The programme has been directly associated with an increased take up of services which, alongside other factors within the local strategy, have contributed to reduction in teenage pregnancy in Dorset.

Further work with young people is needed around contract monitoring and those services where young people have written a specification will be inspected by the Young Inspectors programme, using the young people’s specification as the basis for the inspection schedule. As part of Dorset’s contract monitoring, proxy outcomes will be used as indicators that services are increasingly responding to young people’s needs, rather than long-term outcomes which are far harder to measure. 

Organisational Change

The NHS at senior level has signed up to and created a pooled budget to fund the Young Inspectors programme and are more committed to Young People Friendly standards. The work of the Young Inspectors has informed other commissioning work beyond the specific services that have been inspected including provision of information advice and guidance, Connexions Service and the Transport Action Plan. Furthermore, this approach has gone beyond young people, and parents and carers have been engaged to the same principles, including parent engagement in commissioning of parent support programmes and the development of a Parent Evaluators Group in early years.

The Dorset Children’s Trust Board has regular agenda items looking at issues from young people and all papers to the Board have service user involvement at some level. The Dorset Safeguarding Children’s Board gave over the morning of their annual planning day to young people and young people are now involved in two of their key work streams around Young Carers and E-Safety. 

Benefits

Improved understanding of young people’s perspectives and the link between commissioning values and practicalities of involving young people
A closer working relationship between the Strategic Participation Manager and the Commissioning and Contracts Manager has created a mutual understanding which ensures the sessions with young people are increasingly able to elicit the information which is valuable to commissioners, ensure the specification is correct, and that the young people that use the service get what they need.

Confidence in the Commissioning Process
A separate panel of young people during tendering has added a different dimension to this phase of commissioning. Commissioners have been able develop a deeper understanding of organisations that are tendering and to see how they interact with young people. The panel has also encouraged people to be more creative in how they present and to encourage them to involve the young people they work with. During the tender process for both the substance misuse service and the alternative education services, young people were listening to personal testimonies from young people currently using a service from the tendering organisation. Ultimately Dorset has increased confidence that it has contracted the strongest organisation to deliver the service.

Message to the Market
Dorset is modelling the good practice it expects from service providers. Setting standards and benchmarking in this area is likely to become increasingly significant as new approaches to the provision of children’s services through localism and a greater diversity of public approaches becomes established.

Personal Development and Social Education of the Young People involved
The young people involved have all been able to identify positive outcomes from their involvement. The benefits are personal to the individual but young people have identified increased self-confidence, greater communication and presentation skills, analysis and problem-solving which feed into work around increased resilience. There has also been an increased knowledge of research, local government and commissioning, all of which lead to increased employability. Anecdotally, we know that young people involved in commissioning have gone on to express their views in consultations, attended conferences and assisted with recruitment and selection. The Young Inspectors programme has so far accredited 34 young people since 2009.

Replication

Barriers/ challenges and Learning from experience

Commissioners need to maintain a network of frontline practitioners and accessing ‘hard to reach’ young people
It has been essential to engage with young people who are likely to use, or who have used, the service. Networking with other professionals has been vital in achieving this and enables young people from a wide range of backgrounds from across Dorset, to be involved. 

Accessing ‘hard to reach’ young people and maintaining their involvement
A number of actions are in place to maintain the trust of these young people with professionals, which includes the development of: “Our Say”, the Dorset Participation Charter, which advocates: 
* Use youth centres as the venue for planning sessions
* Use games and activities to break down the process into ‘bite-size’ pieces
* Provide incentive and rewards to their participation in line with our Incentive and Reward Guidelines. 

The Participation Charter and Incentive and Reward Guidelines are available from the C4EO Team at C4EO team at the NFER

Provider pre-conceptions
Some providers have been concerned that young people may be biased either from experience of the existing service provider or experience of a service from those tendering for a contract. This has been mitigated by:
• Preparation of young people has focused on the kind of service they need, the issues that young people likely to access the service face and the values, knowledge and skills that anyone providing the service should have. We have specifically avoided, wherever possible, an evaluation of the existing service, when preparing the young people’s service specification.
• Involving young people who are ‘arms length’ from the service. A cross-section of those that have experience of an existing service provider, experience of similar services and experience of none create a balance expertise and objectivity.
• Training and preparation included fairness and objectivity, as well as equality and diversity which opened up discussion about which factors young people could use to inform their judgements and which they could not.
• Having the courage to defend our process where there have been objections, highlighting the above.

Procurement Rules and Legal Challenge
Legislation and procurement guidelines mean that final decisions on how a contract is awarded must be made by officers of the local authority and can potentially be subject to legal challenge. Therefore young people must be enabled to influence the decision making without their views being given a weighting in the process. We have overcome this with clarity about status; young people advise commissioners who use their involvement to closely inform their decisions. The young people’s specification ensures that the service is designed around the needs of young people as defined by them.

Proportionality
A challenge has been deciding the proportionality of young people’s involvement. When services have a high level of contact with young people, it is entirely appropriate to carry out the intensive work described in the case studies. However, for commissioning back office functions, or contracts of a small value, it is not proportionate. Dorset is considering developing a checklist which will enable contract managers to decide the level of involvement young people should have.

A diagram of the commissioning cycle mapped against service user engagement is available from the C4EO Team at C4EO team at the NFER

Costs and Potential Savings
Exact figures for this work are difficult. However, below are the estimated figures for the additional cost to Dorset of engaging with young people, set against the total contract values for two of the examples above. The cost of involving young people includes activities, transport, venues, refreshments and incentives and rewards, as well as the additional staff time that has gone into the tendering process. This staff time includes a calculation for both the direct work with young people, and the planning and preparation time, as well as on-costs. 

Alternative Education Tendering
Cost of involving young people £1,380
Total contract value (over 3 years) £405,822

Substance Misuse Tendering
Cost of involving young people £1,020
Total contract value (over 3 years) £405,648

Sexual Health Strategy 
Cost of involving young people £4,360

In relation to these two examples, clearly the spend is low, relative to the total contract value. However, where this work becomes very interesting is in examining the potential savings that could be achieved as a result of changes to a service through involving young people, particularly as all three examples, are of services with a preventative role.

Regarding the Sexual Health Strategy, one outcome was an increased uptake in Emergency Hormonal Contraception, which costs around £100 per prescription. This compares with a cost of £1000 for a termination and £11,000 cost to the NHS in the first year of a new born baby. The NHS’s own estimates are that £1 spent on contraception saves £11 on future service delivery. These figures do not look at the longer term impact to the public purse of providing benefits, housing and lower tax yield as a result of teenage pregnancy.

The Alternative Education contract plays a role in supporting vulnerable young people with a Statement of Special Educational Need. The successful contractor provides approximately 34 sessions per week and between 20 and 25 young people per year benefit from this provision at an average cost of £5,400 per person. Dorset estimates that 50% of the young people supported by this contract might have otherwise been placed out of county at a potential total cost of £800,000 to the SEN budget each year. The service plays an important role in reducing exclusion from school. An article in the Guardian in April 2012 highlighted that a placement in a mainstream school costs £4500 per annum whereas a placement in a Pupil Referral Unit costs up to £16,000, underlining the investment in this service. 

The Substance Misuse Support Service supports young people whose drug and alcohol misuse makes them vulnerable and is a Tier 2 service. The contract provider works with 250 young people per year. So typically, each young person costs £540. Looking at where the service might provide potential savings, a young person whose needs escalate to a drug treatment programme might cost around £2,000. However, where a young person takes a drug dependency into adulthood this might multiply many times over. Furthermore, where a dependency leads to a prison sentence, the cost runs to £800 per week. Alternatively the Substance Misuse Service might enable a young person to avoid permanent exclusion from school which would incur the costs mentioned above.

Best practice in participation cannot stand alone without high quality and robust approaches to commissioning and procurement. However ensuring that the specification is in line with young people’s needs, increases confidence that strong and appropriate suppliers will be awarded contracts and that the market is developed in line with the needs of end users.

C4EO Golden Threads

Together with children, parents and families – involve service users 
This is a very obvious Golden Thread to highlight, since the whole thrust of the work is that only by working with young people can we genuinely understand how they receive services and what they need from them.

Culture not structure – learning together Again this Golden Thread has been vital to this work. We have not been able to achieve what we have done as a result of our structures, but rather as a shift to a culture of a child-centred approach. A lot of work has gone on to win ‘hearts and minds’ to create a culture in which practitioners and managers subscribe to a culture of participation.

From good to great – leadership, vision and embedding is key
The third thread to pick up on is that leadership and vision has been key to this work, starting with the decision to create a post with a strategic lead for participation. Beyond this, work has gone on increase the opportunities to be involved in decision making, to develop our workforce, to set standards which define meaningful participation and to involve young people at a strategic level and within service planning and commissioning.

Core leadership behaviours
Eight core behaviours have been identified as part of successful elements of leadership (see National College for Leadership of Schools and Children’s Services/C4EO (2011). Resourceful leadership: how directors of children’s services improve outcomes for children. Full report. Nottingham: NCSL. 

Those that apply to this local practice are:

The ability to create and sustain commitment across a system
The foundation for this work has been all of the background work to create a participative culture. Ensuring that both practitioners and managers are committed to the meaningful involvement of young people has created the environment in which Dorset has been able to start to build young people’s involvement into the commissioning process.

The ability to simplify
The ability to simplify has been crucial to this work stream. The legal and administrative processes that apply to commissioning are immensely detailed and complex. However, by focusing on the needs of the young people who are going to use the commissioned service, the processes have fitted around what is needed. Furthermore, simplification has been vital in breaking down each stage in the commissioning cycle into terms young people can understand and engage with.

The ability to learn continuously
Again being able to learn continuously has been vital to the progress Dorset has made with this work. The sessions with young people, the activities and materials we have used has developed and evolved over time. We have also learnt a great deal about service user expectations and how in services for vulnerable young people vital the relationship with professionals is, and what behaviours make this work.

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