Wielding the knife intelligently

How commissioning can slash budgets and improve services

Guardian Public, December 2009

By Richard Selwyn of PIPC

Cuts, austerity, and planned service improvements put on ice – it has been grim reading of late for those who rely on the state for welfare and health support. But if the most in need thought they were receiving a tough deal before, talk of 30% funding reductions will be a real worry.

Of course, it's a worry too for politicians, the government, councils – indeed, anyone vested to deliver public services. However, as pre-election posturing ramps up and hype subsumes fact, there is a quiet revolution afoot where examples of cost reductions are actually being delivered in tangent with service improvements.

The revolution is commissioning

Commissioning is the new business model for change. Budgets are finite and if costs need to be cut then someone must go to work with a knife. The difference with a commissioning approach – understanding citizen's needs, planning and designing services around the population, and finding innovative ways to deliver outcomes cheaper – is that we can actually achieve more for less rather than less for less.

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. Now that budgets are being slashed, the fat is being sliced off a body exposing unexercised muscle. Simply put, we need to get the body in to shape before we hack away at our services.

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.

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.

The future government business model

There is clear evidence to suggest commissioning is the future government business model, but why is it taking so long to implement? 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.

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. We now 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 must be part of our common language, our only hope to wield the knife intelligently

Richard Selwyn is a consultant, government and public sector, at PIPC UK, and is currently working on the commissioning support programme for the Department for Children, Schools and Families and Department of Health.