Outcome based commissioning

Mark Napier, The Centre for Public Innovation

[email protected]

www.publicinnovation.org.uk

The new direction of travel

“For too long the focus has been on measuring inputs and processes that are remote to patients.” Delivering outcomes will be “the most important and fundamental issue of all.” Andrew Lansley, 2 July 2010 New NTA business plan, “ will seek to reposition the treatment system to focus on sustained recovery, and demonstrate transparent outcomes.”

First principles

What are outcomes?

Specific changes in behaviour, condition and/or satisfaction which demonstrate gains, results or impacts for service users and carers. So: outcomes describe what happens to the client, not what we do.

Allied concepts Performance Targets:

SMART…and link to the outcomes About customer achievement not provider activity

Milestones:

Crucial and verifiable steps to success Measure client behaviour not provider activity Describe the pathway to success

Key Concepts

OUTCOME PERFORMANCE TARGET MILESTONES Commissioners An end state or vision in a given area. In Outcome Based approach this statement is in the domain of the Commissioner.

Specific changes in behaviour, condition that define project /service achievement. Defined by the providers.

A verifiable, critical point in a project that participants must reach to ensure that a project is on course to achieve its performance target.

Providers

Putting this into practice: 1

Outcome based counselling, advice and information programme for prisoners.

Outcome

PDUs will become abstinent and will learn a range of skills to enable them to sustain abstinence.

Performance target

15 PDUs will complete the programme drug free and remain drug free at six months follow up

Putting this into practice: 2

Milestone Learn of Tier 3 and present No 250 Complete initial TOP setting care plan goals 226 Engage in service, describe risk factors associated with overdose.

164 Identify three relapse triggers and describe coping strategies to deal with these.

Demonstrate significant progress at TOPS reviews.

88 132 67 80 73 91 Care planned discharge. 51 58

%

Make initial contact with relapse prevention.

16 31

What are the implications?

• Accurate performance management: what impact are your providers having on clients? Is their engagement actually making a difference to client’s lives?

• Outcome based specifications: Specifications based on what providers will achieve not what they will do. • Efficiency savings: Enables commissioners to ensure that they are not “warehousing” clients in treatment for extended periods of time. Client move-on produces savings. • Payment by results: providers paid by outcomes achieved.

Measuring outcomes

Outcomes can be measured using a basket of indicators: • Self-reported data – client • Programme staff data – reports, assessments,

observations…

• Peer reported data – other service users, family

members, carers, advocates, friends…

• Other external professionals assessment data –

teachers, health visitors etc….

• Empirical data - counting things • Formal third party validation and evaluation

Questions?

E: [email protected]

W: www.publicinnovation.org.uk

T: 020 7922 7823 Twitter: @cpiorg