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.
Very interesting reading – just to add and further a statement made during this blog, I make reference from above: “Muddled diagnosis
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.”
To add: “From 2nd Chance findings (a study of 437 people in the CJS between Sept 2009 – Sept 2013) it took an average 15 organisations to work with one person from initial custodial sentence. Organisations such as Her Majesty Prison Service both Private and Public, Probation Service, Education Providers (Custodial and community), Charitable and Private Resettlement Providers, Job Centres, Employers, Mentoring Teams, Housing Support teams, Health Services, Mental Health Teams, Substance Misuse Services, Advocacy and Financial Support Services to name a few – but it takes one person with positive intention and support towards ‘Change’ to effectively navigate and gain from this process.
From the above 15 organisations, it showed an average of 52 professional and personal persons of influence, for each of the persons in the criminal justice system, throughout one sentence, to stay on track to a positive outcome.”
Also, only half a dozen people – talked to each other – yet many others worked with the client, thus the client was confused as who/what was the most important and necessary factor in the journey to recovery. The other factor that seems to be missing from all of this – what doe the client want? No matter the qualifications, experience or ideas professionals have – the client is the only expert on themselves,their overall need. With regards TR – how many Victims and Offenders have been heard in the making of this change?
Thanks very much for your comment Justin. Somehow I missed the 2nd chance findings study 52 professionals from 15 organisations is larger than even my most pessimistic guess. As you say, engaging with the client and trying to meet their needs is the starting point for successful resettlement.
52 professionals working with one individual is an astonishing figure and a brilliant illustration of the un-joined up nature of services, thank you for sharing it Justin. This problem is being increasingly acknowledged and it was encouraging to hear in the autumn statement that the ‘Troubled Family’ approach (co-ordinating services that all work with one family) is intended to be extended to individuals with multple and complex needs. This will hopefully include many people caught up in the criminal justice system, so let’s hope it makes a difference.
Thought provoking blog and responses. Whilst I applaud the ‘Troubled Families’ approach, I’ve yet to see this in practice. However, I do believe that there are a number of innovative projects around the UK that are achieving multi-agency best practice. It just seems that there is no recognised forum for those to be shared more widely.
Or perhaps they are there and I just don’t know about them??
In any event, a true multi-agency, shared funding partnership is clearly the way forward. If anyone has information about where this is happening effectively, I’d love to hear more!
Thanks for your helpful comment. Like you, I’d like examples of best multi-agency practice, budget sharing is still very rare.
I can give one example of how multi agency working arrangements can work positively for people. In theory it is possible for three agencies (Substance Misuse Community and Residential, Children and Families Social Services and Adult Social Services who are the budget holders for rehabs) to offer shared funding and joint working to enable mothers needing detox and residential rehab with their child/ren to be placed appropriately and with seamless service care. In theory. There are systems, precedents and protocols to allow this but in my recent experience there are usually obstacles in the budget holder’s processes that prevent it from happening.