“What matters isn’t if people are good or bad. What matters is if they’re trying to be better today than they were yesterday. You asked me where my hope comes from? That’s my answer.”
Michael ‘The Good Place’ Season 4 episode 6.
I am the daughter of a philosopher and a lawyer. As a child persuading either of them to let me watch TV, eat chocolate or skip school was both a formidable and a formative challenge. Now well into his seventies, my Dad is still the master of enquiry so when I told him about our recent research into ethical commissioning in drug and alcohol services he had some of his usual incisive questions:
- What does it mean to be ethical at work?
- Where do people’s ethics really come from?
- Can you actually persuade people to be ethical, will principles get you over that line?
The ethical commissioning principles
But before I start, like a good philosopher I need to define my terms and explain what I mean when I say ethical commissioning. The Scottish Government defines ethical commissioning and procurement through a set of principles designed to guide and support decision-making at local and national level in commissioning (planning) and procurement (purchasing) of adult social care and support.
The principles are a mixture of approaches, focus areas and value statements. These tell us a lot about what worries us about the way social work and social care support is commissioned. They also identify wider systems issues such as the need to address climate change and reset the way we do accountability in public service.
| Person–led care and support Human Rights approach Full involvement of people with lived experience High quality care and support |
Outcomes focussed practice Shared accountability Fair working practices Financial transparency, sustainable pricing and commercial viability Climate and circular economy |
(Actually) ethical commissioning
Now these are all things most people would agree are core to competent commissioning within our current model (doing things righter) but they are only part of the picture of ethical commissioning (doing the right thing). From our research we found to do the latter we need to:
- Recognise that the system as it is, often works against ethical practice, driven by financial constraint and fragmentation; competing, fragmented and increasing policy priorities and demands; issues of power and control; and ambiguous and diffuse accountability. We see this across a number of areas of public service from Alcohol and Drugs Partnership (ADP) staff, to medicine, social work and social care workers.
- With that understanding, experiment with fully systemic models of commissioning, anchored in place, focussed on the person and agnostic to service boundaries along with dedicated analytical capacity to help us gather and understand the data that really matters.
- Build a learning oriented system to replace our current bureaucratic target driven one (given we all know it isn’t working.) This requires a whole system learning approach like the complexity friendly and person-led one from our excellent colleagues at CPI. This needs to be persistently implemented over the medium to long term to help bring the system to the right core purpose - supporting people to live their best lives possible.
Where our ethics come from
So those are all things that are possible to do but how might we persuade people to behave in an ethical way? There are lots of reasons why persuading people to be good doesn’t work (no space to discuss right now - that’s the next blog!) but returning to the research we did find something interesting about what it really means to commission ethically. The people we interviewed explained the underpinning ethics for their role came from their:
- Values about what it means to support people to live full lives, not simply to focus on preventing death, important though that is.
- Understanding of the limitations and harms of our system, and how it often makes things even more difficult for people seeking help.
- Personal experience of having friends, relations or other people in their lives who had experienced problem substance use.
Not an ethical commissioning principle in sight. But when we looked into practice we saw that the principles were a way of translating these underpinning drivers into commissioning action. Their ‘values-aligned’ as we would say in implementation theory.
But are they enough? I’d argue it’s a start, it gives us a focus for improving practice as it currently stands. It surfaces and helps us keep in mind the structural challenges of an under-resourced competitive monopsony ‘market’ and it is a way of bringing together and supporting commissioners who see the need to be systems stewards rather than market managers.
However until we address our underpinning cross- system problems with power differentials; funding fragmentation; short term decision making; bureaucracy and the ongoing triumph of rhetoric over realistic action we won’t get to truly ethical practice, because the system simply won’t let us.
If ethical commissioning is something you also like to think about, read the full research report (commissioned by our colleagues Des and Clare in iHub) or better still come along to the free iHub webinar in September.
If you’re a commissioner and would like to practise differently - get in touch! Any workable points about the value of trashy TV would be a massive bonus, it’s never too late to win a childhood argument!
