We still commission according to administrative silos
This is the second in a series of posts on the challenges of modern commissioning stimulated by a recent report from the Reform think tank called “Markets for good: the Next Generation of public service reform”.
Perhaps the single most intransigent difficulty in commissioning has been the difficulty to move towards a joined up system. People have been talking about doing away with commissioning silos for years, but, so far, with little result.
There is a general consensus that most offenders or people with addictions face multiple problems which interlock and reinforce each other. Readers will have seen many examples of the sorts of graphic below used in the Reform report to illustrate this:
The report argues that:
“Whilst the problems faced by the socially excluded are overlapping and mutually reinforcing, for the most part the support they receive is not.”
Despite the many structures and forums in place designed to coordinate service delivery, experience shows that the reality is more likely to be “duplication, muddled diagnosis, poor sequencing, cost shunting, agency sabotage and unnecessary join up bureaucracy”.
This is a description that I recognise only too well from my work evaluating multiagency partnerships. Duplication in particular has proved very difficult to tackle. It’s easy to think of many examples where a number of different agencies all have a case management system with the same individual service user at the centre of it. It’s not that the work isn’t coordinated, it’s that it is coordinated too many times, by too many agencies.
What looks like a clear referral/allocation/case management system on a PowerPoint slide often makes much less sense to the individual receiving the services.
Inevitably, individual agencies focus on their own sphere of operation – offending, substance misuse, worklessness, accommodation etc. – which means that although often as many as half a dozen workers have detailed understanding of parts of an individual’s life, no one agency has a clear picture of the whole.
A term very well known to probation staff, sequencing is about offering the right help in the right order. While everyone knows that an individual is unlikely to make progress in coming off drugs before they have settled accommodation, at the same time individual workers in different agencies all have their own targets to achieve and it’s often not bureaucratically possible to say I’m going to keep this case but not work actively on it until the person has got somewhere safe to live.
A particularly damaging consequence of side load commissioning is “cost shunting”. This is when one government department does something they know will add cost to another department, but goes ahead anyway because those costs don’t fall within their budget. The example that Reform gives is the closure of youth provision by many councils struggling with reduced budgets which, almost inevitably, needs to more youth crime and additional costs for the police, courts probation (and eventually) prison services.
A highly topical issue is what Reform refer to as “agency sabotage”. They define sabotage as occurring when government pays providers to complete a certain task but this requires the assistance of other agencies or providers. A prime example of this is the government’s radical overhaul of the probation service – “Transforming Rehabilitation” – where new (mainly private) providers will require the active cooperation of a wide range of other agencies such as drug treatment providers etc. to reduce reoffending. Some of the new providers have already stated that they do not wish to spend any of their contract revenue on this provision but expect other agencies to provide high quality services to offenders without any additional incentives.
Join up bureaucracy
The Reform report criticises (quite fairly in my view) the number of structures designed to ensure multi-agency coordination. Although this might seem a contradiction, it’s clear to many middle managers who spend a large proportion of their working lives in multi-agency meetings that, despite the best of intentions, the amount of integration is strictly limited. It is rare for a cross-department approach to be truly coordinated when budgets are held separately and individual agencies are required to prioritise their own agency targets.
Joined up commissioning has become a bit of a Holy Grail for policy experts. Everyone agrees that on its value in principle but very few have made much progress towards it. Without pooled budgets it’s hard for even committed leaders to sustain progress.
There was a period in time when some Drug Action Teams were starting to make a difference but DATs themselves are now largely defunct. MAPPA structures appear to function well and largely achieve their purpose in co-ordinating a large number of agencies to manage high risk offenders. However, this is a rare example and it should be remembered that MAPPAs work with relatively small numbers of offenders, agency roles are clearly defined and they benefit from a high level of resources.
Reform’s solution to joining up commissioning is in a radical new approach to public service markets to which I will return in a later post.
If any readers have good examples of co-ordinated commissioning, please share them via the comment section below.