Andy Meakin BA(Hons) MBA, Project Director, VOICES

I spent fifteen years of my public sector career involved in commissioning.  Through much of that time, I accepted the given orthodoxy that emerged from the 1980’s onwards in the New Public Management movement.  This sought to make public sector organisations more ‘business like’ and efficient.  It perhaps began in the context of commissioning with compulsory competitive tendering, went on to incorporate ideas of best value, and matured by around 2010 into what we can call ‘outcomes-based commissioning’ or, perhaps, what some are now calling ‘Commissioning 1.0’.

This approach to commissioning is often rendered as a cycle with stages of plan, procure, monitor, and evaluate.  This is an adaptation of the much earlier Deming’s wheel from management theory (plan, do, check, act).

This model works well for relatively straight-forward procurements that deal with tangible outputs and aim to deliver relatively simple often deterministic outcomes.  Examples include consumables like stationery, tables, chairs, and equipment like laptops.  Commissioning 1.0 can also work well in some types of public sector services such as waste collection or construction projects.  Of course, each of those has its own complexities and challenges, but the thing that they all share is that the outcomes are simple and clearly within the control of the selected supplier partners to deliver.

However, the Commissioning 1.0 model has been over applied to services in the health and social care domains in which it is too often found wanting.  Far from the deterministic outcomes imagined by Deming in the context of 1940’s and 50’s manufacturing industry, instead the setting of health and social care services exhibits the characteristics of a complex adaptive system.  In such systems, there are many processes acting simultaneously that can deliver a range of different outcomes, only some of which are desirable, and over which no single service supplier or stakeholder has control over delivery.

Because of this key difference, many are now arguing that Commissioning 1.0 is not fit-for-purpose in the context of health and social care.

In this short series of articles, I will set out why I agree that the health and social care sectors must depart from the overused commissioning orthodoxy of the past and develop a new paradigm based on a collaborative approach to planning and monitoring the impact of health and social care services.

For now, like many others, let’s call the new approach Commissioning 2.0.

I’ll expand in the next article about the why the current health and social care commissioning system’s foundational assumptions are wrong and begin to outline the alternatives.