Alternatives to ‘traditional’ commissioning and contracting models

Alternatives to ‘traditional’ commissioning and contracting models

A range of alternatives have been put forward by various parties to address the challenges associated with public service delivery in the 21st Century. These emphasise collaboration, people and/or place centred approaches, shared outcomes, a shift toward small scale and local services and co-production with service users. 

Place based Commissioning

Collaborate/ NLGN 2016 define place based commissioning (in this case specifically for health) as commissioning centred around:

·        People (empowered to take control of their own lives);

·        Places (assets deployed to support the wider determinants of health);

·        Prevention and early intervention. 

Place based commissioning differs from traditional commissioning models in that it shifts focus from:

·        Institutions to places and people  (individual personal care plans, collaboration through alliance contracting);

·        Service silos to system outcomes;  

·        The National to the Local.

In Get well soon, Reimagining place-based health, The Place-Based Health Commission Report, Collaborate, NLGN argue for place based commissioning: ‘ health is not seen as something that happens in a clinical setting primarily, it is something that happens in places through a wide range of partners including councils, housing providers, community pharmacies, businesses, shared spaces and people themselves.’

Alliance contracting

Alliance contracting has its roots in the oil and gas industry where it was used to deliver significant improvements to complex projects involving multiple contractors. It has since been developed and refined in Australian and New Zealand and is now widely used in these countries as a procurement method in both the private and public sector.

ACEVO define Alliance contracting as: “a contractual arrangement that relies on all parties having an equal decision-making role in the delivery of services. Its pathway of action is ‘horizontal,’ which is different to the ‘vertical’ contracting structures that are characteristic of a prime contractor sub-contracting out to smaller bodies. This means that a more equitable relationship between providers is enabled and decisions are taken with the whole person in mind.”  ACEVO and NLGN and Collaborate have advocated for Alliance contracting as an effective means for delivering cross-sectoral integration in the NHS (as recommended in the NHS’s Five Year Forward report) and working better with the third sector to deliver community based care (ACEVO, 2015 and Collaborate/NLGN 2016) .

Co-production with service users

To overcome ‘failure demand’ public services must listen to and understand what support is required for people to live good lives or die a good death.

Boviard, 2016 in his review of the outsourcing of public services in the UK over the last 30 years identifies that: ‘successful commissioning needs to mobilize all resources of citizens and communities in the co- commissioning, co-design, co-delivery and co-assessment of public services’ and ‘democratic decision making about desirable outcomes and whether these outcomes are being achieved is more important than efficiency’.

The benefits of service user involvement and engagement not only include improved outcomes for individuals and communities but also reduced demand on formal health and social care services: ‘In 2002, Derek Wanless provided a compelling analysis of the case for engaging the public more actively in keeping themselves healthy. By his reckoning, high levels of engagement would make the NHS £30 billion cheaper to run by the early 2020s. At a time when government spending is failing to keep pace with demand, the need to build individual agency, community capacity and social capital is well understood by professionals, but remains elusive in practice. ‘

Wood et al, 2016 argue that not only is there a growing body of evidence to demonstrate that person centred commissioning ‘works’ both in terms of improved health and wellbeing for individuals and communities and improved efficiency but that there is also a strong moral and ethical case for such approaches.