Greens oppose Brighton & Hove City Council’s move to an ‘Intelligent Commissioning’ model, as I’ve detailed previously.
Commissioning creates a split between who buys a service and who provides it – which in the public sector is often rather artificial. Public services are not like the business sector and cannot be treated in that way. If I recall rightly, the council tried several times to outsource municipal waste collection before having to bring it back in-house after experiencing serious problems with managing the contracts with provide suppliers.
It’s much harder to manage and monitor contracts than many people realise. Which makes the House of Commons Health Committee’s March 2010 report on Commissioning [PDF] very interesting reading.
The report is fairly damning of Primary Care Trusts, the main NHS bodies tasked with commissioning. The committee also pulls no punches on the idea of commissioning itself. The report (which I highly recommend) finds that before introducing the purchaser-provider split (aka commissioning) the NHS had admin costs of about 5% of total NHS expenditure. Since then it has risen to be around 13.5% of NHS expenditure. That’s an absolutely huge increase.
“In the English NHS, the purchaser-provider split, private finance, national tariffs and other policies aiming to stimulate efficiency in the system and create a mix of public and private finance and provision mean almost unavoidably that the more information is needed to make contracts, hence transactions costs of providing care have increased, and may continue to increase.”
(It’s worth nothing that despite commissioning the York study, the Department of Health never published it, the Health Committee had to winkle it out direct from the academics over protests from civil servants. The same civil servants were also rebuked by the committee for failing to provide accurate figures for costs themselves!)
The committee’s report concludes that unless some convincing, rigorous new data shows benefits for the 20 years of NHS commissioning, it should be abolished as a costly failure.
I find it hard to believe that the city council are going to be able to somehow avoid these risks and pitfalls. Commissioning would need to deliver some immense cost-savings (which nobody has the evidence to prove it can) to justify almost trebled admin costs!
I have asked, and will keep asking, for evidence to justify the council’s leap into ‘Intelligent Commissioning’.