Commissioning – How managers can avoid costly failures

The Cornwall scandal highlighted what can go wrong if there is a failure of commissioning arrangements. Andrew Cozens explains how managers and councils can cut through the confusion

Curriculum vitae
Name: Andrew Cozens.
Job: Strategic adviser, children, adults and health services, Improvement and Development Agency (I&DeA).
Qualifications: MA, CQSW, and MSc in applied social studies.
Last job: Corporate director of social care and health (formerly director of social services), Leicester Council.
First job: Community worker, Birmingham Settlement.

A key finding of the inquiry into the institutional abuse of people with learning difficulties at Cornwall NHS Partnership Trust was the failure of those with commissioning responsibilities.

The failures were based on departures from best practice in how services were arranged, delivered, audited and monitored, how case management was functioning, and the absence of advocacy and other safeguards.

But just how clear are managers and lead members in children’s and adults’ services about their own commissioning responsibilities? The looseness with which the term commissioning is used in central and local government adds to the confusion.
How councils perform as commissioners is key to the government’s ambition for public services. In children’s services, councils are expected to continually assess local need, map provision, identify gaps and work with local partners to fill them. They must commission services to ensure diversity of provision, push continually for improvement and intervene decisively when standards are inadequate.

In adult social care there is more diversity of provision in the voluntary and private sectors but little in the public sector. Here the challenge is to promote choice and services that users want. Individual budgets put more control into service users’ hands and commissioners must have regard to the interests of those paying for their own care.

The Commission for Social Care Inspection concluded in its report The State of Social Care in December 2005 that commissioning is the hard nut to crack. They found evidence that councils understood what it is but not how to align resources to a strategy and implementation plan.

Most councils recognise the need for early intervention in children’s and adults’ services but have yet to reflect this in strategic plans. The profile of services is still weighted towards traditional offers.

In our work on commissioning at the I&DeA, we are encouraging councils to view commissioning as a continuum of activities that requires participation by several people inside the organisation, as well as partner agencies, providers, users and carers. In simpler terms, the responsibilities of councils and managers are:

  • To hear, understand and anticipate the needs of their residents now and in the future, and understand what constitutes best practice (“strategic needs assessment”).
  • To know what services are there now, where and of what quality and what gaps exist, and hear service users’, carers’ and staff views on them (“market mapping”).
  • To use area profiling to better understand local differences in need, availability, and quality, an exercise providers should engage with.
  • From these processes, to draw up and develop a commissioning strategy: what services are needed, what is the fit, what are the priorities for development or change, over what timetable and with what resource requirements?
  • To develop a framework for commissioning that converts intent into reality and reflects best practice legally and professionally, through procurement directly, through understanding the intentions of partners, and the impact of service users and carers taking up direct payments or individualised budgets.
  • To use a variety of procurement techniques best suited to commissioning intentions. Where there is an established market this may be by simple tender. In other instances it is now common to identify preferred providers with whom to develop services in partnership.
  • To clarify the role of case managers in matching needs to services individually, and where and how staff from other agencies can.
  • To be clear about review, advocacy and quality monitoring arrangements, particularly where joint commissioning is undertaken, and to plan for the failure of a provider.

    Commissioning strategies should be well-thumbed documents, not just fished out for inspections. By constantly seeking feedback, councils and their managers can respond and adjust and services will continue to improve. 

  • Forthcoming council profiles from CSCI and Dr Foster health care information will help with needs assessment, market mapping and area profiling.
  • Use the experience of the Supporting People programme to help with ideas.
  • In addition to users and carers, talk to staff and service providers about how they think things might need to change.


  • You can easily write a commissioning strategy by next Monday – people overcomplicate it.
  • Unless you specify it, it won’t happen.
  • We can rely on inspectors to check services for us.

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