Mental health commissioning: master
or subject of change?
Robin Miller and James Rees
Robin Miller is a Senior Fellow,
based at Third Sector
Services Management Centre,
University of Birmingham,
Dr James Rees is a Research
Fellow, based at Third Sector
Research Centre, University of
Birmingham, Birmingham, UK.
Purpose – The purpose of this paper is to explore change within the commissioning of third sector mental
health services in England.
Design/methodology/approach – A case study methodology based on survey and interview data of a
sample of third sector organisations and commissioners within an English conurbation.
Findings – Normative commissioning models based on sequential cycles were not fully implemented with
the main focus being on the procurement and contracting elements. There were examples of
commissioning being an enabler of service improvement but overall it seems to have been limited in its ability
to bring about whole system change. Barriers included commissioners’ capacity and competence,
ineffectual systems within their organisations, and fragmentation in commissioning processes between user
groups, organisations and sectors.
Research limitations/implications – The case study conurbation may not represent practice in all urban
areas of England and there may be particular issues of difference within rural localities. The view of private
and public sector providers and those working in Commissioning Support Units were not sought.
Practical implications – To lead whole system change the commissioning function needs to be
adequately resourced and skilled with better integration across public sector functions and organisations.
Greater emphasis needs to be placed on implementing the full commissioning cycle, including the
engagement of relevant stakeholders throughout the process and the practical application of outcomes.
Originality/value – This research adds to the limited body of empirical work regarding commissioning in
Keywords Mental health, Change, Outcomes, Integration, Commissioning, Third sector
Paper type Research paper
Successive governments in England have promoted commissioning as the process through
which public sector services will be planned and overseen. Whilst no one definition or model of
commissioning dominates, they are commonly based around a “cycle of assessing the needs
of people in an area, designing and then securing an appropriate service” (Cabinet Office, 2006,
p. 4; Bovaird et al., 2012). Different sectors have developed their own approaches, and the
recommended models within sectors have been subject to change over time. For example, in
health care there was a progressive move to separate organisations responsible for the
purchasing function from the delivery of services (Department of Health, 2009) whereas local
authorities have been able to retain both functions in principle, even if the majority of their direct
services have been outsourced in practice. Across all sectors there has been a move towards
greater diversity of provision in which public, private and third sector organisations (TSOs)
compete either for or in the market (Gash and Roos, 2012). Policy then portrays commissioners
as the strategic overseers of a mixed economy of welfare, using their purchasing and
influencing power to ensure that the publicly funded system is shaped to achieve the required
outcomes within the resources available. It is worth noting that other governments have different
interpretations of the commissioning cycle – for example the Scottish Government (2012)
The support of the Economic and
Social Research Council (ESRC),
the Office of the Third Sector (OTS)
and the Barrow Cadbury UK Trust
is gratefully acknowledged. The
work was part of the programme of
the joint ESRC, OTS Barrow
Cadbury Third Sector Research
DOI 10.1108/MHRJ-04-2014-0013 VOL. 19 NO. 3 2014, pp. 145-155, CEmerald Group Publishing Limited, ISSN 1361-9322
MENTAL HEALTH REVIEW JOURNAL