After attending EXCO 2018 a couple of weeks ago, I don’t have the answers to what Excellence in the Commissioning of Opioid Use Disorders looks like. But then I wouldn’t expect to. In fact, I think I’m giving the conference the highest praise possible when I say that it got me thinking in depth about commissioning and how we do it.
Any conference has, almost by definition, some element of ‘broadcasting’; people telling a room what they’ve done, and ideally reflecting on what they’ve learned. But sometimes the most useful part of a conference is the human contact, the genuine sharing of ideas. In simple terms, a conversation rather than a lecture. It’s this that sets a conference apart from reading a book or an article, or even watching a webinar.
EXCO was no exception. For me, some of the most interesting and useful moments were in conversations over coffee or lunch.
And I think this applies more widely: there’s a real need for genuine conversations in commissioning. I don’t necessarily mean sitting over coffee and chatting things through. This kind of exchange of ideas could be virtual, through online communities (I’ve just joined an interesting group on Knowledge Hub, generally used by local government staff).
And in fact it’s not just about actual conversations, whether virtual or ‘IRL’. I’m thinking more of an exchange of ideas. It was in some ways a point from Annemarie Ward about our sector being in competition that got me thinking again about how we might approach things differently – and that wasn’t part of a conversation so much as her point percolating through my mind on the (long!) drive home from Manchester.
But writing about how we need ‘an exchange of ideas’ is exactly the sort of thing that generally winds me up. It’s no wonder that when commissioners like me use this kind of phrase we get told, quite rightly, ‘you talk, we die’.
But I think it’s important. It’s about the way we approach our jobs – and without doing this in the right way, we really are in danger of pointless talk.
What do I mean by pointless talk? Well, the kind of ‘broadcasting’ I talked about earlier. Too often, when a group of professionals come together to share ‘best practice’, it turns into a bragging session. Too often, when an organisation like Public Health England (PHE) or the Local Government Association (LGA) release a guide to something it’s full of ‘case studies’ that are simply puff pieces – opportunities for people to boast about how wonderful their organisation (and, by implication, their own work) is.
My fear about an ‘expert’ faculty is precisely that: it will become an opportunity for those involved to broadcast information that confirms their status as ‘experts’. We don’t need another organisation like that. Instead, we should be more honest and collaborative. Perhaps if, instead of talking, we made more of an effort to listen, share and cooperate, then fewer people would die.
I know this sounds rich coming from someone who actively blogs, tweets and writes, sharing his own views, but maybe it takes one to know one. I like a bit of attention, and I find it rewarding to feel like an expert, but on lots of things – actually, everything – the attention shouldn’t be paid to me, and I’m not the ‘expert’ voice you should be listening to.
But what does this mean in practice? It means that I think the Faculty could be a great vehicle for these conversations. But I would suggest we need to approach these conversations differently to lots of interactions I see (and participate in!) at the moment.
(I appreciate it’s slightly odd that I’m stating a definitive opinion at the same time as I’m denying expertise or that anyone has the answer. I’m afraid you’ll have to live with that.)
So let’s turn a management platitude on its head: don’t come to me with solutions, come with problems. If you come to a group with a problem, there’s instantly a conversation. If you come with a solution, you’re often just grandstanding.
You might have thought PHE could play this role as a facilitator of conversations, but it’s clear it’s not quite managing it at the moment. Having heard Rosanna O’Connor speak at EXCO, I wonder if we – local commissioners – are part of the problem. (Of course we are.) She made the point (though not in these words) that the sector can look a bit like it’s crying wolf about funding cuts when all the stats still look rosy, because no-one wants to admit that things aren’t going well in their team, their organisation, their local authority. And if we don’t want to tell them things aren’t working, how can they host open, honest conversations?
So I think there is a potential role for a Faculty of Commissioning, but while I’d love to be an expert, a person can’t be one on their own. Perhaps this faculty could be a place to share mistakes and problems as much as ready-made expertise.
It’s this slightly pessimistic vision that could make me optimistic. How about you?