Commissioning for outcomes in supported housing

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Commissioning for outcomes in supported housing

• Andrew Jepps
• Northamptonshire Supporting People

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Supporting People in 2 minutes

• Sheltered housing, hostels, womens refuges,
  floating support
• More than 20 service user groups
• Historically disparate funding streams brought
  together
• Inherited services
• Reducing funding
• Need for unanimous agreement in partnerships

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Key messages from Audit Commission

• Improve user involvement
• Improve outcomes focus
• Not without irony, but
• The apparent tension gets picked up in our
  outcomes framework

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Moving to outcomes based commissioning

• The context
• National
• Regional
• Local

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First law of developing an outcomes framework

• No two Lead Officers shall at the same time and
  in the same place agree on the definition of an
  outcome
• Possible research hypothesis

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Tensions

• The strategic level
• The service user level
• Making a difference to communities and making a
  difference to individuals
• At the highest level desirable but vague

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Outcomes means

• Making a difference
• and proving it

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Process

• Review of outcomes based approaches being used
  elsewhere in the country
• Consultation with providers
• Using service user consultation messages

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Issues

• Quantum theory the act of measurement is not
  neutral
• Cherry picking especially in SP services
• The balance between hard data and soft/wider
  information
• The cost of/to the system

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Issues

• Some very idealistic systems
• Some systems requiring large amounts of data and
  investment in IT
• Some systems not apparently integrated into
  contract management
• Some systems not apparently compatible with
  letting go

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The move to pragmatism

• Outcomes framework not a number crunching machine
• Dont take data beyond its genuine usefulness
• Contextualise form hypothesis reality check

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Principles for the framework

• Proportionate in its resource demands from
  those involved, especially providers and
  particularly small providers with low value
  contracts
• Affordable cost effective and limit bureaucracy
• Comparable data collected should be comparable
  with other similar data and therefore be of
  analytical use
• SMART - Clear and measurable, relevant to the
  commissioning and management of the contract, and
  easily trackable
• Balanced range of measures to avoid perverse
  incentives

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The compromises

• The information has to be useful
• It has to be used
• Certain desirable mechanisms were abandoned, as
  impracticable to implement

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Provider consultation

• Over 90 positive
• Issues around clarification of indicators
  technical guidance
• Enthusiasm in moving towards making a difference

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Regional basket

• of service users with a GP
• of service users in ETE
• of current service users admitted to hospital
  on a non-elective basis in the last quarter for
  over 24 hours

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The national approach

• Questions under each domain follow a standard
  format
• This format is
• Did the person need support in relation to a
  particular area/ activity? Y/N
• Actual Outcome achieved? Y/N
• If not, why not? Various reasons can be given
  here factors to do with the client, the service
  or wider external factors. More than one can be
  used.

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The national approach - example

• 1b) Did the client need support in relation to
  managing any debt? Yes / No
• Actual outcome for the client
• - Has the client reduced their overall debt? Yes
  / No
• If the outcome did not happen, you need to
  provide reasons. You can choose one or more from
  these reasons

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Lessons

• Not all indicators were useful
• Need to really explain to contract managers and
  providers what the intention is
• Ongoing evaluation

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Outcomes based procurement

• Apples and pears
• PQQ technical scores
• ITT
• Outcomes
• Questions on method, scored and graded
• Suggested PIs and method

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So far

• Over 3 efficiency gains each year
• No measures deteriorating, improvements in over a
  third

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Summary

• Recognise limitations
• Try something rather than nothing
• Simple can be fine
• Make it useful
• Feed into performance systems
• Use an outcomes framework to drive the improvement