For years now local authorities have talked of themselves as “commissioners” of services.
Successful commissioning is about delivering the right outcomes at the right cost and is therefore a core part of achieving good value for money. Indeed you could say that successful commissioning is, almost by definition, what modern local authorities do.
Put that in the context where Simon Stevens, the chief executive of the NHS, is forecasting that in the near future councils will be one of the most important commissioners of health services too and we can see. And yet, when a group of us gathered at a recent SOLACE event, there was a feeling among some that commissioning was rather too much Eastern Promise and not enough real delivery. The worry among some chief executives was that commissioning was too often a new term for straightforward procurement, used to put a fresh spin on old ways of working.
And I can understand some that scepticism. More than 15 years ago now I undertook a review of what was called a Joint Commissioning Unit between a local authority and health board in the north of Scotland. After having been in done our review our conclusion was essentially the JCU was neither truly joint and it didn’t really do any commissioning.
We found that the “the day-to-day management of the JCU was ad hoc and that there were infrequent and inadequate meetings between the senior management in the partner organisations to give the JCU a clear strategic direction.”
We also reported that “the JCU has been an effective project management team, but was not engaged in strategic commissioning.”
And “absence of full mutual understanding and agreement [and there was] underlying disagreement about strategic direction and purpose.”
Overall we found that while the JCU – the council and its partner in health – wished the ends they it did not know how to organise the means. In other words, commissioning came up against two big barriers. How to work across boundaries and how to genuinely challenge and change existing forms of service delivery.
So, when Local Partnerships asked me to do some new research I was intrigued to know if anything had changed.
The research, which involved interviews with chief executives, senior managers and heads of commissioning at more than 15 councils across England, found that much had changed since the days working with the council I mentioned in the north of Scotland.
As one county chief executive put it: “For me it’s less about whether you end up doing a procurement or whether you end up doing a partnership and it’s more about the analysis of the problem and the issue and the group of services and taking a really good hard look at whether and how you could deliver it differently to get the outcome that you want.”
For most chief executives Commissioning was a core part of their strategy for change developed in the face of fundamental business requirements, based on the premise that the status quo is no longer sufficient.
In particular I found:
Commissioning follows from Political strategy for example where a new political leadership wants to do things differently or has a different stance on use of internal/external providers.
Value for money, cuts, austerity drive commissioning too. The need to do more for less changes the way we do things for example generating more income or changing demand by introducing more more self-service.
Some commissioning outcomes can involve eligibility thresholds to move – e.g. more people are eligible for a grit delivery, fewer roads get gritted by the authority.
Many councils see their services as based on historic, out of date, understandings of need. Councils using commissioning to redefine need and to redefine the “service.”
Councils are using users far more to drive change. When we give people greater choice, they want services that promote independence.
Commissioning exercises often take place because there is dissatisfaction with existing provision.
The report therefore concludes that chief executives and others have placed great emphasis on commissioning as a source of strategic service reform.
However, while this much had changed, the research for LP suggests that commissioning remains some way short of being fully developed. In particular we found that:
Commissioning in partnership with the NHS remains extremely challenging. NHS and local government models are different. local government perceives the NHS model to be quasi scientific, brought over from drugs commissioning and not sufficiently subtle or nuanced for the messy world of local government.
Furthermore, the diverging trends of finance in local government and NHS puts further strain on joint commissioning with local government needing to focus more on productivity gains and the NHS feeling much less financial squeeze.
While local government sees commissioning as core to modern management, it also perceives a significant lack of people with the right skills.
The first challenge to local government leaders therefore is to ask why, after a decade or more trying to do commissioning, we haven’t created a supply of people with the right skills.
And this is perhaps the most challenging point, the research found that commissioning is too demand led. Councils seem to believe that if they whistle, suppliers will come running. But there are several reasons why councils may be disappointed. Of course markets can respond to sustained demand over time, but when we are talking about complex services they need time to understand the requirement, they need time to work out solutions.
And, if we look back over the last 10 years we could distinguish policy trends and trendy policies. Suppliers in local government have had their fingers burned responding to so many trendy policies that turned out to be flashes in the pan that it is understandable if they don’t want to invest in every new idea.
Fundamentally, commissioners are reliant on providers with the capacity and capabilities to deliver their objectives. It follows, therefore, that without effective supply, commissioners’ objectives will remain unrealised. Yet, there is no strategic sector-wide strategy for influencing and shaping supply side markets in local government, and it is an area in which local authorities need to invest further.
So I would say that commissioning has matured; clearly commissioning approaches do work in many authorities, especially where there are mature supply markets.
However, the sector still lacks skills (and national capacity), it faces real challenges commissioning in partnership with health and the police and others, and fundamentally as a sector we are too inward looking, too concerned with our demand and not sufficiently curious about how to understand and stimulate markets that can deliver.
The full research report can be found here: http://localpartnerships.org.uk/publications/news/131-investment-news/209-new-research-report-into-local-government-commissioning