Strategic Commissioning Options Appraisal – a new commissioning tool

Is your basic process letting down your systems design? Your relationships holding you back from a user and outcome focus? Or are you sticking to ‘we buy the services we are told to buy’?

A new tool from the Public Service Transformation Academy with RedQuadrant might help you get insight into what’s holding your commissioning back. Commissioned by the Local Government Association’s Care and Health Improvement Programme, jointly run with DHSC and ADASS, we are producing a strategic options appraisal tool for adult social care commissioners.

Commissioners can assess how it’s going in their council, particularly focusing on the extent to which they have ‘room for manoeuvre’ – room to actually be commissioners, shaping the health and care outcomes for their place. We think it will be handy for all commissioners – and that all procurement people should take a look too.

Contact us

To learn more and find out how you can get involved, contact us! Find out more by contacting Benjamin Taylor at Benjamin.Taylor@publicservicetransformation.org and 07931 317230

How does the Strategic Commissioning Options Appraisal work?

A strategic options appraisal for commissioning has three key documents which will guide you through the process. These are

  • Implementation Guide: This is our hands-on guide on how to carry out the options appraisal. It contains guidance on producing and commissioning a development plan, guidance on implementing each of the commissioning approaches, and a strategic risk framework for implementing new commissioning approaches.
  • Self-Assessment: This provides the worksheets and resources required for you to carry out the options appraisal
  • Commissioning Aspects and Approaches: This is a more detailed handbook to explain and give context on terminology.

Carrying out the assessment involves three stages:

  1. Assess yourself against the eight aspects of commissioning

Answer our questionnaire to assess yourself and your team against the core aspects of commissioning. This will help you to identify which factors most enable and constrain you and what shapes your context and room for manoeuvre as a commissioner.

The core aspects are:

  • System design – are we actually able to work as one place and shape a whole health and care system – or, even better, a wellbeing system?
    Procurement folks might like to apply this ‘whole system’ lens to whatever they get involved in – are we just working in our box, or thinking about real world outcomes?
  • Relationships – how do the critical relationships work at present and what could change to help outcomes improve?
    This is always critical in procurement as it is in commissioning – are you empowered to actually bring your best professional judgement and challenge, or do relationships with service, legal, finance, and politicians limit what you can offer?
  • Capacity and capability development – are we helping to build the provision that helps needs to be met and people to achieve their purposes in life (includes market, social procurement, VCFSE, asset-based work, workforce etc)?
    For procurement, we might thing about whether we are ‘just spending money’ or looking at all the ways the desired outcomes of the procurement can be met.
  • User and outcome focus – are we working with the citizens in our area to check and measure that they are actually getting the benefits from our work?
    This is core to procurement – it’s one thing to execute to specification, it’s another thing entirely to actually make sure the benefits were achieved, and were worthwhile…
  • Insight and inspiration – the role of innovation, disruption and experimentation in changing the system – and the respect and role of commissioners or procurement professionals.
  • Policy – are we actively shaping and influencing the core enablers and constraints of the legal and policy framework that we have to operate within, as well as interpreting them?
  • Process – so much attention is usually paid here, yet there’s still room for improvement! Is our commissioning process and practice well developed as a mechanism for commissioning – competition, collaboration, commercials, clarity of contracting? Are we using this for incremental improvement?
    For procurement this is obviously critical too – is our procurement slick, effective, professional?
  • Models and tactics – are we paying attention to the way in which the things we buy get delivered? Service design, workforce, technology, innovation, aggregation, joining up, reducing waste, and improving user journey?

As you can see this is going to be a fairly holistic way for commissioners to look at their situation and work out how to work to create better outcomes.

  • Create a Commissioning Development Plan

Building on your learning from the questionnaire, you need to create a commissioning development plan.

For each aspect:

1. Which factors currently most hold you back?

2. Which most support you?

3. Which of the supporting factors could you boost?

4. Which of the inhibiting factors are:

a) in your control?

b) influenceable?

c) out of your control?

d) require innovation if they are to be changed?

5. Create an action plan to address the inhibiting factors and boost the supporting factors.

  • Identify potential models to fit the context

 Using your questionnaire and worksheet, you can then assess the fit between your context and several core models of commissioning.

Our identified core models include:

  • Prevention and early intervention
    Strong focus on keeping people ‘out of care’ and maximising conditions for people to be able to look after themselves.
  • Leadership of a system in a place
    Acting as a convening body to shape the whole system of health, care, wellbeing, and need in place.
  • Community development focused
    Creating the capability within the community to meet care needs
  • Developing VCFSE capacity
    Meeting care needs through the voluntary, community, faith, and social enterprise sector.
  • Political economy approach
    Maximising spend and re-spend locally where it will have maximum impact, minimising extraction of funding for external profit.
  • Individual focused
    Creating conditions for individuals to manage, select, fund, and direct their own care needs.
  • Values-based commissioning
    An approach that aims to challenge the status quo based on citizen perspectives and equity.
  • Disruptive commissioning
    Focus on innovation, creativity, novel approaches and technology
  • Strategic procurement of services against needs
    Procedural focus on good service provision and management
  • Contestability to drive down costs
    Focus on squeezing providers
  • Market management
    Focus on mixed and healthy economy of providers
  • Small government
    Reducing the involvement of democratic decision-makers in delivery through a focus on contracting for provider expertise and user empowerment
  • In-house delivery, mutualisation etc
    Focus on reducing or removing market dynamics from the provision of care

Check Out the New Reimagining Care Commission by the Church of England

The Church of England has created a new ‘Reimaging Care’ commission to consider the future of ageing and disability. RedQuadrant’s Amber Griffiths summarises the report:

Full report published: see it here.

Some information from the summarised version of the report:

Forward

This is a new commission to change the future of social care. It is a clear Christian vision, calling to rethink attitudes towards aging and disability within every aspect of our society and its aim is to give every person equal dignity, regardless of capacity. The offered vision requires an essential change of priorities and direction. The main changes proposed to the social care system is the long-term aim to make social care a universal entitlement. The commission shows a vision of one-another care, showing we should have a better sense of what we should do for each other in communities and neighbourhoods, find agreements about where different responsibilities lie, and build long-term networks and associations that will allow people to thrive. The development of a National Care Covenant, proposed by the commission, is the beginning of a wider process to make this vision a reality.

Our vision of care and support in England is that:

  • Care and support enables people to flourish and live life to the full;
  • Access to and funding of care and support is universal and fair;
  • How we care for one another reflects loving kindness and empathy;
  • Society, including churches, are inclusive of all people, of all ages and abilities; and
  • How care and support are delivered promotes mutuality and is based on trust.

Rethinking attitudes:

All the evidence we received – written as well as verbal – suggested the need for a fundamental shift in the way in which ‘care’ is viewed. A greater public acknowledgement is required of the varied ways in which we all need and give care and support at different times in our lives, and a realisation that care is about mutuality rather than dependence. In other words, the language needs to shift from ‘them’ to ‘us’. People need to be viewed as having agency rather than seen as objects of pity. We must also value those who provide care, paid and unpaid.

But these shifts in attitudes to care have to go hand in hand with a challenge to current negative attitudes towards old age, disability, and mental illness. This should involve a cross-party coalition getting behind a large-scale, long-term public campaign to change hearts and minds with church and other faith leaders playing their part.

Rebalancing roles and responsibilities:

  • A greater role for and investment in communities to provide universal support and enable participation and inclusion: Many communities (including faith communities) already provide valuable support and care for older and disabled people. Thriving communities are built on mutuality and reciprocity. However, this needs both investment and nurture, especially by local authorities, if it is to be universal and address inequalities. Local government also plays an important role in promoting inclusion and access to transport, housing, and community infrastructure. Local churches and faith communities need to be equipped with the training and resources to provide effective community-based support in partnership with others and in ways that empower people.
  • A new deal for unpaid carers giving them practical, financial and emotional support: It is important that unpaid carers can freely enter into caring relationships out of love, not necessity. They need to be better valued and supported, with adequate recognition, rest, and recompense (together with paid or unpaid leave and flexible working arrangements for those who combine caring with paid employment). Nobody should automatically assume the availability of unpaid care, which for many is not an option.
  • A stronger role for the state in guaranteeing universal access, providing protection against the costs of care, and defining a framework of entitlements and rights: National government should set out a long-term commitment to introduce a universal entitlement to care and support (on a par with the NHS). Everyone should be able to lead a good life by accessing care and support when they need it regardless of wealth and income. This will require a means of collective funding and pooling of risk, probably with a tariff of care charges established on a national basis. National government will also need to put in place stronger mechanisms to ensure existing legal rights and entitlements are upheld.
  • Accepting our mutual responsibility as active citizens: Social care is everybody’s business. We all have a role to play and must contribute (where we can). This means as citizens, being willing to contribute funding through taxation so that everyone, regardless of income and wealth, can get care and support. It means as members of a community, giving time and looking out for others, from small acts of kindness to volunteering more regularly in community support groups. When we or those we love need care and support, it means engaging proactively to shape the care we need and to use budgets wisely.

Redesigning the system:

Piecemeal tinkering with the existing system will not produce the desired result. We need a radical redesign of the system to make it simple, consistent and person-centred.

Early intervention will be delivered through a universal offer of first contact help in the community. Assessments will be simplified, and a budget allocated based on standardised categories of disability as in Germany and Australia. People will have the freedom to shape their care and support and be trusted to manage their budget (or decide who will manage it on their behalf), supported by independent advocacy.

Local authorities will continue to play a role in shaping the services available in an area, particularly where there are gaps. In addition, the challenge of suitable housing needs to be tackled – not least by the Church of England, which could do more (as the Housing Commission has observed) to use its assets and investments to support integrated, community-based housing options. The potential of person-centred assistive technologies to support people in their own homes also needs further exploration and investment.

We urgently need a new approach to care which includes a long-term plan for the recruitment and retention of paid carers as well as the redesign of roles. Their skill and contribution to people’s lives must be valued and given recognition so that social care is regarded as a rewarding career. This has to be accompanied by improved pay, conditions, and training. Recruitment should be based on values and attitudes as well as qualifications and experience.

Conclusion:

Values are the foundation of this new vision for care and support in England. If realised we believe it will transform the lives of all of us, as we share in the benefits of a society where everyone, regardless of age and ability, is able to live a full life. We are not apologetic for the idealism reflected here. But nor are we naïve. We recognise that implementing this vision has costs, that it cannot be the work of government alone, nor will it be achieved in one parliament. It therefore requires a broad coalition, including the Church and leaders of other faiths, to commit to work over the long-term towards this shared vision and make the moral case for change. There remains an urgent need for action to begin immediately.

For further information see the summarised version of the report: https://www.churchofengland.org/sites/default/files/2023-01/Care%20and%20Support%20Reimagined%20A%20National%20Care%20Covenant%20for%20England%20%28Summary%29.pdf

Some other links:

https://www.churchofengland.org/about/archbishops-commissions/reimagining-care-commission

https://www.churchofengland.org/about/archbishops-commissions/reimagining-care/about-reimagining-care-commission

https://www.archbishopofcanterbury.org/news/news-and-statements/care-and-support-reimagined-national-care-covenant-england-0

https://www.mirror.co.uk/news/politics/archbishops-call-radical-redesign-broken-29027203

https://www.local.gov.uk/about/news/we-must-shift-narrative-ageing-and-disability-lga-responds-archbishops-commission-report

https://consent.yahoo.com/v2/collectConsent?sessionId=3_cc-session_fbb40936-7e16-425b-8a9c-fad57021f32d

https://www.theguardian.com/society/2022/dec/30/archbishops-inquiry-to-call-for-better-dementia-support-in-community

https://www.lgcplus.com/services/health-and-care/richard-humphries-hope-for-social-care-will-come-from-outside-government-in-2023-12-01-2023/

https://www.carehomeprofessional.com/breaking-news-church-of-england-demands-15bn-nhs-style-universal-care/

https://www.churchtimes.co.uk/articles/2023/27-january/news/uk/social-care-system-needs-a-clear-vision-says-report-from-archbishops-commission

https://www.theguardian.com/society/2022/jan/07/provide-social-care-on-par-with-nhs-or-education-says-justin-welby

SAVVI and iNetwork UK conference update

By Andrew Humphreys

Since June 2022 RedQuadrant has been providing consultancy support to the SAVVI project, which is the Scalable Approach to Vulnerability Via Interoperability. SAVVI, funded by DLUHC and hosted by Tameside MDC, aims to introduce data standards into the public sector, particularly local government, for finding and supporting vulnerable people. RedQuadrant consultant Andrew Humphreys is providing “SAVVI Coach” services to the project which includes leading the work with local authorities and the Ministry of Justice to adopt the SAVVI approach and standards, implement a model process, develop contextualised data models and design data use and sharing processes. 

On 11th November Andrew Humphreys spoke about SAVVI at the 17th annual iNetwork UK conference in Manchester that was attended by representatives of local authorities, DLUHC and other local government partners from across the country as part of the project’s efforts to see the SAVVI standards and approach broadly adopted by local government. You can watch a video of Andrew speaking about his work on the SAVVI project here: https://vimeo.com/773783757 

Based on success within the local projects that RedQuadrant is supporting, SAVVI is now preparing an application to the Central Digital and Data Office, within the Cabinet Office, to be adopted across Central Government Departments as the mandatory data standards for finding and supporting vulnerable people. RedQuadrant’s work with SAVVI has recently been extended to March 2023 during which time we expect the standards will be deployed by local authorities with which we have been working. 

Commercial Thinking – do we need a new word

By Joanne Peters

“Commercial” is a dirty word in parts of local government. The term is synonymous with privatisation, outsourcing, alternative delivery models, and more generally the extraction of profit, embedded in traditional economic thinking. Often, in engaging with council staff many dismiss commercial thinking as irrelevant or only the concern of those in trading arms or commercial teams.

Commercial acumen is defined as an understanding of how industries and businesses work. It’s about knowing what’s going on in the world and analysing the way that it might impact on your chosen sector and company.

Setting aside the profit connotations clearly associated with the word commercial, there is much to be gained by local government from learning from successful commercial thinking to better deliver against local priorities. In fact, such a negative attitude to ‘commercial’ has implications.

Primarily, being commercial means understanding the organisation’s strategy and priorities, where you and your team fit in, and being able to monitor and measure delivery. It is also about having the skills to understand the local system. Commercial insight is a vital part of understanding the role that a council is playing in local markets, e.g. housing, social care or services to schools, and in building successful partnerships across the public sector and VCS. It is also critical to understanding the implications of often volatile external forces.

Local government is resource constrained. Building a more commercial mindset and understanding how the organisation works supports a shift from rationing a scarce resource to maximising the returns from a scarce resource. It means asking the question, ‘how can we use the budget to get the best outcomes for our residents?’ and having the right information and analytical skills to evaluate options.

Much of what local government does is ‘commercial’, from transactions to contract management, and this is no different from wider commercial enterprise. Being commercial here means being efficient and customer-focused.

Rejecting ‘commercial’, or siloing it to specific teams or entities, means rejecting a mindset and set of skills that are critical for local success. Perhaps we need to develop and nurture a ‘local government acumen’, a nuanced version of commercial acumen?

Commercial skills for successful trading

In 2018, research identified that 59.2% of authorities had at least one trading company, and many more operate venues or sell other services on a commercial basis. Where councils have made a strategic decision to operate services on a commercial basis, having the right skills in place to do this is critical. High profile failures of local council commercial entities have highlighted the risks of not having the right skills at the table.

  1. Get the governance right. Senior leaders and members need to understand roles and responsibilities and have the skills and experience to discharge these effectively. They need to avoid conflicts of interest and bring in the right commercial expertise (e.g. independent non-executive directors)
  2. Sales and marketing. In short, to create profit in an open market you need to create something that someone values enough to buy and to pay you more than it costs to create, produce, sell, and service it. There needs to be an understanding of the market, competitors, and the unique selling point of the services.
  3. Commercial finance and legal advice. Making sure robust tax and legal guidance is available as well as the right financial support built on understanding of sales data, costs, and drivers of profit. Council finance systems are typically not designed to understand this, being focused on resource allocation and budget monitoring.

Underlying this as a foundation stone is an entrepreneurial culture, where staff are supported to take measured risks, to learn, to start and stop activities, and respond flexibly to change.

Are you ready for the next generation? Where is local government in the rapidly changing world of finance? Are the skills in place to navigate the change?

By Jo Peters.

I work with lots of different UK local authorities and I can see that, as a local government finance leader, your inbox is relentless. Pressures are mounting from all sides. Balancing the budget is the top priority. The increasing number of councils that have succumbed to section 114 notices is a constant reminder of why this is. But your challenge is compounded by multiple factors. A few of the biggest headache inducers include continuous uncertainty over funding, changes to the rules which govern borrowing and investing, accounting, reporting and auditing, and the daily frustrations of interacting with creaky systems and often unreliable data quality.

At the same time, the world is changing. Beyond local government, the traditional role of finance managers as ‘masters of the numbers’ has begun to shift. The ONS projects that more than 50% of current finance jobs will be automated within 10 years. Better access to financial information across the organisation will result in less reliance on finance teams and on traditional budget and reporting cycles. Similarly, the growing awareness of environmental and social value will play an increasingly important role in how organisations, including local government, choose to invest and spend.

“When the rate of change inside an institution becomes slower than the rate of change outside, the end is in sight”

Jack Welch, former CEO of General Electric

I have spent the last few months immersed in thinking about the future of finance while studying at the Cambridge University Institute of Sustainable Leadership. Here there is a rapidly increasing shift to a more impactful approach to business, driven by regulation, shareholder and investor pressure, and the demands of civil society. It is projected that over the next 10 years regenerative business models will come to the fore, with organisations committed to the circular economy and applying full cost accounting to all business impact in the environmental, social, and economic spheres[1].

Where is local government on this change curve? For many, there is an awareness that things are changing, but preparing to respond is, unsurprisingly, lingering at the bottom of that very full in-tray. For others, the pressure is more real and new operating models and new ways of working across the organisation have necessitated finance leaders to consider their own return on investment as a finance function and put change into action. I predict that the same shift that is being seen in the corporate sector will need to happen in local government, but the challenges and pressure faced by finance leaders will make this a difficult shift in comparison to more agile organisations.

We think that having the next generation of finance leaders in place is a great way to start to put in place the adaptability, flexibility and resilience that will be needed to navigate this new world and it is something that is possible, despite other pressures. Are you hiring and developing this next generation of finance leaders in your organisation? What should you be looking for? Here are our top five to look out for:

Technical excellence – this is your backbone. Regardless of the digital advances, there will always be a need for technical expertise to understand the numbers, regulations, and tax issues and interpret this for the organisation. The nature of technical expertise will change as there is a shift to a wider definition of value incorporating environmental and social factors.

Commercial acumen – this isn’t about setting up a trading company, this is about understanding how value is created for the community (beyond finance and beyond organisational boundaries) and building this into decision making. For example, in Oldham an asset-based approach was taken to develop a Social Prescribing Innovation Partnership with a consortium of local organisations, investing in community resources and focusing on early intervention.[2]

Systems thinking – you will need an increasing ability to deal with complexity which can be led by diversity of thought and incremental approaches to managing risk. For example, in recognition that service teams are dealing with complex problems and moving targets, there needs to be flexibility and agility in how budgets are used to ensure resources (both financial and human) are directed to the right thing rather than the thing we planned to spend it on. This will require courage in a climate of financial constraint.

Curiosity, empathy, and an open mind – continuously learning, developing, and building relationships within and outside the organisation. Collaboration will be key to addressing the complex problems that we are facing locally, nationally, and globally. Partnership working has failed so often because of poor relationships, mismatched expectations, and imbalanced rewards. Having a team with the skills to engage and learn about others, find common ground with partners, and embrace complexity and change will enable leadership of successful system change[3].

Storytelling – providing engaging, valuable, and influential insight to support purposeful decision making. Turning strategies into stories will inspire and motivate change to such an extent that organisations such as Microsoft, Motorola, Procter & Gamble, NASA, and the World Bank are intentionally training leaders in the art of storytelling. People will always tell stories, this is about setting the narrative and replacing bad stories with good ones.

Do you agree? Does this match what you are looking for? How does your team stack up?

I think this is a conversation worth having and am keen to continue it with those who are grappling with the challenges and questions I started to wrestle with here. We can either do that in the comments below or over a coffee, I’m on joannepetersconsulting@gmail.com

[1] Grayson, D., Coulter, C. & Lee, M. (2018). All In: The Future of Business Leadership. Abingdon: Routledge

[2] https://www.councils.coop/wp-content/uploads/2019/06/Social-Prescribing-Oldham-Council-1.pdf

[3] McKinsey. (2019). Answering society’s call: A new leadership imperative. McKinsey Quarterly, November. https://www.mckinsey.com/business-functions/organization/our-insights/answering-societys-call-a-new-leadership-imperative#

Making Partnerships Work

By Emma Harewood. For more, follow this link to her LinkedIn post on Beyond Therapy.

On 19th May Bluestar hosted ‘Beyond Therapy’, the first ever festival of activism for child sexual abuse in Bristol dedicated to re-imagining our society’s response to child sexual abuse through research, creativity and connection. Emma Harewood hosted a panel with experts from The Lighthouse, Bristol SARC, NHS England commissioner and Claire Bethel of RedQuadrant, to talk about ‘Shaping the system around children and families – encouraging professionals to work in partnership to create whole system change.’

What does it mean to work in a true partnership?

The Lighthouse team explained it takes more than just co-location, although that certainly enables sharing of knowledge and expertise across agencies. Creating an understanding of each other roles, culture and priorities means you can influence others to keep the child central. They described working with police to slow down the process at the start of investigation so the child feels in control. As well as providing expert consultation to support social workers and teachers in the community, allowing the service to reach a wider group of children and embed good practice. And understanding the restorative value of the doctor’s examination.

Partnerships take time to create, and the team advised others to invest enough time in developing agreed ways of working before they open the door to children.  They encouraged commissioners and policy makers to ensure there are enough sessions provided to create safe spaces for children to share and for supporting parents with the skills to be there for their child.

What are the benefits for children and young people when we work in a partnership?

The young people said they really valued all services being under one roof and the holistic service.  Their persuasive voices gave support to recommission the full service offer after the pilot and convinced the judiciary to allow pre-record cross examinations in the Lighthouse. 

We heard how the children felt welcome and ‘almost loved’ at the Lighthouse, only having to tell their story once in a safe place. They had choice and control over who they talked to and when.  For the first time, the professionals had been organised around them, rather than the child fitting in with the professional’s ways of working. Young people in Bristol, Jersey and London have all said that being able to access something as simple as a sexual health follow-up in the safe place they first met the doctor after sexual abuse, is better than travelling to an adult focused GUM clinic where they felt judged. The Bridge in Bristol are looking for young people’s voices to amplify the need for this partnership service in their local SARC right now. Other young people in the AYPH study, remind us how important holistic support is to help re-establish friendships, school and family life.

Why is it so hard to achieve partnership working?

Ultimately the financial resources needed to create joined up partnership services are considerable and seen by some as gold standard. As well as the time it takes to really invest in the relationships and understanding needed to create true partnership. Add into the mix the logistical nightmare of all partners, commissioners and policy makers aligning their shared vision and commitment at the same time as contracts end! And finally, the need for sacrifices to be made in organisational culture and ‘the way we do things round here’ to find a middle way.

Creating new partnership and whole system change need passionate, relentless and creative leaders – but the difference the change can make to children, families and adult survivors is priceless.  The external Lighthouse evaluation and final annual report have shown that investing in holistic, long-term support in a multi-agency partnership improves the experience and outcomes for children and families.  With less victim withdrawals and more cases making it as far as the CPS, the Lighthouse partnership is starting to turn the tide towards a more child friendly experience of the justice system against the backdrop of a shocking all-time low in the conviction rates in the UK for child sexual abuse.

You can read more about the Lighthouse and setting up your own version of a Child House model partnership in the Child House Toolkit and the Home Office Child House Partnership Guidance.

With thanks to the panel members:

Emma Harewood (chair) – Co-founder of the Lighthouse – the first UK Barnahus for children that experience sexual abuse, the Child House model and CSA hub model.

Marian Moore, NSPCC service manager at the Lighthouse

Eimear Timmons, Practice Development Manager at the Lighthouse

 Dr Michelle Cutland, Clinical Director at The Bridge and CSA Centre for Expertise

Claire Bethel, RedQuadrant.  Policy expert in sexual violence and author of Child House Toolkit

Becks Marsh – NHS England Commissioner in the South West

How can you make better decisions in #complexity?

What is one thing you’d like to offer to adult social care commissioners to help them decide their approach?

How can you make better decisions in #complexity?

How do we ensure a better #future for citizens, communities – and ourselves?

How can we encourage #innovation in an over-pressurised and partly broken system?


Adult social care #commissioning is a fantastic space to explore these issues, as we’ve been doing for the last few weeks on an interesting project, and for years before that!

Commissioning in adult social care means shaping a complex system to get better outcomes for people with learning disabilities, physical disabilities or physical or mental health issues.

It can be as narrow (but challenging) as ‘procuring organisations to provide homecare’, and as wide and messy as ‘shaping a community where everyone can thrive’.

As a commissioner, you have varying levels of power, authority, capability, respect, and understanding in your organisation.

…you have to constantly respond to crises (most of them caused by ‘austerity’): a provider of care collapsing; problems recruiting and retaining workforce because they’re paid less than Amazon; 30% of carers off sick with COVID; an urgent need for particular specialist mental health services (say).

…and you have to work in a place, with all its complexities:

– do the chief executives of the council and the hospital trust get along, or can they not be trusted to be in the same room together?

– do our providers trust us, or are they still hurting because we clumsily tried to reduce their fees three years ago?

– do the community organisations agree with our ideas about ‘coproduction’, or do they see it as foisting the costs of care on to them?


What we’re doing is trying to produce a tool to help people doing this messy, complex job to assess their context, and:

1- put together a commissioning development plan to get more ability to influence the system of health and care in their place (or, even, the system of wellbeing)

2- decide which of twelve ‘commissioning approaches’ fits their place and their needs best


We’ve been running this as a #workoutloud process – so if you fancy diving in and contributing, you’re welcome! There’s an open Mural board and an open meeting on Wednesday 20 April at 2:30pm (links below).

Or you can give us a quick comment here:

What is one thing you’d like to offer to adult social care commissioners to help them decide their approach?


As well as the slides (scroll to the bottom), the draft working documents are on a Mural board for comment, at https://app.mural.co/t/redquadrant9812/m/redquadrant9812/1644015309200/e20e0564cb7277f742c6f3923f2cc0d6e90ca20e?sender=benjamintaylor2777

Mural Board

And there’s a final meeting of our open group for anybody who wants to comment on Wednesday 20th 2:30-3:45pm which you are welcome to attend – registration needed at https://us06web.zoom.us/meeting/register/tZYld-CtrDMtH9RG2dYFmpqKoLqPbBZz82eU


About this work:

The Public Service Transformation Academy has been commissioned by the LGA (the Care and Health Improvement Programme, jointly run with DHSC and ADASS) to produce a tool for adult social care commissioners to go through strategic options appraisal – i.e. to assess their place and decide the best approach to commissioning.


The slides in PDF:

Commissioning, community, and ‘levelling up’ – a critical moment

Yesterday I was lucky enough to chair Transforming Commissioning: Levelling Up and Community Investment, a Third Sector Commissioning conference from Westminster Insights. It was one of those events where (all credit to the organisers), each of the speakers had a hugely high proportion of powerful, crisp messages in their very short slots, and the audience were engaged and well-informed.

Here are my rough notes from the wrapup at the end of the day, attempting to summarise some of those very rich messages.

Credit to the speakers is at the end; you can consider that the good ideas in here come from them, and bad interpretations are all mine.


Ad break: as well as the brilliant work we do at the Public Service Transformation Academy to build capacity for commissioning and transformation, we’re currently working on behalf of the LGA on a project to provide structured support to adult social care commissioners to develop their strategic approach.

If you’d like to share your experience or ideas to inform a free, open, local-government-wide tool and learning community, we are interested in hearing from all parties.

There are several different ways that you could get involved. We are looking for interviewees, case studies and focus group attendees.

We are also planning to create an open learning community. This will meet for the first time on the afternoon of Wednesday 9 February and will meet fortnightly on four more occasions.

If you are interested in getting involved, please contact David Mason at david.mason@publicservicetransformation.org, 07887 442487


First, and above all, commissioning that privileged the competitive incentive above all others probably is dead, or certainly deserves to die – we should be seeing competition as one of the very powerful (and risky) tools in the toolkit.

The reality is that twelve years of austerity has left us with a great deal of damage. We heard that civil society – at least organised civil society – is weakest where it’s most needed.


The old saw of fragmented funding comes up every time the voluntary, community and social enterprise sector gathers – and comes up every time local government gathers.

And yesterday I heard about Public Health England not yet having a 2022-23 budget with which to carry out it’s critical NHS workforce planning role. And about NHS capital funding; announced on December 24, and absolutely needs to be spent before 1 April.

There’s a risk this becomes the background noise, the water we swim in. But we need to take this seriously.

The HUGE cost and friction of current funding mechanisms isn’t just ‘something the recipients like to moan about’. It’s an actual economically demonstrable disincentive to value.

If you wanted to design a system to stymie all the good things we are seeking from ‘levelling up’, you would design it this way.


This is of a piece with the absolute fragmentation of coordination across the sector – or perhaps I want to say the fragmentation of coherence – the ‘institutional clutter’, the ‘pinball referrals’, the lack of joining-up which creates a negative multiplier on spend, impact, and citizen experience.

Nevertheless, there’s still a deep strength even in the most deprived, most under-invested communities.

Amongst many philosophical reflections and aphorisms, Will Balakrishnan of the Mayor’s Office for Police and Crime in London challenged us: “Ask yourself – are you the prisoner of your experience?”

I think that’s particularly relevant in the context of fragmentation, and of lack of civil society organisations where they’re most needed.


Another theme – and the antidote to fragmentation – is relationships.

This is all about relationships – relationships between levels of government, levels and peers of the community and voluntary sector, and between citizens and ‘providers’ (and between citizens themselves – especially when you consider a starting point of ‘we are all citizens’.

It’s easy to get carried away and think ‘relationships’ is all about sweetness and light and connections.

Relationships are NOT just a love-in – I mean, have you ever been in a relationship?

Good relationships are robust, challenging, they provoke growth.

Will reduced all of commissioning to three questions:

1.      What is life like now for people?

2.     How is it changing?

3.     How might it change if we do things differently?

And added two provocations:

  • Imagine there are no services
  • How do we make space for conversation?

This relational underpinning to commissioning and to voluntary and community sector investment and whatever ‘levelling up’ means is critical.


We heard two really great comparable challenges:

  • This should be about paying forward, not in arrears, from Kathy Evans of Children England
  • And an exhortation to focus on measurable outcomes as a way of bringing the fragmentation together, from Andreaa Anastasiu of the Government Outcomes Lab

This will feed in to the balance of story and data later, but I want to make the point that this relates to relationships too. A transactional relationship can never focus on the bigger picture.

Governance – another word for relationships – also emerged as a really critical issue – and like other forms of assets it needs to be built up (in advance) – and can be measured by trust.

Learning and adaptation came through as really critical – a sector with people literally leaving because they are worried about the ‘precarity’ of their own jobs, with 30% of the effort and cost going into bidding, managing, measuring and reporting (my own illustrative figure) – who has time to learn?


At the heart of this is the UK as one of the most unequal countries in the developed world.

There was a strong push to better connect the grassroots with the national policy agenda, which is always ‘playing catch-up with what’s on the ground’.

Part of this is that MPs and Councillors have to spend some time connecting to community and the voluntary, community, and social enterprise sector. But civil servants don’t. Give them opportunities for secondments, visits, deeper, embodied understanding.

They are bright, well-intentioned people and they are listening. There was particular praise for the government’s response to the procurement green paper responses – ‘hey, it looks like they actually listened!’

The question was put to VCSE attendees: “What do you know about the system that no-one else knows?”

How can you use your insight at the grass roots level (at the level of the reality of people’s lives!) to break through – to confront people with human, electoral, economic realities – that changes perspectives, mindsets, and policies.


The really good news, as we heard from Matt Whittaker of Pro Bono Economics, reinforced by real data from many others, is that the economic and social pictures are aligned and clear:

  • Moving money to the local pays back better
  • For every £1 into social infrastructure, c63p is re-spent locally (using the Calderdale case study from Sian Rogers at Calderdale Council and Rachel Bentley of the Centre for Local Economic Strategies)
  • And you get £3.20 back in the following decade – it regenerates places

So civil society spend not only has a massive impact on civil society where it’s most needed, it also gives a massive economic boost.

And we had a reminder – how easily we give up on this – early intervention and prevention offer us enormous value!!

Not to mention that, just perhaps, we should be thinking about key services – especially services for children – not as a luxury but as a huge investment. If ‘schools should be cathedrals’, is it really right that we might recoil in horror at the idea of accidentally over-investing in children? God forbid we might ‘gold-plate’ anyone’s pre-school experience…

Furthermore, investment in civil society can shift core services (as Calderdale showed).

And you get an extra multiplier on these effects if you work with organisations led by and for minoritised communities.

The bottom line is: attempts at transforming economic context succeed when there is the right community and social context.

Matt Whitaker pointed out to use that the WELBY measure – ‘wellbeing adjusted year of life’ – is now in Treasury mainstream Green Book guidance – so let’s use !

(And the Treasury has the Magenta Book for complex evaluation)

So certain parts of government still ‘need persuading’ about the benefits of devolving spend and the ‘efficiency’ of the community and voluntary sector – but even their own evidence is pretty clear – so let’s use it.

Kathy Evans, Children England – Eight Principles for Commissioning

So changing mindsets from thinking about individual activities (fragmented) to thinking about outcomes – and gathering data and evidence – is critical. We need to articulate the cause by better articulating the value – to get to a place where “you can’t be a serious politician and talk about building a better UK without talking about civil society”.

One really big takeaway for commissioners from all this is – despite all the pressures – to really play an active market stewardship role – understand your provider market role, and really thinking about the relationships you are involved in and shaping.

This, inevitably, means investment. And that includes – especially with covid – making sure core funding includes funding for sector resilience and wellbeing.

It also means seeing the bigger system of which we are a small part, understanding that ‘giving away power’ is just a myth – that if we see ourselves as a small influential part of a bigger thing, we can go much further.


There was an inspiring belief in the power of local authorities.

Despite facing the greatest struggle of resource and capacity ever – lots of positive things can happen locally, particularly in partnerships between the sectors locally.

The rallying cry here was to build the infrastructure to take things out of the hands of central government. To build that core economy, abundant economy, based on relationships and people connected with each other, not on the scarcity of goods and things.

At the same conference last year, I gave a talk on ‘commissioning is dead – long live commissioning’ (a favourite topic since at least 2012). The ‘commissioning cycle’ which puts procurement at the heat of commissioning deserves to die.

As we are slowly moving out of the equivalent of a wartime footing with the pandemic, the hope for the future is in continuity of funding, building local governance capacity and relationships, and building community power in which the public sector plays a constructive role.


Speakers at the event were:

  • Andreea Anastasiu, Senior Policy and Engagement Officer, Government Outcomes Lab (University of Oxford)
  • Vidhya Alakeson OBE , CEO, Power to Change
  • Matt Whittaker, CEO, Pro Bono Economics
  • Will Balakrishnan, Director of Commissioning and Partnerships at Mayor’s Office for Policing And Crime (MOPAC)
  • Rachel Bentley, Associate Director, Centre for Local Economic Strategies (CLES)
  • Sian Rogers, Policy & Projects Manager, lead for Voluntary and Community Sector, Calderdale Council
  • David Holmes CBE, CEO, Family Action
  • Kathy Evans, Chief Executive, Children England

There are five core things which, if you make them your practice, are likely to lead to organisational success.

Three basics:

  1. Honest conversations, discussing the undiscussable of emotions and reasoning – nothing can develop unless there’s a shared effort to get at the truth
  2. Clarity – no learning is possible, and productivity and psychological safety are unlikely, without clarity of roles, tasks, decision-making, and relationships
  3. Learning – true learning isn’t possible without planning, prediction, and learning and reflective practices

These three create a learning system

4. Culture shaping, understanding that leaders and systems and emotional responses to them create conditions which generate psychological safety and productivity – or not.

A productive system.

Intent – measure customer / citizen / community outcomes – as they judge them.

A purposeful system.

Culture and achievement of intent are self-correcting measures – if you measure the actual outcomes of your practices; the experience of employees and customers, and learn what works, you can’t go wrong.

But you have to make them a practice – daily, built-in, acknowledging your weaknesses.

Download the ‘five core practices’ here:

https://www.dropbox.com/s/fqlktld46xcmgs4/Benjamin%20Taylor%20-%20five%20core%20leadership%20practices%20for%20linkedin.pdf?dl=0

Which practice do you need to work on the most?

#complexity#transformation#culture#leadership

Why is a bridge and water such a good explanation of how people go wrong with business transformation?

Why is a bridge and water such a good explanation of how people go wrong with business transformation?

This image has an empty alt attribute; its file name is bridge-and-water-1.jpg

I use this image to open a lot of my learning and teaching on service and business transformation. What do you see?

Some see

  • white water – froth and waste which we can remove one obstacle at a time, allowing us to see more at each step
  • the chance to bore out a concrete channel to carry the water smoothly… until the detritus builds up again
  • a flood of demand we need to build defences against
  • a rich, living ecosystem we should explore
  • upstream and downstream opportunities for improvement
  • a keystone arch – a miraculous way to make a bridge support its own weight. But try to copy someone else’s business excellence without understanding the scaffolding needed to make it work, and you’re just throwing stones in the air and hoping they stick.

The point is that when I say ‘here’s an image which is about business transformation’, everyone responds from their perspective, their understanding.

What do you see?

#businesstransformation #servicetransformation #metaphor #learning