Vive la devolution: devolved public-services commissioning

HITCHCOCK Alexander, BORROWS Maisie, HARWICH Eleonora
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This report argues that there should be an acceleration of devolved commissioning of public services in England, in order to deliver outcomes that matter to users at the lowest cost. It argues that commissioning of over £100 billion of public-services spend, including 95 per cent of the NHS’s budget, can be devolved to around 38 regions. It draws on international examples to show that this model can deliver better outcomes at a lower cost to taxpayers. The paper builds on previous research by Reform, ‘Faulty by design’ which argued that central one-sized-fits-all services fail to respond to different needs and do not deliver value for money. The report argues that commissioners need the power to design contracts for providers to meet local needs most effectively. To achieve this commissioners need to: hold non-ring-fenced budgets, have freedom to design contracts to offer to competitive public-service markets, and work in commissioning areas covering geographies requiring similar interventions, and governed by single, integrated and accountable commissioning bodies. Sections look at progress in devolved public-services commissioning to date, areas that would benefit from further devolution of public-services commissioning, including healthcare and offender management; ensuring coterminosity of services - that is the coincidence of geographical boundaries between two or more variables or organisations; and different governance models. It also outlines where central government should continue to commission services to provide benefits of economies of scale, where there is a need for a one-size-fits-all approach or there is a very small provider market. (Edited publisher abstract)

Subject terms:
public sector, commissioning, cost effectiveness, devolution, place-based approach, outcomes, service provision, central government, health care, joint commissioning, integrated services;
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United Kingdom
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