Long live commissioning

Benjamin Taylor in the Municipal Journal

https://www.themj.co.uk/Long-live-commissioning-/221192

Commissioning is dead. So why the hell won’t it go away?

In fact, this piece is in a long tradition of articles headlined ‘Commissioning is dead, long live commissioning’, right back to 2012 (and commissioning was only really introduced in its modern form in about 2010). The answer is that ever since it was introduced, it has been trying to deal with too many problems at once. And those problems won’t go away.

There are two fundamental ways to see ‘commissioning’: first, as spending (ever-decreasing) money to pay for services to meet (ever-increasing) needs. This feels a lot like procurement. It means that every time the ‘purchaser/provider split’ is criticised or ‘removed’ (again), it sounds the death knell for commissioning, and it is not as sexy as ‘commercial’, which in central Government, at least, has taken the crown for deal-making, contract management and (in theory at least) shaping markets.

This concept of commissioning is what Dr Carolyn Wilkins, chief executive of Oldham MBC, illustrates by talking about procuring street cleansing services. It is worthwhile, complex, and a tough job that needs support and training.

Second, as working on how to shape complex systems for better citizen and community outcomes, this is expansive, constructive, and essential. It is at the heart of ‘building back better’.

It makes commissioning a far more humble endeavour – but paradoxically generates more potential power. And it is top of everyone’s agenda – we can’t rebuild the high street, ‘build back better’, tackle childhood obesity, do community wealth-building, integrate health and care, or deal with any complex situations, without recognising that we are in the game of influencing complex systems. And our budget – the thing that, in the first model, makes us the god-like creators of the universe – is actually a tiny part of the bigger picture.

Spend on pre-school support, advice, and ‘settings’ is a tiny proportion of what influences whether or not kids are prepared for reading and society when they start school. And in Dr Wilkins’ example, if you think about commissioning for clean streets, you are immediately playing on a bigger stage – thinking about urban design, litter bin design, location, enforcement, responsibilities of citizens and shops that sell ‘litter’, etc.

The second mindset is what we have been attempting to offer in the Cabinet Office Commissioning Academy for nearly ten years. It can include the first, which gives rise to a lot of the confusion (working on clean streets means you will still need to procure street cleansing – just that it isn’t the entirety of the system you think about).

So associations of commission with procurement, the ‘purchaser/provider split’, competitive tendering, and outsourcing won’t go away, and the integrated care White Paper removes the NHS reforms which were most symbolic of this.

Procurement, commercial, and contract management are still vital and under-invested skills, especially with the procurement Green Paper shaking things up, and social value continuing to develop and offer real possibilities.

Commissioning is here to stay because it is a way of thinking and a way of working that is vital for the real challenges we are trying to deal with in local public services.

We are increasingly working with people doing place-based change, integrated care systems, and general integration. Some examples include:

• Working with a range of local authority and police and crime commissioners around domestic abuse. Though it is true that need is growing, and funds are very much insufficient, it quickly becomes clear the immediate problem with the system is lack of joining-up across agencies (despite strenuous efforts), and people falling into the gaps, being passed around, and horrendous situations being repeated at enormous public cost. creating enormous trauma and family problems. The challenge is making the system a true one, rather than less than the sum of its parts.
• In our Leading Greater Essex work, which we are co-delivering with Collaborate, groups from across the county and cross-sector are developing challenges as varied as linking anchor organisations to the green economy and childhood obesity. These tie in to the overall board priorities, with a nominated champion for each project, and the learning is as much about how to make the system work better as the challenge itself.
• In Kent and Greater Manchester, groups have self-selected their own challenges, from building co-production into all their work through an accessible toolkit, to digital inclusion and special education needs and disabiities. These are examples of ‘power in the middle’ – with or without senior leaders, groups empowering themselves to take action to progress strategic issues.
• Another county is working on overall carbon reduction – and even on something more prosaic, like reducing the risk of trips and slips. It becomes immediately obvious that the potential influences on outcomes start from the citizens themselves, then neighbours and community, and then partners – local government can influence, convene, and shape, but seldom control and direct.
• In Somerset, our academies worked towards systems change in terms of prevention, early intervention, and joined-up working as part of the ‘Fit for my Future’ wellbeing strategy, funded by Health Education England and working across the council and clinical commissioning group – but situated locally, bringing together voluntary and community sector groups. Exploring very local and specific themes, from the complex needs and poor and expensive outcomes of young people who ‘go missing’, to creating a dementia-friendly environment in a retail outlet village with high shopper footfall, offered two things. First, it allows a focus on the realities of the situation, and low- or no-spend experiments. And second, it highlights systemic issues which prevent barriers to progress.

Integration and place-based working, or ‘systems change’, is happening because all of these places are starting from understanding and acknowledging multiple perspectives and how the system is working (or not) at the moment.

All this underscores how important it is to replace the idea that it is the job of Government to spend money for services to meet needs (a deficit focus) with a new idea: experimenting and learning how to influence complex systems to achieve better outcomes for citizens and communities.

So, long live commissioning! I’d be happy – even keen – to call it something else. But the work is needed more than ever.

Benjamin Taylor is chief executive of the Public Sector Transformation Academy

@antlerboy