Developing Relational Commissioning #1

From NCERCC Commissioning is a parenting and child care activity (2010)

Commissioning is about enhancing the quality of life of service users and their carers by:

• having the vision and commitment to improve services
• connecting with the needs and aspirations of users and carers
• making the best use of all available resources
• understanding demand and supply
• linking financial planning and service planning

Commonly agreed elements of commissioning

• a common set of values that respect and encompass the full diversity of individuals’ differences
• an understanding of the needs and preferences of present and potential future service users and their carers
• a comprehensive mapping of existing services
• a vision of how local needs may be better met
• a strategic framework for procuring all services within politically determined guidelines
• a bringing together of all relevant data on finance, activity and outcomes
• an ongoing dialogue with service users and carers and service providers in all sectors
• effective systems for implementing service changes, whether of in-house or of independent sector services
• an evidence-based approach which continuously evaluates services with a view to achieving measurably better outcomes for service users and their carers
• an improving alignment with the way that other health and social care services are commissioned

These ambitions are affected by other demands imposed from outside of the parenting and child care task, ‘economy, efficiency and effectiveness’ or ‘challenge, comparison, consultation and competition.’ These parameters lead us to a definition of commissioning as procurement, purchasing and contracting and these can easily become an end in themselves and do not necessarily lead on to relational commissioning.

Other terms used to describe commissioning but which are not commissioning in themselves include:

• Procurement: sourcing, selection, securing services.
• Purchasing: buying services
• Contracting: one specific part of the wider commissioning process – the selection, negotiation and agreement with the provider of the exact legally binding terms on which the service is to be supplied.
• Commissioning: the process of specifying, securing and monitoring services to meet individuals’ needs

Here the task is seen as focused attention on what people are doing, defining a problem, seeking to fix it in some way, then trying to measure or assess whether the solution has actually worked.

Petrie and Wilson define relational commissioning as

A shared identity and common value system; mutual dependence and trust; risk-sharing; a presumption of the incompleteness of the contract; a commitment to managing contractual arrangements; and to extensive communication.

Relational contracting requires

• an appreciation that personal, professional and social values influence the nature and process of the working relationship
• the importance of building relationships over time, trust has to be established or anticipated  – there has to be a history and a future.
• mutual trust is greater than individual self-interest

Walsh et al see that it is the social process of contracting that is important not the contract itself. Relational contracting is underpinned by interaction, negotiation, flexibility and mutual trust rather than by sanctions and penalties, and this goes to build the ‘contractual community of interest’

There seem to be 4 connected features for effective contractual relationships

1. Pivotal, respectful relationships between key senior staff members
2. Collaborative relationships at lower levels of staff
3. Success with difficult to meet needs cases
4. Mutual advantage

The development of relational commissioning will require the current activity of commissioning to be transformed;

• Shifting from product to learning;
• Developing explicit skills, attitudes, and abilities as well as knowledge;
• Developing appropriate assessment procedures;
• Rewarding transformative practice;
• Encouraging discussion of practice  of both commissioner and provider;
• Providing transformative learning for all commissioners and providers
• Fostering new collegiality;
• Linking quality improvement to learning;
• Auditing improvement.

Further reading

Walsh K  Deakin N Spurgeon P Smith  P and Thomas N 1996 Contracts for public services; a comparative perspective in Contract and Economic  Organisation: socio-legal initiatives eds Campbell D and Vincent-Jones    P Dartmouth Aldershot

Brownsword R 2004 From cooperative contracting to a contract of co-operation in Contract and Economic  Organisation: socio-legal initiatives eds Campbell D and Vincent-Jones    P Dartmouth Aldershot

Sellick C 2006 Relational contracting between local authorities and independent fostering providers; lessons in conducting business for welfare mangers Journal of social welfare and family law vol 28 No 2 June , Routledge London