Don't mention the C-word

Public service commissioning can deliver cuts AND better outcomes...

Richard Selwyn, Government and Public Sector

Government & Public Sector Journal Online, Dec 2009

You can't go 10 minutes without a politician banging on about the looming cuts to public sector spending. What you won't hear is anyone explaining how we are actually meant to find and deliver these savings. The word cuts has quickly switched from banned to election winning, but there is another C-word that politicians and senior civil servants must embrace if we are going to get through the next few years without decimating our services. That word is commissioning.

Commissioning is a new model for change. It is about understanding citizen's needs in a new light, planning and designing services around the population, and finding innovative ways to deliver outcomes cheaper. More for less. Some local authority chief execs are considering massive 33% cuts - can commissioning continue to improve outcomes and deliver savings targets?

Public services have been making steady progress during the last 10 to 20 years and this has led to a strong social and public expectation of continual improvement. The trouble is that improvements have often been thanks to additional funding rather than the fundamental effectiveness of services. Previous increases in funding have led to a degree of lazy management and government leadership that shies away from tackling the big problems in society or the inefficiencies in our services. Looming spending cuts mean this cannot continue.

We must now make large savings whilst maintaining service quality and outcomes- we can't just tweak services but have to transform them. Commissioning is the model for doing this - emerging in its current form from children's services and gaining credence across central and local government. It is about taking a whole system view of the needs of the population and available resources, and then finding much better ways of delivering outcomes by moving away from traditional, outdated service models. The commissioning revolution is driven by transformation through a better understanding of the complex public sector system, new ways of designing services around the population (such as patient choice), innovation and entrepreneurship, and a fresh ethos that embraces partnership working and joint leadership.

The question now is whether this revolution can meet social expectations within spending cuts? Are we developing fast enough to rescue public services?

Positive examples are now emerging across the public sector where commissioners have redesigned services, cut spending and still improved individuals' outcomes.

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. Better outcomes - for a reduced cost.

In some London boroughs childcare was badly designed; it often subsidised well-off families and stopped 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.

The proposed change to the donor card scheme (from opt-in to opt-out) is a simple tweak to make it much more effective, with no added costs. Understanding the system - and redesigning it to work better.

Commissioning sounds like it's coming to the rescue - but why is it taking so long? 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 forwards and enabling commissioners to transform services.

There is now overwhelming evidence that targets deliver just the statistic, and not the improvement to lives or service efficiencies that were first desired. A comparison of disparate management approaches between the private and public sectors is stark. Which FTSE 100 company is run through micro-management and ring-fenced funding attached to the latest untested headline-grabbing idea? Excess funding can no longer cover up mis-management. 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 commissioning and are delivering more for less. We now need this good practice to be reflected across the whole system.

Politicians and senior civil servants must use the looming cuts as a burning platform - to change the way we run public services, to move away from initiatives, command and control leadership, micro-management, spurious targets and headlines. Commissioning must be part of our common language, our only hope to avert decimation.