Public sector commissioning of local mental health services from the third sector

TSRC Working Paper 122

by James Rees, Robin Miller and Heather Buckingham

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Abstract:

Growing attention has been given to the role of commissioning as part of a policy environment that has emphasised the promotion of greater supplier diversity in the provision of public services, with the public sector acting primarily as ‘system leader’ rather than ‘direct deliverer’. In contrast to earlier policy which referred to procurement of public services, the shift to commissioning offered the hope of a cyclical purchasing process that is grounded in the needs of its population, encourages innovations in service design, sensitively manages a local ‘market’ of suppliers, and can create well integrated, comprehensive services. From a third sector perspective commissioning is viewed, it seems, with a mixture of guarded optimism and concern due to its crucial importance in shaping the nature of the relationship between that part of the sector that delivers services and the state which funds it.

This working paper provides an initial report on research that sets out to discover the realities of commissioning from the perspective of the public sector bodies responsible for its implementation and the third sector organisations who choose to engage with commissioners as part of achieving their missions. Based on a case study service field (mental health) and geographical locality (an urban conurbation in the UK), a survey and series of semi-structured interviews were undertaken with key stakeholders from the public and third sectors to understand the practices of commissioning. Due to the key focus (and often concerns) of third sector organisations on procurement this was explored in particular.

The findings suggest that within, this case study locality and service field, at least the commissioning cycle is not yet in full operation. For both commissioners and TSOs the procurement and contracting elements continue to take precedence. Whilst there is evidence that practice around these elements has changed to some extent (in particular the greater use of contracts rather than grants and more competitive processes), there is also considerable continuity in the importance of personal relations between the commissioner and provider and which organisations receive funding. In contrast with previous studies, many of the TSOs welcomed regular tendering as an opportunity to expand their services and also as it involves the public sector reviewing what they fund. From the perspective of TSOs the public sector can improve its practices through ensuring that its commissioning staff have the skills and experience to undertake these roles, that the organisational processes are undertaken effectively and fairly, and that the different commissioning teams work across the user and service group silos. The tendency of the public sector to undertake whole system (e.g. health) and internal organisational (e.g. social care) changes appear to lead to considerable disruption in the commissioning process and the relationships that underpin it. From the findings of this study commissioning is still to fulfil its expected potential in relation to improving outcomes for people with mental health problems and efficiencies within the system. It is not possible to infer if this is purely a question of commissioning not being implemented thoroughly as yet or if its principles are fundamentally flawed – what is clear is that without the necessary capacity, time and expertise it is unlikely to succeed.