Commissioning for health and community sector reform: perspectives on change from Victoria

Abstract

Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.

Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia

“…Third, governments can bear the costs of fragmented policies and funding within government through co‐commissioning. Co‐commissioning provides an opportunity to reduce fragmentation and move towards sector‐wide design (Silburn & Lewis, 2020). While this may incur costs particularly in the learning phase, as this article shows, the costs of co‐commissioning are likely to reduce over time.…”

“…Co‐commissioning, while addressing some of the costs of contracting, is not on its own the panacea to service fragmentation and other problems experienced by clients, providers, and funders caused by other aspects of contracting. Higher level system‐wide collaboration in system and service design may be required (Silburn & Lewis, 2020).…”

“…This can potentially be managed by having common IT infrastructure (Greener, 2015) to support service delivery and easy reporting; however, there are risks that this leads to the use of multiple systems when infrastructure provided does not meet the needs of service providers, and ‘obviously the less systems you can use the better’ ( Service Provider ). Finally, the way services are commissioned and managed can determine and be determined by the expertise and knowledge of commissioners and service providers, the types of relationship between them (such as the ability to use bureaucratic and relational controls), affecting the identification and resolution of risks, opportunities to innovate, and ultimately the effectiveness and efficiency of services (Bates et al., 2022; Regmi & Mudyarabikwa, 2020; Silburn & Lewis, 2020).…”

“…As this article shows, neither commissioning or co‐commissioning is unlikely to be the panacea to service fragmentation on its own (Addicott, 2014; Field & Oliver, 2013; Silburn & Lewis, 2020). This article highlights there are multiple opportunities for the public sector to reduce risks and costs associated with contracting and increase service outcomes—co‐commissioning being one tool—benefitting governments, service providers, and the community.…”

“…Human services,1 such as health and social care, are increasingly being delivered by third‐party providers (providers) under contract to government; this can be attributed, among other things, to political, economic, strategic, and practical considerations (Butcher & Dalton, 2014; Gallet et al., 2015; Hood, 1995; Kurunmäki, 2009). In Australia, multiple Federal and State/Territory public sector organisations (PSOs) outsource the delivery of a large range of human services to multiple providers, creating a poorly planned and fragmented service system which is difficult for consumers and other stakeholders (such as carer, general practitioner, or other service provider) to navigate and access (Australian Government, 2017; NZ Productivity Commission, 2015; Silburn & Lewis, 2020).…”