We have to balance the imperative to deliver quality public services on the one hand, and to save taxpayers’ money on the other. One possible consequence of this is the commoditisation of service users on the ground so that measurable outcomes translate easily into contract payments. Under these circumstances risk is passed from policy maker to commissioner, commissioner to deliverer and from deliverer to the service user. Such is the current landscape: an economic model that encourages marginalisation and cherry picking so that outcomes are more easily achieved and so that payments flow. Factor in demographic change, increasing need, pressure on the publicpurse, and so forth, then the tension I set out above will deepen.
From the perspective of the Third Sector, charities in particular, this increases the risk of having to provide services to the most complex clients out of limited resources, often fundraising or self-generated funding to bridge the gap. In many ways their charitable objects are compromised by the contract environment: they do not want to marginalise or cherry-pick. They want their doors open to as many as possible, some charities even pride themselves on working with vulnerable people no one else will offer a service to.
Thus arises the ethical question of subsidising public services through donations. Perhaps that is a question for individual charities to solve as things stand. But the question we should be asking of ourselves now is how do we as a community influence the commissioning process to accept that so called ‘hard outcomes’ really are only part of the story? Sustainable positive social impact requires societal change beyond the usual contract horizon, certainly beyond the horizon of the ‘pilot’ schemes, absolutely beyond the current national budget horizon. How do we change that? It is well known that creating better futures for vulnerable people result in savings across a number of government departments. Yet we are still, it seems, light years away from breaking down commissioning silos so that spending in one department on early intervention can be offset by savings in another – maybe down the track, but this is the 21st century so don’t tell me it is beyond our wit and resources to work that out and do something about it. The Third Sector is really moving ahead to integrate provision, yet integrated commissioning and policy still seems embryonic?