How effective is joint
commissioning? An exploration
of processes, practices and
outcomes in five English
localities
Helen Dickinson, Health Services Management
Centre
h.e.dickinson@bham.ac.uk
Joint commissioning is...
is concerned with the ways in which relevant
organizations might work together and with
their communities to make the best use of
limited resources in the design and delivery of
services and improve outcomes.
Joint commissioning

Policy aspirations outstrip
developments at practice
level (despite aspirations for
JC dating back many years).
 Limited research (often
conflated with joint working
or commissioning more
generally).
 Research often process,
rather than outcome
focused.
Research questions

How can the relationships between joint
commissioning arrangements, services and
outcomes be conceptualised?
 What does primary and secondary empirical data
tell us about the veracity of the hypothesised
relationships between joint commissioning,
services and outcomes?
 What are the implications of this analysis for
policy and practice in health and social care
partnerships?
Methodology

Interpretive (what and how does joint
commissioning mean..)
 Based on surfacing programme theories in 5
in-depth case studies.
 2-phase using POETQ, focus groups, semistructured interviews, documentary analysis
Viewpoints of joint commissioning





Ideal world commissioning’: joint commissioning is a “nobrainer”.
‘Efficient commissioning’: delivering the same for less and is
more about benefits to local organisations than it is about
improving people’s lives.
Pragmatic commissioning’: good in theory, but difficult to
achieve in practice (and also comes at a price).
‘Pluralist commissioning’: joint commissioning as a means of
achieving fairer access, inclusion and respect for service users
‘Personalised commissioning’: joint commissioning should be
about offering the highest quality service and a seamless
service to users. However, joint commissioning can sometimes
be cumbersome and costly.
Case study Primary aim
A
Tackle health inequalities
Secondary impacts
Preventative services
Efficiencies
Wider range of services for users
Create one stop shops and easy access
Empowerment
B
Productivity – bang for buck
Efficiencies
Redesign services over larger area
Consistency of services
Streamline services
Early intervention
C
Service user at centre of service
design
Seamlessness
Single contact points
Key-workers
Value for money
Choice
D
Kick-start merger process into
Care Trust
Focus on health inequalities and preventative services
Economies of scale
Innovative services
E
Empowerment of community
More appropriate services
Efficiencies
Reduce waste
Preventative services
Structures, processes and practices
of JC

Formal structures are time
and resource consuming to
develop but local
respondents valued them
as means to cement
relationships and make
local partnerships less
dependent on the
contributions of key
individuals (who might
leave and put previous joint
initiatives at risk).

Respondents found it
difficult to identify
particular practices
associated with joint
commissioning and which
are different to other ways
of working – be they in
terms of more general joint
working or commissioning.
Impact of JC

Respondents often found it difficult to identify the
impacts that joint commissioning had in practice.
Whilst there were many examples of positive
initiatives, people struggled to link these to joint
commissioning per se or to cite formal evidence of
impact.
“I think we’ve not always been as focused on
demonstrating the outcomes that it’s achieved and
some of that’s to do with data information systems...
not being...robust enough to sort of come up with
what we want really.”
Impact of JC
Joint working “better” or “stronger”
 Efficiencies (although not necessarily a
positive)
 Improving access (although service users not
necessarily share this belief)
 Are efforts put into what service user wants?

Four key themes

Is there anything specific about JC?
 Identifying evidence of impact remains difficult – technically
and practically.
 Sometimes faith in the potential of joint commissioning
appeared to run ahead of detailed collective thinking.
 Several sites talked of ways in which they had been able to
make efficiency savings through joint commissioning.
However, these often seemed to derive from one-off actions
or initial changes and there was little evidence of scope for
recurring savings.
What does this tell us about joint
commissioning?

Range of different interpretations of joint
commissioning – demonstrated in an empirical sense
(Qdata).
 JC as a ‘framing concept ‘– value lies in its ambiguity
and symbolism and consequent capacity to attach
people to it.
 JC as a ‘boundary object’ – plastic enough to adapt to
local needs but robust enough to maintain common
identity (Star and Griesmer, 1989)
 Ability of practitioners to nimbly adapt to successive
policy changes
Conclusions

Not able to demonstrate link between ‘best practice’ joint
commissioning and outcomes.

Need to ask different questions of JC than those
traditionally asked.

Value of JC not as a rationalist service improvement
intervention
Dickinson, H, Glasby, J, Nicholds, A, Jeffares,
S, Robinson, S, Sullivan, H (2013)Joint
Commissioning in Health and Social Care:
An Exploration of Definitions, Processes,
Services and Outcomes
This project was funded by the National Institute for
Health Research Service Delivery and Organisation
programme (project number 08/1808/260). The
views and opinions expressed therein are those of
the authors and do not necessarily reflect those of
the NIHR SDO programme or the Department of
Health