Commissioning: if we can’t see it’s broken, we won’t fix it

Commissioning: if we can’t see it’s broken, we won’t fix it

Outcomes-based commissioning. It’s supposed to be what’s happening across health, social care and other local government functions now. The way things will be made to happen. Except… at risk of being the little boy in The Emperor’s New Clothes I’m just not sure that it is (yet). At its best, commissioning has the potential to create space for innovation and new approaches; new collaborations and development of creative, responsive markets. But I’m not so sure that there’s really much of it happening.

In our work with a range of localities, there are a number of challenges we are helping organisations to address:
1. Identifying  clearly what the desired outcomes are: this is still a big challenge in some places – moving beyond specifying ‘things’ or services, to identifying outcomes that might be achieved through a myriad of approaches
2. The skills and capability gap: outcomes-based commissioning demands a wholly different approach, but commissioning roles are often being shouldered by people who were previously doing quite different managerial or procurement roles. Clarity on what great practice looks like is illusive; people are unclear what skills they need to develop (and there’s not much space or time for professional learning anyway)
3. Everything is being driven by existing contract schedules: commissioning timeframes are often set in motion by a panic about the next contract that will be up for renewal: thus implicit is the idea that the answer will be a ‘service’ that replaces what is currently there, making genuine innovation difficult – and decommissioning next to impossible. In a great example of the tail wagging the dog, contract schedules drive commissioning workplans.
4. Horizon scanning: the knowledge about what is going on elsewhere, and the expertise to challenge, shape and develop the market is in short supply.

And perhaps most importantly,

5. The connection with citizens, communities, and service users remains terribly weak; the need to problem-solve collaboratively and co-productively is under-prioritised and under-resourced.

We’d like there to be more honest conversations about the scale of the ambition and the size of the challenge (and more story-telling about emerging and promising practice!).  Pretending outcomes based commissioning (or indeed genuine commissioning as opposed to procurement) is what’s already happening isn’t helping.

Does this resonate? Anyone got encouraging stories or reflective learning to share?

Ruth Kennedy

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