Tuesday 26 June 2012

How much to empowerment?

You’ll never guess what I learned in the back of this cab yesterday... 

I’ve been spending a lot of time thinking about commissioning recently. Having heard so many stories of bad commissioning (poorly thought through tenders, slashed budgets, no demand analysis, ineffective monitoring, prioritisation of price over quality...) the subject consumes much of my thinking.  And then suddenly, sitting in a taxi at the end of a long train journey, I realised that a good model was staring me in the face. There, on a laminated yellow card, was a table saying what I'd pay for getting in, mileage, luggage, cleaning costs etc.
It struck me that this set of charges effectively took price out of the equation of competition in the local taxi market. Freed from this consideration, other factors come into play; how quickly the cab will appear,  how reliable the service is, the courtesy of the operator, ease of ordering.....The choice is made on quality because I already know what I’ll be spending.

I have nothing against competition, in fact I quite like it. But there are some fields where competition on price is useless, and independent advocacy is among them. So I’ve been trying to identify relevant examples of other forms of competition and this table of tariffs gave me one.

I would argue that price driven commissioning in advocacy creates an incentive to provide poor quality. In independent advocacy, too many commissioning decisions appear to have been made on price. If current trends continue, the “advocacy” that is being commissioned is at risk of becoming a purely mechanical response to an identified need; neither seeking to change the system or empower the individual. That is not advocacy. Commissioning such services as advocacy, or pressuring advocacy services towards such a model, leads to a waste of public funds and denies people the support they need to have control over their own life. 

Price driven competition is at risk of defeating its own objective. It takes longer to be creative, create change, release someone’s potential or challenge systematic poor practice than it does to tick a box. Using price only comparisons in advocacy commissioning is like judging Masterchef on who can get their weekly shop at Lidl for the least money (in case of a draw, winner decided on speed). 

So why aren’t we looking for that tariff of fares? Why aren’t we saying, “This is the need in the area, these are the resources that are available. Show us what you can do with that. What difference will you make?” 

That would create competition based on excellence, make monitoring simpler and more relevant, make local commissioners accountable.... and make it more likely that people have a strong and equal voice. That's a destination it's worth paying to reach. 


  1. I completely agree. Price driven commissioning devalues the quality of service and puts quality providers at a disadvantage to those who overestimate their ability to deliver the same for less. Net result is poorer service.

    If more commissioners were willing to state a fixed taxi fare style price then, even if it's low, at least it levels up the playing field in terms of competition to deliver.

  2. I believe there are two fundamental issues here:

    Number 1: commissioners, procurement officers, contracts and tendering managers etc don't actually in the main understand what they are buying, I include other public services in this generalisation not just advocacy. Some brilliant providers with more than enough skill in all areas of their business do not win advocacy contracts, and the reasons are not because they are too expensive or their quality is low, it's sometimes because of poor public sector commissioning processes; I know this well because it happened to me when I owned and led Advocacy Experience (I sold the company in November 2011 after 10 and a half years growing it). It's like going to buy a pair of shoes, being really professional and studious about the deal and the quality but not actually knowing what they are for and what benefits they bring to you.

    Number 2: the advocacy sector is pretty grown up, effective and respected having been active and established in the UK for 25 years or so. However in respect of business acumen, pricing, negotiating with purchasers and other key business skills it is not yet out of nappies. The changes in the public sector took most providers by surprise and they got washed along with what they were told was the new way of doing things, rarely getting ahead of the game and finding the angles that would maximise success in short medium and long terms. The advocacy sector I would argue has seen bigger cuts than a great deal of other public sector providers, way in excess of what most commercial sectors have seen. We didn't prepare to protect what we had, we got into a bun fight and ended up with a stale doughnut. If you look at other industries as I do, you see them struggling but you also see the plans they have put in place to ensure they will prosper when (and if) the good times return. And critically they seem to know where their lowest sector price is and they stick to it...

    This is by no means a criticism of a sector I hold dear, its more a reflection of the here and now and in many respects some bad luck; I honestly believe if this recession had come ten years later the advocacy sector would have been skilled up business wise and we wouldn't have seen the size of cuts the sector has taken.

    Commissioning needs to change, I have argued for a central commissioning body and I still hold this view, their expertise would provide some consistency on resourcing and cost and service delivery levels to service users. Secondly point 2 explains what the sector is automatically doing as it grows and develops in different stages, the same as any other sector in the business sense.

    Nice post Martin.

  3. Martin, your proposal makes a lot of sense.

    Here in Scotland we are finding that quality of services is not the only thing being compromised by competitive tendering. Some of the other impacts on independent advocacy commissioned we are already beginning to see are:

    • It forces advocacy organisations to compete with one another for funds, thereby potentially damaging relationships between organisations.

    • Larger, more established organisations may have the resources to fill out complicated tender forms potentially leaving smaller local organisations without funding therefore making it harder for advocacy to be truly rooted in the community.

    • Routine retendering can destabilise advocacy provision causing anxiety among service users and their carers as well as staff and volunteers.

    The full article can be found in our Spring edition of About Advocacy (http://bit.ly/wu0A5w)

    The conversation about this has been continued in our Summer edition (http://bit.ly/O31EOh) where Peter Beresford (long time service user, Chair of Shaping our Lives and Professor of Social Policy) and Anne O'Donnell (service user and Convenor of The Consultation and Advocacy Promotions Service) contribute.

    You talk about the effect of competitive tendering on advocacy sees it becoming more "a purely mechanical response to an identified need; neither seeking to change the system or empower the individual" we are seeing this here and are worried that this could spell the end for the the user led, small, grassroots organisations which are particularly responsive to local need.

    Worrying times.

    1. ...worrying times indeed.

      Many of the things you describe have been happening in England and Wales for a number of years. But there have also been some good aspects of competition. Bigger doesn't always mean worse, small doesn't always mean effective (and vice versa). And it's possible to effectively share good practice in a competitive environment; sharing of your own good practice as a way of demonstrating how advanced you are, every organisation that uses that model becomes an advertisement of your effectiveness.

      I believe the real challenge is to work out how to structure commissioning and monitoring to ensure that it's the service user, not the provider or commissioner, whose needs are kept at the centre of the process.

      Thanks also for the link - will take a read.

  4. Interesting stuff Martin. The issue of price as the basis for competition has been covered a bit by the people at CMPO in Bristol Uni - I seem to remember some research that said when tariffs for interventions were set then the response was to compete on other factors. The only thing I can find is this http://www.esrc.ac.uk/_images/COMPETITION%20IN%20HEALTHCARE_tcm8-20589.pdf but there's definitely a paper by Carol Propper on this.