Commissioning with communities and complexity

I was presented with a spreadsheet of tasks; ‘follow this process and you can’t go wrong’ was the advice given to me. In relative terms, we had some money to play with. I worked with some amazing people both in the Council and across the VCSE sector, and I followed the process. But I wasn’t once advised to talk to a young person. I wasn’t young and I didn’t live locally but I was making all the decisions.

After austerity hit, the youth and play sector was decimated by two third budget reductions and we realised we needed to do something differently. I had the unique privilege to work with the New Economics Foundation (NEF) to shift our process driven commissioning to outcomes focused facilitation with co-production at the heart of everything we did. 

Looking back, I think we tried to do too much, and I apologise to the VCSE sector who attempted to keep up. But for the first time, we were out there talking to young people and bringing them in as colleagues so that we made those same decisions together. Overnight, our commissioning came to life – it sprung out from the spreadsheet, it demanded creativity and fresh ideas and it challenged us at every step as we continually asked ourselves ‘why have we been doing it this way?’. The young people we worked alongside were just as excited and energised as we were; and the decisions we made felt like the right ones. 

That was fifteen years ago and I’ve had the unique privilege to support other commissioners as they reawaken their passions and step into the uncertainty of commissioning with co-production and people at the heart. Across the Local Authority sector, things have shifted significantly. I no longer walk into a room to rolling eyes when co-production is mentioned. Co-production is stated as a CQC assurance framework necessity, and as budgets continue to be squeezed, more and more council officers are realising that we can’t keep doing what we’re doing. We need a rethink. Commissioning with co-production and collaboration is tried and tested across the UK. We’ve been doing it since 2008, so the evidence is there and bold commissioners are now many.

So, this is the landscape that NHS commissioners will be joining as they seek to implement the new NHS strategic commissioning ambitions. Nothing within this strategy is surprising or unfamiliar. In fact, it exactly describes how many Local Authorities have been developing and working, which should give the NHS a blueprint on which to build. The challenge will be whether there is the space, time and vision for NHS commissioners to challenge themselves and the system around them. It will only need a few to step out – and some are already doing it. The support and learning is out there, and Jessie Cunnett and I hope to be a part of that offer. 

One of the reasons I set up the Ideas Alliance was to build a community of people – including commissioners – who were trying to do things differently in an environment of scepticism and sabotage. I had been in that environment and it’s lonely and frustrating. Without the support of NEF, I wouldn’t have got to where I did. I totally understand the need to have someone hold your hand and help you to be brave. So it is from this understanding that we offer NHS commissioners that hand and that bravery.