Our first post of the week is from Dennis Holmes. His ‘Deputy Blog’ posts have been the most well read and responded to on the blog….so far. Is it the style? Is it the content? Maybe even the introduction!! Perhaps all.
In this post, Dennis talks about the often confusing world of commissioning. Is it an art, is it a science?
Dennis Holmes, Deputy Director, Adult Social Care Services
There was an article in the paper the other day about commissioning. It reported that an estimated third of all public spending on services is now delivered by third-party providers ranging from private companies to social enterprises and charities.
It led me to thinking about the growing interest in commissioning in the Leeds health and care market, with a new breed of general practitioners emerging, who suddenly find they are commissioners in the Clinical Commissioning Groups (CCGs).
Now, commissioning is a much-misunderstood activity. Fundamentally, it’s about moving resources in an intelligent way around a rather large system, to achieve better outcomes for people. It requires vast amounts of data and sophisticated modelling tools to find better ways of doing things and delivering services, when they are wanted and where they are wanted.
And it’s not just about procurement, although this can be an important tool. Equally important is the way commissioners can use their intelligence and influence to shape services and society.
A good example of this is Age Friendly Leeds, a movement to ensure Leeds is a good place in which to grow old and live in our later years. A large amount of resource is going into making Leeds an age friendly place, but the council’s Adult Social Care service is in control of hardly any of it.
What we are doing is influencing others. Take Dementia Friendly Rothwell, for example, a south Leeds community that has decided to declare itself a zone where people with dementia are understood, supported and where individuals and businesses alike act positively to help people with dementia, function well in the community. There has been no financial intervention from Adult Social Care services, yet somehow we have inspired and motivated the Rothwell community to act as a provider of its own brand of social care.
The big thing we struggle with is how to measure the outcomes of our activity. In a complex NHS and Council world it is hard to say exactly by how much people’s lives have improved as a result of our interventions.
Of course, hand in hand with commissioning goes decommissioning. It’s a word we don’t like, but in moving resources around the system, sometimes we have to close things down. We can’t just keep opening up more and more services. As I have said in an earlier post both the council and the NHS face a dire financial situation and we must rely on commissioning in its broadest sense to help us get more out of less.
So who are these commissioners? It has often been said that ‘commissioners are made, not born’. That goes for me, too. I’m a trained social worker and manager but 10 years (or so) ago I found myself responsible for commissioning for social services. It has been a steep learning curve, I can tell you!
And where next for commissioning? Well, from where I sit, it seems that if we are really going to make a difference for Leeds people, we need to move to closer commissioning arrangements with GP colleagues. We need to focus more on what the different localities of Leeds want and we need to think about how we, collectively, across the council and NHS, improve the lives of families as well as individuals.
But I’ll leave you with this thought: given that commissioning in the public sector is such a big deal, I wonder how many youngsters ever said to their careers teachers: “I want to be a commissioner when I leave school”? Where are the college and university courses on commissioning? Maybe the time has come to put commissioning on the timetable of mainstream education as the new growth industry of public service.
‘Til next time.