Transcript Measuring outcomes in social care

PST 2020 seminar series
The outcome delivery toolkit:
a third sector win?
Joy Dobbs & Francesca Cignola, NCVO
Outline
 Third sector win – the right question?
 Third sector growth in public service delivery
 Measuring Outcomes
 context
 challenges
 some existing approaches
 current projects
 Quality Measurement Framework project
 Camden outcome-based commissioning model
 Where next?
NCVO & its Public Service Delivery
Network
A free network for anyone interested in
third sector commissioning and public
service delivery issues
Over 1500 members from the public
and voluntary sector
www.ncvo-vol.org.uk/psdnetwork
A third sector win - the wrong
question?
more a win for service users and
taxpayers
third sector providers
• not automatically better than other sectors
• exist to provide benefits to users & society
third sector have range of roles
• identifying need
• lobbying providers
• public service delivery
A growing role for the sector in psd
Total government spending & statutory income to sector,
2000/01 – 2006/07 (2000/01 = 100)
Source : The State and the Voluntary Sector,
NCVO, Sep 2009
Local and central government are main
source of statutory funding for the VCS
Is there figure showing % of charities income
that comes from central Gov, over last 3 yrs?
Dave’s Fig 5 (showing that it’s nevertheless
only small % of Gov depts spend)
Statutory funding to the voluntary sector by ‘tier’ of government, 2004/5 – 2006/07
(£ billions)
Source : The State and the Voluntary Sector,
NCVO, Sep 2009
Statutory funding by sub-sector, 2006/07
(% of each sub-sector’s income)
Source : The State and the Voluntary Sector,
NCVO, Sep 2009
New ways of working
Outcome focus
Procurement
Individual budgets
Responding to changing times
 value/impact/outcomes
• Public Administration Select Report
• need evidence to demonstrate what we can offer
 procurement and commissioning
• sector needs better understanding of rules and
principles
• also need commissioners/funders to focus on right
things
 individual budgets
• flexible and enterprising
• ensuring and monitoring quality and outcomes
Measuring outcomes : context
 move towards outcome-based commissioning and
monitoring in public service delivery
 move towards contracts rather than grants
 limited progress in practice
• more talked about than practised, variation
• requires cultural shift
• plethora of tools but often process-oriented
• need for more consistent & robust approaches
 is compulsion essential to overcome barriers?
Measuring outcomes : challenges
 Strategic challenge
• defining desired outcomes - be clear and specific
(even if can’t measure them)
 Measurement challenges
• identifying outcome indicators
• balance depth of information with practicality of
collecting it
• attribution and baselines
• conceptual model e.g. whose assessment
• people adapt to difficult circumstances
Measuring outcomes : some
approaches
 Communities : Outcome Based Accountability
 Organisations
• National Outcomes Programme (CES)
• Social Return on Investment (nef)
• Social accounting & audit (various)
 Services
• Outcomes Star (Triangle Consulting)
• NPC well-being tool for children
• Substance project reporting system
Measuring outcomes :
developments
 Quality Measurement Framework
project
 Camden Outcome-Based Commissioning
Framework
QMF project
 adult social care
• care homes
• daycare
detailed observation/assessment
self-completion
 pre-school education
 compare detailed measures and regulatory lower
burden indicators
 volume & characteristics of services by third
sector
Uses of QMF adult social care
measure
 Validated approach to establishing outcomes
for care home residents & day-care users basis for outcome-based commissioning & monitoring
 Relationship between regulator assessments
and resident experiences – support tand
influence regulation using outcomes
 Provide national measures of quality – to allow
outcomes-related quality adjustment of National
Accounts
Older adults : needs and outcomes
control
accom
100.0
80.0
60.0
40.0
20.0
0.0
care
occu
meals
social
safety
current needs
needs without
services
Camden Outcome-Based Commissioning
framework

Commissioning
Devising OB commissioning & procurement processes / tender
documents / guidance

Contract monitoring/performance management
Developing and embedding appropriate outcome measurement,
capture and reporting mechanisms

Culture Change

Piloted on
•
•
Adult Social Care mental health services
Supporting People [SP] programme
OBC Framework
Commissioner &
service user
priorities
1.
Activity
2.
Output
Community strategy
& Corporate
priorities
3.
4.
Service level
outcomes
Camden
Community
outcomes
National
outcome
frameworks
social
economic
environment
5.
Value
Quantitative
Qualitative
Monetizeable
Where value
accrues:
- To Service
- Camden wide
- central
government
What next - Changing times
 spending cuts
• long term outcomes vs short term savings
 policy environment
• How to ensure consistent outcome monitoring in a
more fragmented “personalised” market
Further information/contact
 Websites
www.ncvo-vol.org.uk/publicservicedelivery/
www.statistics.gov.uk/qmf
www.pssru.ac.uk
 Email:
[email protected]
[email protected]
[email protected]
Additional slides
Conceptual base for measurement
 9 domains e.g. personal care; control over daily living
 outcome gain= Q x CfB on each domain
• Q : what current service delivers
quality /outcome achieved /current level of needs
• CfB: what service could deliver
difference between need level in absence of services
(how reliant) and ‘perfect’ service
• add across domains using preference-based
weighting
Example: Personal care
 I feel clean and presentable
 I do not feel as clean and presentable as I
would like
 I do not feel at all clean and presentable and
have poor personal hygiene
1.2 Community level outcomes (example tender doc for SP service)
Camden
Sustainable
Community
Strategy
objectives
Camden
Corporate Plan
Improvement
Priorities
Sustainable
Growth
•Promote environmental
sustainability
Create a sustainable
social infrastructure
Improve housing
opportunities to meet
residents’ needs
Strong
Economy
Connected
Community
Promote active
citizenship and social
cohesion
Make Camden a
better location for
business
Improve the life
chances and life
choices of our children
and young people
Maximise education
and training
opportunities for
young people
Increase access to
skills and employment
Improve the range of
support available to
help people maintain
independence
Support people to
lead healthier lives
Safe and
Vibrant
•Reduce crime and
the fear of crime
•Make Camden
Town a better place to
live, work and visit
•Enhance the
attractiveness of the
borough
•Promote Camden
as the cultural centre
of London in the run up
to the Olympics and
Paralympics
4 - Participate in chosen training and/or education, incl. achieving
qualifications
Intermediatelevel SP
outcomes
1 - Maximise income, including
receipt of the right benefits
5 - Participate in chosen leisure / cultural / faith / informal learning activities
2- Reduce overall debt
7 - Establish contact with external service / family / friends
3 - Obtain paid work / participate in
paid work
8 -Better manage physical health
6 - Participate in chosen work / voluntary
/ unpaid work activities
9 - Better manage mental health
10 - Better manage substance misuse
11 - Better manage independent living as a result of assistive
technology / aids and adaptations
12 -Maintain accommodation and avoid eviction
15 -Greater choice and/or involvement at service level and within the
wider community
Service-level activity
13 -Comply with statutory
orders and processes (re
offending behaviour)
14 - Better manage self
harm, avoid causing harm
to others, minimise harm /
risk of harm from others
Efficient &
Responsive
•Improve our focus
on customers and
citizens
•Deliver the better
and cheaper
programme and instil a
culture of efficiency
•Develop a high
performing workforce
•Provide effective
and enabling support
services
2. ENJOY AND ACHIEVE
Activity
Outputs
(example of a tender schedule for Supporting People services)
Service User
Outcomes
Outcome Indicators
4. Participate in
chosen
training and/or
education, incl.
Achieving
Qualifications
In training or education
(specify minimum hours per
week)
5. Participate in
chosen leisure /
cultural /
faith / informal
learning
activities
If not in paid work or training/
education, doing something
meaningful with their time
(specify minimum hours per
week in activities defined by
SP outcomes 5 and 6)
6. Participate in
chosen work /
voluntary /
unpaid work
activities
Way of Measuring