Designing whole-systems commissioning of public services

What is it about?

This study identifies determinants of successful strategic commissioning and assesses the overall state of current knowledge. It reviews the published literature and interviews a range of stakeholders in strategic commissioning in England. The evidence suggests that structural solutions alone cannot deliver effective relationships and will not be effective when relationships are neglected. Critically important is staff, partner, and political buy-in. Work is required to ensure the right balance and distribution of commissioning skills and competencies. Many of the skills needed for strategic commissioning may be found in partner agencies (including providers), so organizational boundaries must be seen as porous as the new commissioning/provider roles emerge and are refined. Finance and incentive alignment are also crucial to ongoing strategic commissioning since organizations that contribute to the achievement of multiple outcomes will expect funding streams to recognize and reward these achievements. Overall, while evidence and evaluation are important, in a rapidly changing environment there are no clear-cut guidelines for success and there is an equal need for experimentation and flexibility.

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Why is it important?

The paucity of formal evidence, allied to the requirement for strategies that are sensitive to local history and context, means that a ‘blueprint’ for successful strategic commissioning is not available. However, this article proposes ‘design principles’ for those seeking a whole systems approach to strategic commissioning. People and relationships are of critical importance all the way through the chain from strategic commissioning to micro-commissioning. Most crucially, structural solutions alone cannot deliver effective relationships and will not be effective when relationships are neglected. The need to ensure staff, partner, and political buy-in suggests that relationship management and consensus building are an integral component of the leadership role in moving toward strategic commissioning. As with any major re-organization, the move to strategic commissioning is essentially a change management initiative and therefore will stand or fall according to whether it adheres to good practice in the change management process. Central to this, and to achieving commissioning outcomes, is the requirement for meaningful service user and public engagement. Effective commissioning emphasizes individual capabilities as well as needs, and community assets as well as deficits and problems. Adoption of strategic commissioning approaches is still at the developmental and learning stage and arguably all current structural arrangements should be regarded as transitional. Local authorities would be advised to remain open to the evolution or re-organization of their structures in light of ongoing evidence and experience. Work is required to ensure the right balance and distribution of commissioning skills and competencies. Finance and incentive alignment are also crucial to ongoing strategic commissioning. Local strategic commissioning for outcomes is best served by bringing together the different service traditions which exist within local authorities as well as across the local statutory sector so that commissioning provides a common platform for improvement and transformation. Local change leaders should attempt to create a shared and continuing understanding of community needs, commit to a single set of priorities, and provide transparency of available resources across organizations.

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