Is Commissioning the Answer to Public Service Reform?
In recent months commissioning has emerged as an important concept within Australian public services and has been seen as a way to reform public service delivery and act as a catalyst for better citizen outcomes.This post considers whether commissioning can, in fact, be such a catalyst, some of the challenges that may present and lessons on how to make commissioning more effective.
The argument that in many advanced liberal democracies, governments are facing significant challenges is well rehearsed, with storylines relating to changing demographics, new technological advances, increased consumer expectations and shrinking budgets. Against this background, it is argued that governments need to significantly reform the ways in which they meet public policy objectives. In recent years the language of commissioning has started to enter the lexicon of politicians and policy makers, being seen as a way to help deliver on this reform agenda.
Commissioning was highlighted as a capability that government should develop in the National Commission of Audit and was an important feature of the Federal Budget that followed. State and territory governments around the country have expended significant effort in understanding how commissioning relates to their various activities and what competencies and capacities their workforces might need to deliver on this agenda. In the context of healthcare, Primary Health Networks (PHNs) have recently been established with the aim improving the health status of those individuals residing in their local areas through a commissioning approach.
The speed of the appearance of the concept of commissioning and the enthusiasm which it has been embraced by policy makers and politicians is perhaps surprising given that there is a lack of evidence to demonstrate that commissioning approaches are successful in driving such reform efforts. The UK has employed commissioning approaches in many policy areas for nearly 20 years and there is a lack of clear of evidence to demonstrate that this has significantly improved outcomes of service users or citizens.
It should be noted that commissioning is notoriously difficult to evaluate and that in many policy areas there has been a high degree of turbulence in these spaces from successive policy shifts, reorganisation of functions with regularity and more recently significant reductions in budgets. However, significant claims are being made for commissioning approaches, such as the ability to shift choice and control from the state to service users, allow a focus on outcomes rather than outputs, free up providers to be more innovative, rethink service delivery models and demand management, and drive efficiencies. Experience from the UK suggests that it is difficult to achieve multiple different reform aims at the same time and that this is even more challenging where these incorporate changes not only to structures of organisations and markets but also the culture and practices of organisations.
Against this background it appears unlikely that the introduction of commissioning will lead to substantial changes within Australian public services overnight (and in some cases may have very little effect in a substantive way at all). The evidence does, however, suggest that there are some factors that do seem to be helpful in developing a commissioning approach.
- Definition matters. The term commissioning is being used in a whole a range of different ways. To some extent this is not problematic in the sense that commissioning is a broad term, although it does mean that for some actors who are working with multiple different partners they may be working with different definitions at the same time. Commissioning in a textbook sense is often presented as a complex process with many different constituent components. Without an agreed sense of what this looks like and the level at which commissioning function operates then it can be difficult for professionals to deliver on this agenda or to understand where to engage. Commissioning is sometimes used as a nicer term for outsourcing or contracting out, but it is about more than an extension of the privatisation agenda. If this term is only used as a polite synonym for activities which might otherwise be less politically palatable then clearly there will be very little impact in terms of reform processes, other than in terms of who provides aspects of public services.
- There is no silver bullet. The evidence on the processes and impacts of commissioning suggests that there is no single or simple process that can create effective commissioning. As outlined above, there is a range of high aspirations tied to commissioning and these have not necessarily always been achieved in practice. Where organisations have succeeded in aspects of their reform processes they have typically stated their objectives early in their commissioning processes. In other words these organisations and their partners hold a shared sense of what is to be achieved through commissioning processes and they have worked through what processes will be appropriate to support these activities. Organisations need to be able to create locally appropriate solutions to the specific problems they face within their particular context if they are to be effective. One-size fits all solutions do not exist when it comes to commissioning.
- Pay attention to staff competencies, data and incentives. Having suggested that one-size fits all solutions do not exist, there are a range of factors which do seem to be important in terms of commissioning. Workforce skills and abilities are absolutely crucial and yet public services often lack a clear and systematic picture of their staff capabilities and competencies. Appropriate data and having the right sorts of incentives in the broader system are critical to creating the conditions for commissioning to flourish. Yet this does not mean that commissioning is simply a technical activity: it is both a science and an art. Judgement and political astuteness are crucial to commissioning approaches, which inevitably involve negotiating a series of highly contested debates over what we should value at any one time.
- Community engagement is critical. In the UK there are a series of examples of where commissioners have forgotten about community engagement at their own peril. To make good decisions commissioners need to understand their local community well. This is more than a technical exercise of needs assessment and involves detailed understanding of dynamics and tensions within different part of the community. If commissioners are to have legitimacy and a mandate to act then it is important that they have fully engaged with a range of different communities. Without this, it can be incredibly difficult to take challenging decisions or to implement change.
The concept of commissioning seems to have a high degree of political salience at present and is being hailed as the next great idea in terms of reforming public services in Australia. The evidence base suggests that this will not be a simple or quick fix and indicates a series of important aspects to focus on if seeking to develop an effective commissioning approach. Whether this concept will have significant impact in practice or is simply the next fad term in management circles before the next big thing, remains to be seen