Outcome based commissioning Mark Napier, The Centre for Public Innovation

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 MILESTONES PERFORMANCE TARGET OUTCOME A verifiable, critical point in a project that participants must reach to ensure that a project is on course to achieve its performance target. Specific changes in behaviour, condition that define project /service achievement. Defined by the providers. An end state or vision in a given area. In Outcome Based approach this statement is in the domain of the Commissioner. Commissioners Providers

Putting this into practice: 1 Outcome based counselling, advice and information programme for prisoners. 15 PDUs will complete the programme drug free and remain drug free at six months follow up Performance target Outcome PDUs will become abstinent and will learn a range of skills to enable them to sustain abstinence.

Putting this into practice: 2 Milestone No% Learn of Tier 3 and present Complete initial TOP setting care plan goals Engage in service, describe risk factors associated with overdose. Identify three relapse triggers and describe coping strategies to deal with these. Demonstrate significant progress at TOPS reviews. Care planned discharge. Make initial contact with relapse prevention

What are the implications? Accurate performance management: what impact are your providers having on clients? Is their engagement actually making a difference to clients 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

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