This document discusses challenges with the current system for delivering Disabled Facilities Grants (DFG) and proposes adopting an alliance contracting model. The current DFG process is described as overly complex, with split responsibilities and costs across different organizations. This leads to conflicts and inefficiencies. An alliance model is proposed to foster greater collaboration across health, social care, housing, and other sectors through a single contract focused on outcomes rather than processes. Key aspects of an alliance contracting model are described, including shared governance, risk-sharing, and a focus on system-wide goals over individual organizational priorities. Adopting this approach may help reduce conflicts, costs, and stress while improving services for DFG customers.

1. National Body for Home Improvement Agencies
Improving Delivery of the Disabled Facilities Grant
Conflicts &
Friendships
A Relationship Perspective
DFG Roadshow Oct 2019

2. OT
LA
GO
HIA
DFG is
Process Heavy
 OT responsible for
establishing clinical
need.
 GO responsible for
protecting the public
purse
 HIA CW responsible
for advocating on
behalf of the client
Assessor
Facilitator
Enforcer

3. Health
Public
Health
Social
Care
Planning
3rd
sector
Housing
DFG
Services and budgets split:
 DFG, Community Equipment, Sensory Impairment,
Assistive Tech, Repairs, Wheelchairs.
 Overly complex for customers & professionals
Split Legal responsibilities
 Housing authorities have the mandatory duty for
the DFG
 Social Care has duties to older & disabled
people & disabled children.
 Health has a duty to respond all at the point of
need
Costs and benefits split:
 Capital costs - Central Govt and
Housing Authorities
 Revenue costs - Housing
Authorities and Social Care
 Overall benefits - Health and Social
Care
Cost-Benefit
Conflicts

4.  Essentially Parent/Child relationship
 Referee and fixer of disputes
 Multiple contracts to monitor
 Output not outcome drive
 Process costs/micro management
stifles change & innovation
 Risk are unfairly distributed
 Quality VS Cost trade-offs.
Commissioner
-Contractor
Tensions
Hierarchical, transactional
leadership

5. OT
LA
GO
HIA
Health
Public
Health
Social
Care
DFG
Housing
Customers
Customers

6.  1700 FTEs costing £76.5M (15% or 17% with man costs)
 Local Government Ombudsman activities
 120-150 statements/year
 1% but 50% higher than £1 spent on other
council services
 10 times more likely per household (0.3% vs 0.04%)
 Significant levels of work related stress
 High in Health, Social care & local government
 1/3 of all ill health at work
 Leading to average 31 day sickness
 Sclerotic processes
Costs of
conflict

7. Let’s Pull
Together!
 Shared Commitment to
Integrated Care & Support
(2013)
 Care Act Duty to Collaborate
 Better Care Fund (2014)
 National Memorandum of
Understanding on Health &
Housing (2015 & 2018)
 Collaborative HIA (2016)

8. A new way
to engage?
 Collaborative
 Co-produced
 Person-centred

9.  Provides a vehicle to share
risks, responsibilities &
opportunities
 Provides a way of working
based on alignment around
outcomes and commitment to
principles & behaviours
 Not a legal entity as Alliance
participants retain their own
identity & internal controls.
An
Alliance

10. Alliance Contract
AllianceTraditional contract

11. Governance Arrangements
Risk-sharing
Rewards
Performance
P1 P2 P3 P4 P5
Alliance
Contract
Structure
 One contract, one
performance framework
 Contract sets out
agreed outcomes and
relationships
 Strong Relationships &
Trust
 Aligned objectives,
shared risks
 Shared Responsibility
drives improvement
 Success judged on
performance overall
 Decisions are made
against principles
Alliance Contract
between all
parties
Alliance Participants

12. Alliance
Collective
responsibility
for all risks
‘Best for
Service’
Decisions
Unanimous
decisions on
all key
issues
‘ No Fault,
No Blame ‘
Culture
Open Book
Accounting &
Transparency
Appoint on
best person
basis
Act
according
to Alliance
values &
Behaviours
Alliance
Principles

13.  Alignment of Goals:
 Will achievement of Alliance Goals
lead to achievement of our own Goals?
 Alignment of Drivers:
 Will our own strategic objectives be
met by being a member of the
Alliance?
 Alignment of Commitment:
 Are we prepared to make collective
decisions & play our part in
implementing them?
 Alignment of Governance:
 Does the decision making, policy
setting & assurance role of the Alliance
fit with our own governance?
Organisational
Alignment

14. 14
Integrated
Governance
Wider Integrated Team
Alliance Management Team (AMT)
led by Alliance Manager
Alliance Leadership Team (ALT)
Commissioner
 Commissioner as Owner
Sets mandate, outcomes, risk-strategy.
Focus on system & Behavioural leadership
P1
Delivery
Teams
P5
Delivery
Teams
P2
Delivery
Teams
P3
Delivery
Teams
P4
Delivery
Teams
 Alliance Leadership Team
Senior members (including commissioner)
with authority to commit on behalf of their
organisations; One Leadership Forum to
replace contract monitoring
 Alliance Management Team
Key people with subject expertise from each
of the participating organisations
 Alliance Manager
Runs the alliance (‘go to’ person or CEO)

15. Collaboration
is….
 Making decisions
together
 Implementing
those decisions
 Being jointly
accountable the
results

16. Alliance
Contracting
 Drives Collaboration & Innovation
 Values Different Perspectives &
diversity of provision
 Democratic and equal: Everyone
has a say, decision making is
shared
 Single Risk Sharing Contract
 Integrated governance; principle based
decision making
 Performance Framework focused on
whole system outcomes
 Financial risk share through gainshare
& pain-share mechanism

17.  The Targeted Prevention Alliance
Stockport
 6 Community & Housing
organisations
 The Lambeth Living Well
Collaborative
 2 Charities, Foundations Trust &
ASC
Alliance
Contracting
A little closer to
Home

18.  Risk (and opportunity) share not
risk allocation
 The collective dynamic of several
interdependent features is unique
to alliancing
 Collaborative leadership skills
needed – from commissioners
especially
 Build relationships strong enough
to have hard conversations
Conclusions
“we thought we
were good at
partnerships. Now
we are working in
an alliance we
realise we hadn’t
really collaborated
before”

19. Alliance Logic Chain
Inputs Activities Outputs Outcomes Impacts
Switch
Resource
from contract
management
to service
improvement
 Alliance
strategy
 Governance
structure
 Alliance
members
 Alliance
agreement
 Greater
number of
people
helped to
stay well at
home.
 Reduced
Financial
Risks
 Fewer conflicts,
complaints &
stress.
 Greater
Systemic
Resilience
 Better
Communities
 Alliance
Principles,
Values &
Behaviour
 Organisational
Alignment
 Financial
framework

20. Interested in Exploring Alliancing?
FrancisP@Foundations.uk.com
Dr Linda Hutchinson LH Alliances: http://lhalliances.org.uk/