Approach 8: Delivery model design

June 2025 teaching template, slide 79

Approach 8 Delivery model design

Effective delivery models enabling effective practice

June 2025 teaching template, slide 80

Approach 8: Delivery Model Design

Introduction: Focuses on how services are structured and delivered to improve quality and citizen experience.

How to move toward: Engage users, map processes, and learn from service design innovations elsewhere.

What to do: Link design with real practice, co-develop models, and ensure practical implementation.

What not to do: Avoid rolling out untested models or becoming fixated on structure over impact.

Risks and issues: May challenge entrenched interests and stretch delivery capacity if not managed well.

Commissioning skills and structure: Needs design thinkers with operational understanding and credibility across services.

June 2023 adult social care pre-reading, approach 8

Strategic Commissioning Approach 8. Delivery model design

Effective delivery models enabling effective practice.

Introduction to this approach

This approach is paired with the ‘models and tactics’ commissioning aspect, and is about designing effective delivery models to support effective practice. It begins with a view that there are real savings and improvements to be made at the level of delivery model design. At its extremes, it can support an ideological view of how care should be delivered, but in general it considers that how the work is organised, governed, and delivered, is critical. This sees commissioners moving into, or working closely with those in, the service design space, undertaking customer journey mapping, empathy work, ‘citizen safaris’, ‘mystery shopping’ and so on, to understand the experience of care and to look for improvement opportunities at the process or organisational level.

Such an approach works best where there is enough access to services to work closely with those drawing on them, and enough control or flexibility to be able to direct their adaptation. This requires good working relationships between commissioners, managers, and practitioners.

How to move towards this approach

Building engagement with services and the skills to analyse structure and processes are critical for this approach, as is relating the ‘architecture’ of individual services to the bigger picture. An outward-facing view is also important to pick up examples of innovative models and technology – and lessons learned – from elsewhere. It is important that time and focus be allocated to delivery model design and therefore building examples of success and demonstrating the business case is critical.

What to do, and what not to do, when you are pursuing this approach

It is important to connect social care practice with strategic commissioning, and to be open to innovative use of technology and new business models to deliver, thinking carefully about how these are implemented. Consider yourself as co-designing with staff and service users, and seek to connect small experiments with larger, well thought through changes.

Do not get so focused on practice and structure that you lose sight of the gaps between different delivery models, and do not get so excited by innovative ideas that you end up implementing them for their own sakes.

Quality delivery, connecting with citizens as the main source of innovation, is at the heart of this approach.

Specific risks and issues

To be effective in this approach requires the freedom and credibility to engage at both social care practice and executive decision-making level. Be aware of risks of interfering with people’s power bases or disrupting expectations and ideology.

Take the cost of change and the capability, learning, and engagement of the workforce seriously, and spend time thinking about the real practicality of new ideas. Ensure you are scanning the landscape beyond your own council and learning lessons from elsewhere.

Considerations for commissioning skills and structure

To be strong in this approach, you will need sufficient expertise, experience, and credibility amongst commissioners to engage effectively with the social care workforce and their managers, and for commissioning to be seen as a partner to delivery. You will also need good data, feedback loops, and shared learning across delivery and commissioning.

A commissioning structure which follows the existing service structures is likely, and commissioning is likely to be more focused on adult social care. For that reason, you will need good mechanisms focused on working with and identifying gaps between services, and monitoring and understanding the whole journey of service users.

You also need commissioners who are full of bright ideas and constantly scanning the horizon, but practical. They need the credibility with senior managers and politicians that they can be trusted and deliver results, and need to build strong relationships with parts of the council like legal and procurement, and similarly manage partner relationships well.

Examples of this approach in practice

• Review of discharge to assess which identified that people were not being contacted following their discharge (along with other practice issues), and put in place alternative mechanisms to contact them as well as addressing other issues.
• One borough introduced technology-enabled care at home to reduce the requirement for residential care. This was introduced through service design study of homecare interactions and research into citizen needs, combined with an understanding of the potential of technology, and a business case for investment to reduce overall costs.
• A commissioner carried out interviews with service users in their own homes – seeing them in context and understanding their lives as a whole helped to significantly inform her work, and fed directly into small but significant changes to requirements when homecare was re-commissioned.
• A council was paying extremely high prices for mental health supported accommodation from specialist providers, and despite significant engagement, was not able to shape the offer from those providers. They therefore took the service in-house, starting on a small scale, using housing stock and both in-house and contracted provision for care. They have cautiously scaled up the service and are still learning the lessons from practice to feed into the overall model.

One thing to read

A radical new vision for social care – how to reimagine and redesign support systems for this century. Hilary Cottam. The Health Foundation 2021 https://www.health.org.uk/publications/reports/a-radical-new-vision-for-social-care