Mike Webster poses this question and comes to the conclusion that, yes, there is a point to commissioning when it is a creative force that gets the best out of people and organisations.
To be honest, I’m not sure that anyone would admit to having had the ambition to be a commissioner when they grew up. Add the goal of doing the role in today’s social care or health economy and it is even less likely.
However, there are no shortage of jobs with commissioning in the title and seemingly no shortage of applicants. Finding a common idea of what commissioning is and should do is much harder. Blurred lines are all too easy to find between people who say they commission and those who procure and contract. Health and social care commissioning adds another layer of complexity.
There is no doubt that provider organisations, users of services (and probably readers of this article) often feel that they know more about what is needed than those who are paid to commission. Put more bluntly they are sometimes seen as just another layer of bureaucracy that leaves fewer resources in an already stretched system.
With the public sector and especially local government facing unprecedented financial restraints the incentives to be a commissioner are few and far between.
Unpopular
As often with unpopular professions (or dare I say ‘scapegoats’?) this is fine until you try to do without them.
We could surely do without accountants but their advice and guidance has been invaluable in establishing systems that mean, even in hard times, for local government at least, the money has not quite run out. In fact in the early 1990s and the introduction of community care the system would have cracked without some financial expertise. Let’s not forget that social security funding of private residential care was out of control.
According to the Daily Mail, social workers interfere when they shouldn’t and ignore when they should. Yet they form a critical part of the system when they work well. Skilled assessment and solution finding assists both at the wider strategic level and in making arrangements that are individual and often economical.
Is there any redemption for
commissioners?
Most commissioners come from social work, management or business suggesting that commissioning is a ‘bolt on’ to other skills and professions. Although some qualifications are starting to emerge these are a long way behind; for example, procurement (MCiPS – Member of the Chartered Intuition of Purchasing and Supply) or an MBA.
Health and social care organisations therefore have a strong (and probably expanding) commissioning section made up of people from varying starting points which contributes valuable diversity and potential for innovation that is desperately needed.
At its best, commissioning can build on a range of ideas and through a structure (Commissioning Cycle) bring a rigour to service development and crucially evidence-based reviews.
A key skill is being able to harness creative ideas and adapt them. The ideas may not be new but being able to re-invent and implement them in a different setting is a precious talent.
Dangerous
Commissioning, when it works well, can simply be about pulling together ideas and using them to offer solutions to new problems. It becomes dangerous when commissioners think they know best and have all the answers.
Reasons given for keeping to this apparently safe approach are:
- It takes too long to consult or engage;
- It’s too difficult to find the right people;
- Social/health care is too complex to involve people;
- Procurement rules do not allow providers to influence service specifications.
Use of these excuses is both arrogant and short-sighted. Expertise comes in many forms and no-one, especially commissioners, have the monopoly on it.
Provider organisations know most about how to provide services. On issues around workforce, logistics and even simple things, like putting together an effective staff rota, they are likely to offer both efficiency and innovation to a service.
Good procurement and commissioning should involve early market engagement often promoted through ‘discovery sessions’. As long as the invitations are open there is no danger of falling foul of even the new procurement regulations.
The key skills are in pulling together ideas and creating an environment where providers feel on an equal footing and safe enough to speak openly. Such discussions can die a painful death if because of commercial sensitivity providers are not prepared to share ideas or good practice. It is not unknown to hear complaints that commissioners do not include providers in discussions but then, when the opportunity is offered, they use it to take notes for future tender submissions and are unwilling to talk in front of the ‘competition’.
Good commissioning needs co-operaton from all sides.
Users of services know how it feels to be on the receiving end of commissioning decisions. Understanding that is also crucial to good commissioning and also to developing flexible and responsive services.
Organisations like the Care Quality Commission now use ‘Experts by Experience’and as a result their inspections have gained credibility and their findings are harder to argue with.
Real user involvement
Involving people in all areas of the Commissioning Cycle can similarly strengthen both the result and allow changes and good practice to be introduced at all stages. Much time and energy is given to the high profile aspect of initial commissioning and service procurement but often the real dividends occur through on-going review (and contract management). That cannot effectively be done without real user involvement.
A quote from a contributor to the Guardian Social Care network puts the point succinctly:-
“Those holding the purse strings and making the funding decisions need to respect those who need caring for…Compassion and understanding at the highest levels are what is needed. When that happens things may change.”
It’s no good saying it takes too long or finding the right people is too difficult.
So the answer to my question, ‘Is there any point to commissioning?’ is yes, when it is done well. Certainly there are skills and knowledge that are needed. There is also an underlying theoretical base and process to follow.
But the most undersold skill is an ability to ‘hold the ring’.Commissioning can become a creative force that can get the best out of people and organisations. It can also bring to life the often over-used concept of co-production.
The best services are those with the best input, centred on users’ needs and experiences, and the worst are those put together in ignorance and isolation.
Mike Webster is Assistant Director, Health & Adult Services, North Yorkshire Council.
