Commission a HIA

Although many Home Improvement Agencies are now provided in-house rather than externally commissioned, there are a number of reasons why a Council may choose to commission an HIA from an external provider. This section provides an overview of the commissioning cycle for HIAs, which will be useful not only for Councils considering commissioning an external agency to deliver their HIA but also for Councils planning to review their current provision.

These pages also include a section on Alliance Contracting as a way to commission and deliver joined-up services locally. Where a Council is commissioning an HIA externally we can support both commissioners and providers during procurement exercises by deploying different Regional Advisors and implementing a ‘Chinese wall’. Foundations’ Regional Advisors are also able to provide advice and support with reviews of HIAs which may not necessarily be part of a formal commissioning process.

Commissioning is now one of the most used phrases in local and national government, but one that is not often understood. Commissioning is the process by which needs and problems are assessed and solutions are then designed and implemented to deliver positive outcome.

There are a number of important and overlapping phases throughout the commissioning process. Often different names are used for the different stages and the amount of stages can vary, but a typical commissioning cycle will feature:

Foundations can support commissioners throughout the commissioning cycle with a range of tools and resources as well as advice and information from our network of Regional Advisors.

For providers, these resources will help you to understand the commissioning process and how you need to mould your services to meet the requirements of commissioners. This article from the Kings Fund provides an overview of health and social care commissioning and also outlines how the commissioning landscape is changing.

The wider context

It is also important to understand the wider context within which services are commissioned and delivered. All service design should be person-centred and flexible, with an approach which seeks to engage with users of the service, building on what they can do and what they want. This is often referred to as an asset-based or strength-based approach. The objective of the strengths-based approach is to protect the individual’s independence, resilience, their ability to make choices and their wellbeing. Supporting the person’s strengths can help address needs for support (whether or not they are eligible for care and support as a the result of a care needs assessment) in a way that allows the person to lead, and be in control of, an ordinary and independent day-to-day life as much as possible. It may also help delay the development of further needs.

The RCOT publication Making Personalised Care a Reality also highlighted this approach noting that ‘in order to ensure that people ‘live the life they want’, practitioners in health and care, people in receipt of services, and their carers, must work together to embrace risk-taking to achieve positive outcomes. In addition, services must move away from an approach that focuses on needs and problems to one that works with people to establish the strengths and assets that they bring to achieve positive change in their lives’.

The commissioning of services should be based on a clear understanding of the outcomes that are to be achieved. This is usually referred to as outcome-based commissioning. The Integrated Commissioning for Better Outcomes framework supports the general integration agenda across health and local government. It is intended as a practical tool in the support of improved outcomes though integrated commissioning.

Another useful tool in supporting this approach is the theory of change. A theory of change shows how you expect outcomes to occur over the short, medium and longer term because of your work. It can be represented in a visual diagram, as a narrative, or both. A theory of change can be developed at the beginning of a piece of work (to help with planning), or to describe an existing piece of work (so you can evaluate it). It is particularly helpful if you are planning or evaluating a complex initiative but can also be used for more straightforward projects.

There is a wide range of data available on which to base a robust needs analysis. Much of this data may already be available within a local Joint Strategic Needs Assessment (JSNA).

Homes for health – strategies, plans, advice and guidance about the relationship between health and the home (Opens in a new window)

Public Health England also hold a wealth of data including Local Authority Health Profiles which provide an overview of health for each local authority in England. They pull together existing information in one place and contain data on a range of indicators for local populations, highlighting issues that can affect health in each locality.

NHS England’s Quick Guide: Health and Housing – practical resources and information for Clinical Commissioning Groups on how housing and health can work together

Other sources of data include:

Projecting older people population information

Projecting adult needs and service information

Health and wellbeing in England: a focus on housing

Productive Healthy Ageing Profile

The Housing LIN’s Strategic Housing for Older People (SHOP) Analysis Tool

Another key aspect of needs analysis is mapping existing services and identifying gaps. This is likely to include researching:

• The range of current providers – public, private and third sector
• Types of services delivered
• Location of services by district/local ward
• Discussions with stakeholders
• Good practice
• Early prevention

At Foundations, we have mapped home improvement agency services across England and can advise on good practice.

In terms of the ‘commissioning cycle’, development refers to the development of the range of providers able to meet demand for a particular service, which may also be referred to as ‘market shaping’. The Care Act introduced new duties on local authorities to facilitate a vibrant, diverse and sustainable market for high quality care and support in their area, for the benefit of their whole local population, regardless of how the services are funded. An element of this is the development of a Market Position Statement, and the Care Act states that commissioning and market shaping should be a shared endeavour, including the production of Market Position Statements:

“Local authorities should take the lead to engage with a wide range of stakeholders and citizens in order to develop effective approaches to care and support, including through developing the JSNA and a Market Position Statement”.

The development of the local market may be particularly important for people whose homes may need adapting but who, for a number of reasons, may not apply for a Disabled Facilities Grant.

Foundations can assist commissioners to develop services through:

Soft market testing: an informal, and generally confidential, conversation with sections of a perceived market. Invited participants are interviewed to gauge market interest in a proposed service, and to help shape it to ensure it would be deliverable once brought to market. Soft market testing is not part of a formal procurement process.

Commissioning for outcomes: meaning the long-term changes that services and other activities achieve.

Co-production: to make services more effective and customer focussed, by working in partnership with the people using their services. Think Local, Act Personal has some useful information about this.

Social value: placing social, environmental and economic outcomes at the heart of commissioning.

Procurement is where a commissioner chooses a provider to deliver a service, usually based upon a written specification. There are four types of procurement procedures in common use across the public sector:

The open procedure: You’ll be asked to return a tender by a set date. All tenders will be evaluated before the contract is awarded. This procedure is often used by local councils.

The restricted procedure: This is a 2-stage process. In the first stage, interested providers are asked to fill out a questionnaire and a short-list is drawn up. In the second stage, the shortlisted providers are invited to respond to an invitation to tender (ITT). The tenders are then evaluated and the contract awarded.

The competitive dialogue procedure: This procedure is used for more complex procurements. After a selection process, the buyer then negotiates with providers and invites chosen companies to put in a bid. Providers put in their tenders and the contract is awarded.

The negotiated procedure: In this procedure, the buyer enters into contract negotiations with one or more providers.

The Local Government Association is developing a new National Procurement Strategy for Social Care Services (opens a new window) and a range of tools for use by local authorities. These will reflect the intent of the Care Act 2014, the Children and Families Act 2014 and Commissioning for Better Outcomes. The strategy and tools will give procurement officers and commissioners ways to develop integrated commissioning and to develop provider markets in their area.

Of particular interest are:

• Myths about procurement: (opens a new window) a resource to share with stakeholders which is designed to promote a better understanding of the powers and restrictions of procurement

For providers, there are some great tendering tips on the Tenders’ Direct Blog. (opens a new window)

An alternative approach to these procurement approaches is that of Alliance Contracting based on a collaborative approach to commissioning services.

Alongside the traditional commissioning and procurement exercises, more collaborative approaches to getting the services needed in local areas have emerged. Alliance contracting aims to provide a means to construct a more mature relationship between commissioners and provides, generate better outcomes in complex systems such as local DFG programmes and ensure better division of risks for everyone involved in providing HIA services. It is becoming increasingly common in the health and social care economy as it explores the means to deliver better outcomes for a range of people reliant on its services.

Alliance contracting is not a means to circumvent procurement rules governing the public sector. Instead it is a way to ensure a range of providers in the housing, health and care sector work together better in a common framework. At a time when we are seeking to integrate housing, health and care services better, a formal alliance may just be what will help you concentrate on service improvements rather than contract management.

An Alliance contract replaces the traditional bilateral contract between providers and commissioners with a group of equal partners committed to achieving the outcomes agreed rather than the outputs contracted.

 

In a traditional contractual relationship, funders tend to try and retain as much power and control as possible whilst pushing the risks onto providers. Furthermore, because rewards are based on fulfilling the contractual outputs, providers do not feel free to make service improvements without express permission from the funder.

Alliance Principles

Regardless of whether an alliance is formed between local authorities and third sector providers or between statutory service providers across a local Health Care and Housing system, there are a number of principles underpinning an Alliance:

• Alliance partners assume collective responsibility for all the risks involved in providing services under the alliance agreement
• Decisions are made on a ‘Best for Service’ basis. That means that agreed strategic outcomes trump narrow self interest of any one partner in the alliance.
• Decisions are made unanimously by all partners in the alliance and are principle and value based.
• An alliance adopts a ‘no fault, no blame’ culture between participants and will seek to avoid formal disputes except in the very limited case of wilful default.
• An alliance operates open book accounting and transparency in the conduct of its business.
• In an alliance all participants act in accordance with the agreed Alliance Values and Behaviours at all times

An Alliance Contract enables diverse stakeholders to work to a common goal within complex systems and supply chains. It embeds collaboration by enabling joint decision making, the most rational implementation of those decisions and joint accountability for the results. A well-functioning Alliance will impel collaboration and service improvements. As participants retain their own legal entity and internal controls, an Alliance values diversity of perspective and promotes a diverse range of services. Finally, an alliance promotes equality as everyone has a say and decision making is shared. More information on alliance contracting can be found here.

Alliance contracting approaches have been adopted by a number of commissioners in Health and Care.

Lambeth

Lambeth Together will help Lambeth residents lead healthier lives, and give them better access to health services. It will also mean big improvements for staff working in health and social care. Lambeth aims to bring services together based on people’s needs and where they live. In Lambeth there are four ‘Delivery Alliances’: Living Well Alliance, Neighbourhood and Wellbeing Alliance, Children and Young People’s Alliance, and the Personalised Support Alliance.

Stockport

The Prevention Alliance provides early support for anyone who is vulnerable due to their health, wellbeing or situation, with the aim of preventing things from getting worse and enabling them to work towards independence, whatever that may look like. Highly personalised, caseworkers from 6 community and housing organisations work with people on a range of issues including physical wellbeing and their housing situation.

Plymouth

A ‘Complex Lives’ Alliance brought together by the City Council and including 7 Community organisations and Plymouth Council to tackle homelessness, drug or alcohol misuse, mental illness and offending.

Delivery

The completion of the procurement exercise is when the real work begins, and services start to deliver outcomes.

Foundations can assist with:

• Implementation planning and support
• Accreditation / Quality Mark assessments
• Training and events

DFG audits and service reviews. Over the last two years Foundations has conducted several reviews of adaptations services and HIAs including for Newcastle, Gateshead, Slough and Bracknell Forest. DFG audits and service reviews are generally free, but Foundations may charge for more extensive reviews. These are usually subject to a tender or can be agreed by negotiation.

DFG Mentors. Through the DFG Champions Facebook group, it is possible to be linked up with a DFG Mentor. Mentors are people with a range of relevant skills and experience who have offered to act as mentors. Any DFG Champions Facebook Group member can ask someone to mentor them when they see that person listed as a mentor. Here’s how the programme works:

You sign up, match yourself with a partner and get helpful conversation starters each week so that you get to know each other better. It’s up to you how much time you want to spend together and what goals you want to work towards.

Details of mentors can be found on the DFG Facebook Group.

Service reviews may either conclude a procurement cycle or be part of the work which initiates a procurement cycle. Foundations has a number of tools which can be used to support service reviews.

Foundations has developed a Quality Standard. The DFG Quality Standard sets out what ‘good’ should look like by taking little pieces of good practice and fitting them together like a jigsaw puzzle to build the bigger picture. It’s intentionally brief so you can see that bigger picture without getting lost in the detail. You can download a free Quality Standard checklist from Foundations’ website. You can use this to carry out a do-it-yourself review. Alternatively you can ask one of Foundations’ Regional Advisers to work with you on this.

The Foundations Quality Mark is the recognised seal of approval for Home Improvement Agency and Handyperson Services. The Quality Mark was originally designed as a passporting assessment for the Supporting People QAF, and has always been informed by those working in the sector. The latest version of the Quality Mark, being rolled out from June 2019, includes new objectives around DFG transformation (if applicable), consumer rights, and alternative dispute resolution.

The documentation also now includes interactive links to example documents and on-line training resources, to ensure you get the most out of the assessment process.

To take account of the increased emphasis on information and advice provision in the Care Act, HIA Quality Mark now acts as a feeder qualification for onward progression to obtain the Advice Quality Standard (AQS).

Foundations’ Regional Advisers are available to support local review processes. This can include:

• supporting the local process of completing the Quality Standard checklist
• undertaking a DFG ‘audit’
• undertaking a comprehensive service review.

Support and advice from Foundations’ Regional Advisers is usually free. Where a comprehensive service review is required a local authority may either negotiate a fee directly with Foundations or tender the review and invite submissions.

For more information please contact one of our Regional Advisers.

Outcomes

A commissioning review should include consideration of how and what outcomes are to be measured and evaluated. This is important in order to be able to produce an evidence base so that you can demonstrate the impact of your service and to be able to help shape further change and development. The need for ‘improved local reporting focussed more on outcomes’ was one of the recommendation contained in the national DFG Review, published in 2018.

The Royal College of Occupational Therapy (RCOT) has produced a helpful introduction to measuring outcomes, including a brief overview of some commonly used outcome measures. The Housing Associations’ Charitable Trust (HACT) have carried out work on measuring social impact in the housing sector. At the core of the approach is a set of values derived through the Wellbeing Valuation approach.

Foundations’ training programme includes a course on A Beginner’s Guide to Outcome Measures.

We collect a range of data about Home Improvement Agencies to track how the sector changes over time. This page provides a snapshot of the HIA Sector.

HIAs are managed by a diverse range of organisations. This pie chart shows the share of managing agents based on number of districts covered.

In 2016 we asked HIAs which services were most important to the ongoing viability of their organisation. Home adaptations and handyperson services topped the list.

The majority of Council areas in England maintain HIA services

 

1. Map with home improvement agencies vs. Statutory duty only 

There are currently 315 housing authorities listed in England, all these authorities have a statutory duty for providing the DFG. There are 148 Home Improvement Agencies accredited by Foundations. Some of these cover more than one local authority area. 

 

2. Map with In House:

Generally, Home Improvement Agencies can be categorised as In House and Outsourced. 
101 were listed as In House, and as Outsourced

3. Map with outsourced breakdown:

Those which are outsourced fall under the categories: Registered Provider (RP), Independent and Private Sector Provider. Currently, 12 are Independent, 29 are Registered Provider and 6 are Private Sector Provider.

4. Map with Private sector providers 

There are 6 Private Sector accredited Providers. 3 are contracted: Millbrook, Mears, ENGIE.
There is also: DG Accessible Designs which is spot-purchased by 7 districts, Happy Energy and Eastern adaptations