Government plans to introduce “commissioning” as the means to deliver social, human and community-based services now threaten both the Community and Voluntary Sector and the effective delivery of essential social and community-based services. The Departments of Health, of Children and Youth Affairs, and of Environment, Community and Local Government are now moving to a commissioning model to deliver services. Traditionally they had been funded through block grants to Community and Voluntary Sector organisations. Commissioning is commonly understood as a strategic planning process that links resource allocation with assessed current and future needs, to achieve better outcomes for citizens and service users. The 2011 Programme for Government had the catchier definition: “Choice and Voice” for service users. The assumption of the coalition Government was that the marketisation of social and community-based services will benefit service users and communities.
However, we have evidence from the UK, where public services have been privatised for many decades, that the commodi cation of social and community-based services has generated adverse impacts. It has resulted in a shift to one-size-fits-all models of delivery. Its focus is on cost-per-unit to be minimised, regardless of the outcomes for different groups. This ends up in a so-called ‘cherry-picking’ of participants most likely to achieve positive outcomes. As a result, the more marginalised communities and individuals with complex needs are excluded. The impetus driving the move to Commissioning model has been set out in various Government briefings. It includes the desire to link service development and delivery to assessed need and outcomes. It is focused on reducing costs and ensuring value-for-money. This assumes that Community and Voluntary Sector service providers are not already out-comes-focused or allocating resources on the basis of need. This, however, has never been comprehensively assessed by the relevant Departments or State agencies.
It assumes that the current model of grant funding to Community and Voluntary Sector organisations is not delivering value-for-money. ‘Value-for-money’ is a contested term. It is all too often reduced to a simplistic cost- benefit equation, rather than being based on an assessment of outcomes for diverse communities and groups. This would take account of, and prefer, the added social value that accrues to individuals and communities as a result of how Community and Voluntary Sector services are delivered.
The Government’s own review that examined the evidence for moving to commissioning would suggest it
is fraught with risk. This review found: “limited evidence to date that commissioning approaches result in better outcomes” for service users; “a weak evidence base for commissioning as a strategic planning and resource allocation tool”; and the cost of the commissioning process could be extremely high to the commissioning Departments and State bodies. A House of Commons Report has found that almost 14% of the NHS budget was being spent on its commissioning infrastructure, for example.
It is a significant undertaking to execute commissioning properly. This is underscored several times in the Government’s own review. The elements in the commissioning process of identifying needs, setting outcomes, and measuring impact all require significant national and regional infrastructure.
Comprehensive national, regional and local data, and robust tools to capture the specific needs of different groups and communities are required to assess the social and community service needs of communities across the country. There is a significant absence of such data and tools currently. Until this is rectified it is difficult to envisage how comprehensive needs – assessments can be carried out.
The Government’s review noted that expert knowledge and technical skills would be required in commissioning Departments and State agencies. This would include: expertise in needs analysis and service user engagement; robust data information and management systems; expertise in contracting and procurement; and expertise in evaluation. It is not credible that such resources will be found in the Department of Environment, Community and Local Government, to say nothing about the already hugely over-stretched and under-resourced Departments of Health and of Children and Youth Affairs.
This lack of infrastructure leads to a very real risk that the costlier, more complex elements of the commissioning process will be dropped. Instead the focus will merely centre on reducing cost and increasing the marketisation of services, regardless of outcome. The Government needs to heed the warnings in its own report, because it will be impossible, under competition law, to revert back to grant-based funding once services have been opened up to competitive tendering processes as part of this proposed commissioning model. There is an urgent case to now press the pause button on this fashionable but insidious and dangerous process.
Rachel Mullen
