Involving older people in commissioning: more power to their elbow?


This study of older people’s wishes and experiences of commissioning health and personal care services published by the Joseph Rowntree Foundation was conducted by researchers from the London School of Economics.

Key aims of the research:

The aim was to understand how far, and with what effect, older people were involved in commissioning:

1. to extend understanding of participation by older people in the commissioning process at individual, locality and strategic level

2. to understand the tensions and connections between those levels in order to understand how older people can influence commissioning more effectively

3. to develop a framework that will specify what needs to be done in the future to ensure meaningful contributions from older people in the development and design of services in each ‘stage’ of the commissioning cycle.

The team studied the systems and processes in place for engaging with older people, their outcomes, and the older people’s perceptions of their involvement and effectiveness.

Research methods

The methodology involved a literature review and fieldwork in two local authority areas (Dorset and Salford). Twelve focus group meetings were conducted, 2007–09, in two stages: one to produce preliminary findings and one to sense check these with participants.

Key findings

Context and culture: true engagement requires high levels of commitment. Particular efforts need to be made to engage the ‘hard-to-reach’ groups.

Structures and processes: Transparency is required.  It must be demonstrated that older people’s input makes a difference.

Focus of involvement: There appears to be a tendency for more broadly based engagement to result in basing strategies on population and place.

Conclusions and policy implications

There is little evidence that participation of older people in commissioning has improved outcomes

Amongst its conclusions the report recognises that giving older people more of a say may not weaken but strengthen commissioners and service providers.

The report recommends exploration of two strategies:

1. Involvement should concentrate on outcomes more than processes and, as a condition of their participation, older people should insist that public services ensure that commissioning is effective

2. Older people’s and other groups might find it more effective to devote their resources to scrutiny and campaigning, rather than to participation in commissioning. They should not assume that engagement in commissioning processes is necessarily the best route to improve outcomes


Wistow, al. Involving older people in commissioning: more power to their elbow? [PDF 0.4MB ] Joseph Rowntree Foundation, Dec 2011


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