Tensions in commissioning: Services for children's speech, language and communication needs in one English region

Objectives: To investigate the tensions faced in commissioning services for children's speech, language and communication needs and to identify variation in commissioning practice in response to these tensions. Methods: Quantitative and qualitative evidence from a review of speech, language and communication services in one English region, focused on three case studies. Results: The case studies reveal variation in practice in relation to commissioning tensions generated by: low incidence/high needs cases, blurred boundaries between health and education, multi-agency working, parental voice and service development. The introduction of commissioning and models of practice such as 'the commissioning cycle' has left huge variation between localities in levels and type of provision for these services. Conclusion: Large variation in commissioning practice is associated with commissioners' adoption of one of three models: a market model, an integrated model and a top-up model.