Across the NHS, local authorities and wider public services, commissioning is still largely organised around contracts, activity and organisational accountability.
That model made sense in a more stable environment.
It does not hold in systems where outcomes are shaped collectively — across providers, neighbourhood teams, voluntary organisations, housing, education and beyond.
The reality is this:
We are trying to deliver system outcomes using organisational tools.
What has changed in public service systems?
Over the past decade, the context for commissioning has shifted significantly.
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NHS England has driven the development of Integrated Care Systems (ICSs)
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Local authorities are working more closely with health partners
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Provider collaboratives and neighbourhood teams are taking on greater responsibility
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Outcomes such as health inequalities, prevention and population wellbeing depend on coordinated action
In this environment, no single organisation controls the outcome.
Which means:
Commissioning cannot simply be about procurement, contracts or performance management.
The core problem: commissioning hasn’t kept pace
Despite system changes, much commissioning practice still reflects an earlier model:
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Activity is measured
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Contracts are managed
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Compliance is monitored
But outcomes — particularly population outcomes — are:
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shared
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emergent
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shaped by multiple actors
This creates a structural mismatch.
Leaders are expected to:
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influence across systems
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align multiple organisations
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deliver long-term outcomes
But are often equipped with tools designed for:
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organisational control
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short-term performance
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transactional relationships
What is a strategic commissioning mindset?
A strategic commissioning mindset is not a new process or a single framework.
It is a shift in how leaders understand and operate within complex systems.
It involves moving from:
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Financial value → Public value
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Compliance → Accountability
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Transactional service delivery → Transformation for populations
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Silos and competition → System leadership and collaboration
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Activity → Outcomes
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Reactive → Proactive, preventative impact
At its core, it recognises that:
Commissioning in complex systems is about shaping conditions for outcomes — not specifying inputs.
The core components of strategic commissioning
In practice, this mindset requires capability across several interconnected domains:
1. Understanding systems and ecosystems
Mapping how organisations, communities and markets interact to shape outcomes.
2. Using intelligence as a driver for change
Moving beyond data reporting to using intelligence strategically to inform decisions and priorities.
3. Defining and delivering outcomes
Developing outcome frameworks that reflect real impact for populations, not just organisational performance.
4. Market shaping and stewardship
Working with providers and partners to influence how services evolve, rather than simply procuring them.
5. Collaborative commissioning
Designing and leading joint approaches across organisational boundaries.
6. Selecting and adapting commissioning models
Using different approaches depending on context — not relying on a single method.
What this looks like in practice
In systems beginning to adopt this approach, you see:
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Commissioners working alongside providers and communities, not just contracting with them
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Greater focus on prevention and long-term outcomes
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Shared accountability across organisations
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Use of intelligence to shape strategy, not just monitor activity
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Flexible approaches to delivery, rather than rigid service specifications
This is not theoretical.
It is already emerging across parts of the NHS and local government — but not yet consistently or at scale.
Why this matters now
The direction of travel is clear.
Policy, system design and operational reality are all moving towards:
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Greater integration
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Provider-led and neighbourhood-based models
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Increased expectation of system leadership
At the same time, pressures on services continue to increase.
This combination creates a critical requirement:
Leaders need to be able to think and act systemically — not just organisationally.
Without this shift, there is a risk that:
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new structures are layered onto old ways of thinking
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opportunities for improved outcomes are not realised
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complexity increases without corresponding impact
Developing capability for strategic commissioning
In response to this gap, we have developed The Strategic Commissioning Mindset™: Leading outcomes across complex systems.
The programme has been designed specifically for leaders working within integrated environments across health, local government and the wider public sector.
It is a collaboration between:
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The Wicked Problems Hub
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Culture & Engagement Experts Ltd
And is approved by the Institute of Leadership.
What the programme covers
The programme focuses on practical capability development, including:
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Defining strategic commissioning challenges
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Understanding systems and mapping ecosystems, power and politics
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Using intelligence as a case for change
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Developing outcome-focused approaches, using co-production and public engagement
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Shaping markets and interventions
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Leading collaborative commissioning arrangements, relational governance and power
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Exploring and selecting appropriate commissioning models
Participants work on:
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a live commissioning challenge
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cross-sector group learning
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individual coaching support
Who it is for
The programme is designed for:
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NHS and Integrated Care System leaders
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Local authority commissioners
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Provider and neighbourhood leaders
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VCSE organisations involved in commissioning and delivery
Final reflection
If outcomes in your system depend on multiple organisations working together, then commissioning is no longer a technical function.
It is a leadership capability.
The question is not whether commissioning needs to change.
It is whether we are equipping leaders to operate effectively in the systems we have created.
To find out more about The Strategic Commissioning Mindset™: Leading outcomes across complex systems or if you are working in a system where outcomes depend on collective action, you can find full details of the programme, including structure, dates and participation options, here:
