Finally, commissioning involves the awarding of contracts from healthcare organizations on a competitive basis to companies, charities, or social enterprises. Commissioners can, in different countries, include public health bodies, hospitals, private health insurance companies, local or national health boards, and social care teams, among others. Commissioning is very popular in many countries as a way of reducing the amount that a healthcare service has to deliver itself and instead bringing in external providers to deliver strands of work. As with social investment, commissioning depends on an arts intervention meeting the priorities and strategic needs of the commissioner. But unlike social investment, there is not normally a direct financial return for the commissioner. There are various models, including a single provider model (where an artist or organization is commissioned directly by the commissioner), a subcontractor model (where the artist or organization is contracted by another provider to deliver a strand of work as part of their larger programme), and a consortia model (where artists or organizations group together to provide a larger project, with peer learning and shared resources strengthening the bid). In some countries, there are also moves towards a personal health budget, whereby patients are allocated a sum of money proportionate to the complexity and severity of their health condition and they can decide what services they feel would best support their health and are the most important on which to spend their money. These services can include conventional treatments, psychological therapies, and others such as exercise programmes or arts workshops. Applications for commissioning are sometimes sought through a tender process. Alternatively, some commissioners operate a competitive dialogue approach, whereby ideas can be developed by the commissioners and potential partners together.
In the UK, the NCVO has produced a series of guides on cultural commissioning, which are available on their website www.ncvo.org.uk.