In the middle of an election campaign there is still one word which eludes politicians. It took a long time to admit that government spending outweighed what we can afford, it took even longer to talk about real cuts to public services. But still no politician will say how we should make those cuts without reducing quality. Why is commissioning the hardest word to say?
The scale of the economic challenge (upwards of 30% cuts in some parts) is unprecedented and it will require a new model for cutting services, whilst continuing to improve the value of those services to citizens. Across central and local government, we need new ways of thinking about services, about systems, about technology, about relationships, and how we understand the needs to achieve outcomes. Commissioning is that quiet revolution. It’s underway and is already proving successful. It’s demonstrating that cuts can be made without compromising service delivery.
The public sector is emerging from two decades of increased spending where progress was the result of additional funding rather than changes to the fundamental efficiencies of services. We have lost some of the skills of service redesign and tend to revert to the old ways of cutting services: salami slicing, raising thresholds to exclude those in need, freezing posts regardless of the value of those posts, and removing back-office functions which then results in additional burden for the frontline. But there is another way.
Examples of where commissioning has already been effective include boroughs of London where childcare was badly designed. We often subsidise well-off families and stop those in most need from accessing services. Commissioning redesign has identified families that are disadvantaged and changed the system so that their children can access childcare – limited resources now have a much greater impact.
In recent years use of tele-care has enabled more traditional services for the elderly to be replaced by responsive remote care and in-home supported equipment and assistance.
Disabled adults can now receive a budget similar to the value of previous services which they spend themselves. This has resulted in better services that are designed around the individual, more community accessed support, and huge improvements in satisfaction.
Technology has enabled us to share data better and integrate post-code marketing information with needs analysis and professionals’ risk assessments. This greater understanding of vulnerable families means that services can be directly targeted to those in need, rather than offered universally at much greater expense. Better outcomes – for a reduced cost.
There is clear evidence to suggest that commissioning is the future government business model, but why is it taking so long to implement, why isn’t it the buzz-word of the election? The truth is that Government is beset with historic and traditional approaches which are barriers to the new ways of working. Old structures, targets and initiatives are preventing us from moving forward and enabling commissioners to transform services. It’s time for change and we are starting to see visionary public servants who understand what is needed and, given half a chance, have embraced the commissioning revolution and are delivering more for less. Post-election we need this good practice to be reflected across the whole system.
Politicians and senior civil servants must use the economic crisis as a burning platform for change – a once in a generation opportunity to revolutionise the way we run public services, to move away from initiatives, command and control leadership, spurious targets and headlines. Commissioning cannot be whispered – it must be the mainstay of future government.
Richard Selwyn is an expert on designing commissioning systems in central and local government, at PIPC UK www.pipc.com . He is currently working on the Commissioning Support Programme for the Department for Children, Schools and Families and the Department of Health.
