Reform and the (not so) new role of stewardship

This is a re-posting of a blog I wrote for the good people over at Power to Persuade

The Victorian government recently announced a new reform agenda to develop a ‘public sector that delivers exceptional outcomes for Victorians…[and] set out a new way of thinking about how government works, all the way from strategy to service delivery’.  This will be achieved through a focus on four areas (outcomes, systems, people and accountability) which are interconnected around the improvement of government and delivery of ‘public purpose’.

The case for change includes some of the more well-rehearsed factors (e.g. demographic, digital, environmental shifts) and also the re-emergence of others (e.g. corruption).  Perhaps, though, the most significant driver outlined in the report is that of the changing nature of government.  The argument goes that over the past few decades we have seen a gradual erosion of the volume of direct service delivery that government does, as a range of different activities and functions are delivered by third party agents (either commercial or community sector organisations) under contract.  We have reached a point in time where this shift is such that government is no longer principally a direct deliverer of public services and instead has moved to being a designer, manager and steward of systems.

Use of this kind of language stretches well beyond Victoria and can be found in Australia and beyond.  The Productivity Commission published their preliminary findings into their human services review this week, where they argue that the role of government should be principally concerned with stewardship.  As this review describes, ‘Stewardship encompasses almost every aspect of system design, including identifying policy priorities and intended outcomes, designing models of service provision and ensuring that services meet standards of quality, accessibility and suitability for users’.  We have also seen the creation of ‘commissioning-only’ organisations in health, Primary Health Networks.  PHNs have been charged with ‘increasing the efficient and effectiveness of medical services for patients and improving the coordination of care to ensure ‘the patient receives the right care in the right place at the right time’.

In response to this agenda, there has been great interest in overseas experience of ‘commissioning’ and the types of factors that are important in driving this.  New South Wales recently establishing a Commissioning and Contestability Unit to help drive similar kinds of reform processes as we see in the Victorian reform document.  However, the terminology of commissioning has fallen out of favour in Victoria over the last 18 months, with some equating this to a greater push for outsourcing and the externalisation of services.  As such, the activity of systems steward seems to be (for the moment at least) a more politically palatable concept in Victoria.

What is interesting about this flurry of language for the ‘new’ role of government is that it isn’t really all that new.  This is because stewardship has always been an important role for government and also because it represents the zenith of public management reforms that started in the 1980s.

Stewardship is arguably the reason we have governments at all.  The World Health Organisation quite nicely encapsulates this in describing stewardship as a ‘political process that involves competing influences and demands’.  But if it is the case that stewardship has always been around then why has it become so popular of late?

The argument goes that with the creation welfare states and expansion of public services in developed counties, public services have become overly focused on the delivery services and often in rather separate silos.  As a result, services lack integration and duplication of efforts is rife.  Moreover, workforces have developed around the services and we lack appropriate strategic workforce planning.  The philosophy of New Public Management encouraged governments to divest themselves of the responsibility of service delivery and, in the words of Osborne and Gaebler, ‘focus on steering and not rowing’.  The implication here was that it doesn’t really matter who does the service delivery, providing the strategy and the leadership of the system is right.

As the Productivity Commission’s interim findings indicate, there are potential challenges with this approach.  Contracting out services does not always lead to more coordinated services and the most vulnerable are particularly at risk in terms of poor services, failure of services or inability to exercise choice and move between providers.  While some would point to this being an indication that outsourcing doesn’t work, those more sympathetic to such an approach would likely point out that the problem resides less with the idea and more with the execution.  While many governments succeeded in doing less rowing, it has been suggested that some have failed to effectively focus on the steering – the strategy piece.  That is, governments have only focused on one piece of the puzzle (supply-side), to the detriment of the demand part of the equation.

We might therefore see this ‘new’ turn in government as less of a dramatic shift and more of an extension of the previous reform agenda.  Indeed, although the Productivity Commission’s recent report acknowledges the limitations of market-based reforms in human services, it goes on to identify six areas that are in need of more competition (or at least contestability).

Without some fairly fundamental reform, the ‘new’ world of stewardship is likely to be a case of plus ça change.

Why commissioning is like a unicorn

Anyone who I have had even the briefest of acquaintance with knows that I have a thing about unicorns.  You will no doubt have seen many of the things people have tweeted me about unicorns and if you are lucky enough to have been in my office you will have seen “unicorn corner”.  I’m not entirely sure where this comes from, although it is pretty difficult not to like a mythical creature that poops rainbows.

Anyway, a little while back I was trying to think of a way to finish an elective subject I taught on the Masters of Public Policy and Management at the University of Melbourne that was all about Commissioning Public Services. The course was an introduction to the topic and most of those who took it had little direct experience of commissioning.  The students included a great mix of different policy areas and countries that they worked in.
As I’ve written about before, commissioning isn’t an easy task and it is one that is difficult to cover comprehensively in a classroom context.  It is an incredibly broad topic area and one that is quite complex and I was finding it difficult to think about how to conclude the course.
So I started to think about what metaphor I could use to sum up how we might usefully think about commissioning.  Something that took us beyond the Emperor’s new clothes analogy which I have used to describe the current policy debate surrounding commissioning.  Then it came to me – commissioning is like a unicorn. For those of you who have stuck with me and not stopped reading in disgust or gone off to contact some sort of welfare professional on my behalf, well done.  As a treat I’ll now explain why I think this is the case.
Unicorns are mythical and majestic creatures that exist mostly in folklore (and now the dearest recesses of the Internet). I don’t know anyone who would readily admit to disliking unicorns – how could you? Many of us, I imagine, would love to wake up and find a unicorn at the foot of our bed – or maybe outside if you happen to live in a particularly small apartment!  In the commerce literature, the term unicorn is used to describe start up businesses that are valued at over $1 billion and include companies such as Uber, Snapchat and Dropbox. So clearly I’m not the only person to think that unicorns are an amazing thing.  Outside of the commerce literature, No one has ever seen a unicorn and there isn’t much evidence that they exist but it doesn’t stop people looking for them or aspiring to be a unicorn. People will go to great lengths to catch a sight of one or to try and become one.
High quality commissioning has a number of similarities with unicorns. The concept of commissioning is a compelling one and policy makers and organisations go to great lengths in search of this mythical approach. While it looks good on paper as an idea, there is not a huge amount of evidence to suggest that examples of high quality commissioning exists in practice.  But that doesn’t stop us putting a whole series of things in place so that we might try and pursue this mythical creature.
One of the cool things about unicorns is that they have a horn.  I suspect that as people search for unicorns there is the potential danger of being stabbed by this (you can see this in action in these great t-shirts – with thanks to Sophie Yates for spotting this). To some extent the search for high quality commissioning is no different and there are any number of tales of injury in its pursuit.
My former office neighbour, the wonderful Sara Bice isn’t just an expert on Responsible Mining, but is also well versed in children’s books.  She introduced me to the book Thelma the unicorn by Aaron Blabey and this sheds some great insight into the idea of chasing the idea of becoming a unicorn.  Thelma is an ordinary pony with a desire to become much more.  She finds a carrot on the ground and ties it to her head.  A truck coming around the corner swerves and sloshes pink paint all over her.  Thelma is now an internationally famous unicorn with many fans who chase her everywhere and non-fans who are mean to her.  Thelma realises that this life isn’t for her so she washes off the paint, takes off the carrot and goes back to her former life.
This is the tricky issue that many embarking on a commissioning approach are faced with: how is it possible to make a reality of a commissioning approach and in the process drive improvement through public service systems and make better use of resources – and not just simply become a horse with a carrot tied to your head?  For sure there are no easy answers to this question.  But, just like unicorns, high quality commissioning might be elusive but for sure it exists out there somewhere.  Just watch out for the horn.

Myths about commissioning

Recently I seem to have spent quite a bit of time speaking with people about commissioning, particularly in health care where I think it is fair to say that there is still some lack of certainty over what commissioning is – or at least what this means to an Australian context.  I have come across a number of myths about commissioning in these conversations.  In this post I speak about some of these and draw on the evidence base to demonstrate the degree to which these statements do and don’t hold up.

  1. Commissioning is a coherent model. It isn’t unusual within everyday speak to hear someone refer to a ‘commissioning approach’ or ‘the commissioning model’, but commissioning is anything but a singular or coherent model. Commissioning is a broad term and frankly the terminology isn’t terribly helpful as the word doesn’t mean much to many of us (and even less to those outside the system).   There are many different definitions of this concept and often they are fairly broad in nature such as ‘the process of finding out about public needs, then designing and putting in place services that address those needs’. As this definition suggests, commissioning approaches vary according to the contexts they operate in and need to be tailored to the aims of the process and the environment this takes place in.
  2. There is one way to do commissioning. Following on from the previous point, it probably comes as no surprise that there is one right way to ‘do’ commissioning. Indeed, just a cursory glance at the literature reveals a whole range of different forms of commissioning: joint commissioning, strategic commissioning, outcomes-based commissioning and even “intelligent” commissioning (important for those of you out there planning unintelligent commissioning!) amongst just a few. Commissioning can take place at a number of different levels, aim to achieve different things and draw on a variety of tools to support this process. Commissioning happens in lots of different ways and one size does not fit all.
  3. Commissioning is just a different word for procurement. This myth has emerged because although the definition of commissioning is broad, in practice much of the attention has been around one particular aspect of this approach. Despite the fact that most commissioning cycles incorporate needs analysis, planning, stakeholder engagement, service design, performance measurement and a range of other different sorts of functions, a remarkable amount of the literature and the debate among policy makers and professionals involved in commissioning processes seems to focus on the procurement or purchasing of services. The emphasis has been on the processes of identifying suppliers and buying these under some sort of contracted arrangement. Australia is not alone in this situation, in a study of mental health commissioning in the UK, Miller and Rees observed that although organisations have moved towards a commissioning approach, many typically focused simply on a few components (typically purchasing and contracting) and not enacting a broader notion.  But the important point about this is that where this has happened, commissioning approaches have not been successful and commissioning has been seen as simply another word for procurement and not a broader process of reform.
  4. Commissioning is just about outsourcing.   Given that much of the policy literature tends to focus on processes of procurement, then it is not surprising that there is significant concern with the relationships with third party providers of public services. It is true that in the UK discussions about commissioning emerged around the same time that a number of different policy areas have increasingly shifted from being predominantly delivered by government agencies towards an expansion of involvement from private and community organisations. It is sometimes assumed that a commissioning approach should involve a process of outsourcing as services are externalised from the public sector. The Institute of Public Care argue that the existence of a market of some sort is necessary for commissioning (and I’ll post a more detailed analysis of this case soon). However, markets do not need to be dominated by, or even necessarily involve, private or community organisations. Indeed, much of the early experience of commissioning in the English NHS took place in a quasi-market where purchaser and provider functions had been separated and the majority of providers in the secondary care market remained within the public realm. The key message here is that outsourcing is not an inevitable part of the commissioning process and a decision needs to be taken about the most appropriate provider for the purpose of the services.
  5. Commissioning is a technical exercise. One of the problems with commissioning approaches that I often hear described is a lack of data or an ability to pull together information systems to facilitate commissioning processes. Data is a crucial part of commissioning, of course, but is not the only crucial element and just analysing more data and better will not help overcome these challenges. For example, needs assessment exercises in health care often become debates over epidemiological and demographic data and what receives less attention is debate over what we do value in terms of services and health outcomes, where we should invest and where not.  If at its most basic commissioning is about improving services for a particular population, then it involves difficult decisions about what to focus on (and by implication what not to).  This is not a technical exercise and is highly normative.  To believe all this can be achieved through just a closer analysis of data is unrealistic.
  6. Commissioning is a new thing. If the discussion of the last few myths demonstrate anything, it is that commissioning is broad and crosses a number of reform-related themes and issues that public services have been grappling with for some time. Yet, many of the present discussions around commissioning tend to work from the starting point that this is a new idea and agenda. As the UK Health Committee recognised: ‘Although the term ‘commissioning’ has only been in use since the 1990s, the functions it refers to have been present, in one form or another, since the inception of the NHS. It has always been necessary to determine the health needs of the population and to design services accordingly, with due regard to the available level of resources. The NHS has always aspired to ensure that its services meet high quality standards’. It may therefore be that there is nothing entirely new or specific about the commissioning agenda. Having said this, organisations have not, on the whole, attempted to bring together this full range of themes and activities within the context of one strategic reform programme as is associated with a commissioning approach. The processes and activities associated with commissioning should therefore be seen as an extension of a reform journey, rather than an entirely new path.  A further implication of this is that even if a specific focus on commissioning retreats from policy, these themes are not going to disappear overnight.
  7. Someone else will be more expert in your commissioning approach than you.  If the UK experience demonstrates one thing, it is that commissioning agendas are able to spawn entire support industries. There are a number of different organisations presently position themselves so that they can garner business from the current commissioning push.  But the reality is that no one else can do all of your commissioning approach for you.  Nor are they more expert in your organisational context and history than you are.

If there are other myths or dilemmas around commissioning that you have come across and want me to examine the evidence base around then please get in touch.

Pastures new

Last week I said goodbye to my wonderful colleagues at the Melbourne School of Government.  This week I started a new role at the University of New South Wales in Canberra, where I will be part of a group who will establish the Centre for Public Service Research.  I greatly enjoyed my team with a group of great people at Melbourne, but am very excited about my new role and the great group we are developing. Here’s a little about what we will be developing over the next few months.

The Centre for Public Service Research (CPSR) will perform timely, high-quality and reliable research into public policy implementation. We bring a breadth of knowledge and a depth of experience to our work, taking an inter-disciplinary and inter-methodological approach that recognises the complexity of contexts and plurality of interests involved in any policy implementation.

Our research projects build local practice while advancing global knowledge. We enable independent practice and collaborative thinking, and provide educational activities that embed new policy and program implementation insights into practice settings.

Our approach will be guided by 5 commitments:

  • We will use a recognition of the messy reality of implementation to inform our choices of different knowledge and tools to create novel insights
  • We will foster a holistic, system focused approach in all that we do, enabling a better understanding of the causes, rather than symptoms, of issues
  • We will engage in mutually beneficial relationships with partners, adopting an asset-based approach that enables the partner to achieve better outcomes and develop new capabilities
  • We will provide thought leadership and contribute to both local practice and global knowledge of public service delivery, implementation and evaluation
  • We are professionals who deliver projects in a timely, quality and reliable manner.

Evidence and experience indicate that a policy is only as good as its implementation. Despite the context of policy implementation having become highly contested and complex, policy implementation has received very little research attention in the last 10-20 years.

CPSR will provide research, research consultancy, professional development, research translation and thought leadership to develop knowledge and capability in the areas of: social policy and health policy; human resource management and capacity building in the public services; project management; gender equality strategies in the public service; occupational health and safety; auditing and governance in the public services.