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The 10 top issues with procuring behaviour change services

Posted by Amy Smith

Stressed man in an office with a sign asking for help

Commissioning services is a difficult, long winded, complicated and expensive thing to do. You have limited time and resource and are spending a lot of public money. The decisions you make can last for years and impact the health and wellbeing of people living and working in your locality.

After working in public health for 5 years and continuing to support commissioners from my role within PHE and as a provider, I have pulled together some of the key issues faced by commissioners in their words and from what I have personally witnessed. The blogs that follow this one in the Commissioning Series will delve into some of these issues in a bit more detail.

Books in a pile with an open one at the top

1. “As a commissioner, you often get advice from procurement to limit the word count for each section meaning you get limited responses.” 

This can seem like a good thing – however, it is the job of the providers to present meaningful information and not flood every answer with irrelevant information. It is a chance to demonstrate style, language and how good at engagement a provider is. Offering 300 words to describe how a service conforms with 20-odd NICE guidances is very tricky! Stay tuned for a blog on this specifically, as this has a big impact on the result of many tenders.

 

2. “The legal nature of the commissioning process means that it is difficult to get a ‘feel’ for the service because of the strict rules about engagement and clarification.” “The interview can be just a formality too!”

This is true, and the frustration of many a commissioner. When I did my procurement training, we had the life frightened out of us that if we did anything wrong at all, we could jeopardise the whole tender, have to start again and open the council up to being sued. It didn’t leave me feeling like I had a lot of room to ask questions and get a feel for the way it would be delivered or the true ethos of the providers. The interview should be a place to genuinely engage with providers to ask questions that help them get a feel for their organisation and the answers to specific and important questions.

3. Sometimes providers don’t want to show their hand during the ‘clarification questions’ period for fear of giving away details of their bid.

Having worked with a few partners and knowing most of the other providers in my field, I know that it is sometimes better not to ask a question, the answer of which will be made public, than indicate to competitors what you intend to do. I have certainly done this in the past for fear of giving away what we consider to be competitive advantage and know a lot of providers who do the same! This creates a situation where some guess work is involved but is a hazard of the way procurement works.

 

4. It isn’t something that you do regularly and so it can often feel a little overwhelming and not something that you are well-practiced at.

I know when we transitioned from the NHS to the local authorities, it was a big learning curve to move to this far stricter commissioning methodology. Colleagues are saying that this is improving as everyone in public health gets used to the process. However, a big criticism is that people move jobs regularly and so the learnings from one procurement process are often lost by the time this is repeated due to people moving on. Also, as this is something that happens so infrequently (average of 3-5 years in weight management), it is easy to become rusty even if you do repeat the process.

 

5. There is no repository where you can see all of the contracts that providers are delivering and whether they have hit the targets they set out to. 

You are assuming providers can deliver what they say they can, which is often not the case. It would be beneficial to have a source of information about past performance, however, who is incentivised to share the most crucial data – where providers have not delivered what they stated they would? Anomalies are understandable – we are dealing with the public after all – however, repeated missing of targets is not reported anywhere. There will be a blog about this coming soon too.

Homer Simpson saying 'D'oh!'

6. There is no incentive for you to admit any mistakes.

If the provider you pick doesn’t perform, ending a contract seems difficult to do within local authority legal processes and particularly since most are risk averse. It also feels drastic to end a contract as you have spent so much time executing the whole process. Who is to say that another provider would fare any better anyway? When someone is telling you there is nothing they can do about missing targets, does it feel mean to stick to the targets? A good commissioner should flex with the new information that presents, so how do you know when you are being told stories that truly justify a difficult but unavoidable situation, or just being told stories to cover a providers arse?

7. The scoring mechanism has a big impact and needs thinking through carefully.

The weightings applied to certain elements within the tender have a big impact on their outcome. Often, these processes are decided by 1% or 2%. A provider that you believe will do the job better could lose out because you over-prioritised something that won’t affect the delivery to the public as significantly.

 

8. Following on from number 7, clarity or purpose of KPIs is essential as it affects the whole life of the contract.

This might sound obvious. However, in a recent tender, the commissioners had been incredibly brave, aspirational and even inspirational, but it was clear that they didn’t have the KPI structure to give them the assurance that their money would not be wasted. So, the KPIs are focused on short term outcomes and not the long term outcomes we should be focused on. I will be producing a blog on this topic as it is fundamentally important if we are to see the genuine incentivisation of provider behaviour that actually acts in the interests of the people they serve and not the KPI itself.

 

9. The procurement tools and the way they are set up does not allow the ability to determine the nuance between providers.

The shorter the wordcounts, the less opportunity you have as a commissioner to determine the subtle differences in ethos and approach that might be all the difference on the ground. Many providers are likely to say very similar things in order to conform to the service specification. So, it is in the nuance, that you are likely to find reasons to commission or not commission a provider. Do the tools currently allow for this? If a service says it is ‘evidence-based’ and ‘compliant with NICE’, how do you know this is true? What does ‘compliant’ mean? It could mean all sorts of things but the commissioning tool being used rarely affords you the ability to make a distinction. If a service is being commissioned to change peoples’ behaviour, shouldn’t much more emphasis and weighting be placed on describing the full detail of this evidence-base and approach?

 

10. Using a ‘text-only’ procurement system.

We were recently informed that we had to upload all answers to a tender through a procurement system. I could sort of understand this if it is a legal requirement for reasons of fairness. However, this was not the reason. It was because it established a clear paper trail for the procurement lead. This is a prime opportunity to learn something about the potential providers that is missed. Providing a document – even if uploaded to the procurement system – means that commissioners can see the way an organisation writes, their attention to detail on presenting information and how this engages readers. In an industry like weight management (but really in any industry), engaging people is the whole point! Seeing how a provider presents themselves and their organisation is a key indicator of how they will approach the public too. Since recruiting people to most public health services is the principal issue, think twice about simply having them upload text to an outdated procurement system.

Summary

I have no doubt that these issues exist to varying extents within different organisations and that a range of none to all will be experienced by any one commissioner. If you have experienced any of these issues, subscribe to my blog below and I will be providing our take on some of the solutions that you can try to make sure you end up procuring services for the people you serve in your locality that they truly deserve.