Guardians of the overall picture
Commissioners, it seems, have a huge weight of responsibility on their shoulders. Not only are they in control of budgets which can total hundreds of millions of pounds, they also have to assess exactly what services are required in their area, while securing value for money.
But commissioning is not just about tendering or "buying in" services. Primarily, it is about understanding and responding to local need.
Marion Davis, director of children's services at Warwickshire county council, is a "strategic commissioner", who oversees the planning, managing and commissioning of services throughout the county. She says: "It is important that we match properlythe needs of children and families and that we react to changing needs, rather than perpetuate past patterns of service, which may no longer be appropriate. The commissioning process allows us to constantly review services, taking into account people's requirements."
Commissioners from both PCTs and local authorities work closely together and with others, monitoring demographic data through which a multitude of needs can be analysed, such as how many children may need to be placed in local authority care or might require specific health care. They also look at census surveys, speak to consumer groups and consult children and families themselves to assess whether services are appropriate and effective.
Regular meetings with children's trust board members, such as the police and young offending organisations, allow commissioners to assess what kind of services might be required and whether there is sufficient existing capacity. Working together in this way minimises duplication and overlap of services, which is far more costeffective in the long run.
Needs assesment
"Knowing your demographic is vitally important," says Jean Massam, children's trust director for Sefton council, on Merseyside. "Sefton is a diverse area with pockets of affluence as well as areas of high social deprivation. It would be easy to think, for example, that children who come from affluent backgrounds need fewer services, but actually having money can bring its own problems with alcohol and drug abuse, for example. The trick is to ensure that you bring in the right services for the right people."
Where some young people are concerned, that might mean making use of private service providers, says Davis."There may be a perceived stigma attached to accessing services from the local authority, for example in advocacy for young people in care or vulnerable groups and an independent organisation may be more appropriate. We have to listen to what the service users want when we make these assessments."
Dialogue between partners is vital to the smooth running of services. "We work very closely with the PCT and other departments in the council who have specific data on the needs in their areas," says Massam."We also speak to schools and headteachers who work directly with children to find out what is worrying them. By doing so, we create an overall picture of what is required, and what works and what doesn't."
In the London borough of Newham, services are monitored by young people themselves to ensure they are fit for purpose and providing value for money. The trust even uses "mystery shoppers" to test services. In one such exercise, young people were sent to a sexual health clinic posing as patients and asked to assess, for example, whether staff made them feel embarrassed or patronised them.
Robert Maragh, Newham's head of commissioning for children and young people's commissioning, says: "We are always looking for evidence of good service and a welcoming approach. It helps us to formulate quality as there is no point in commissioning a service that young people find inaccessible."
In addition to commissioning, the children's trust offers support and development opportunities to providers in the form of building capacity, helping them to achieve charitable status or providing training on matters such as staff recruitment and health and safety.
Commissioners agree, however, that the role has its challenges. In these financially difficult times they cannot be sure that funding will be available in the long term to sustain services. And in some areas, establishing and maintaining partnerships has been difficult. The brave new world of integrated services can seem a long way removed from the time when education, health and social services all worked independently, used different practices and spoke a different working language.
But the role definitely has its rewards, as Maragh explains: "Recently, when our examination results were published we found that 12 of our looked-after young people had got into university, which was absolutely fantastic. We were able to help them achieve this by commissioning additional tuition and access to computers, as well as to place them in good and supportive foster care, which is crucial to them achieving academic success. Children like these really need a champion."