Outcome based commissioning Mark Napier, The Centre for Public Innovation [e-mail] www.publicinnovation.org.uk

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Outcome based commissioning Mark Napier, The
Centre for Public Innovationmark.napier_at_publicin
novation.org.uk www.publicinnovation.org.uk
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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.

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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.

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Allied concepts
Performance Targets
SMARTand 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
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Key Concepts
Commissioners
An end state or vision in a given area. In
Outcome Based approach this statement is in the
domain of the Commissioner.
OUTCOME
Specific changes in behaviour, condition that
define project /service achievement. Defined by
the providers.
PERFORMANCE TARGET
A verifiable, critical point in a project that
participants must reach to ensure that a project
is on course to achieve its performance target.
MILESTONES
Providers
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Putting this into practice 1

• Outcome based counselling, advice and
  information programme for prisoners.

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Putting this into practice 2
Milestone
No

Learn of Tier 3 and present
250
Complete initial TOP setting care plan goals
226
91
Engage in service, describe risk factors
associated with overdose.
73
164
Identify three relapse triggers and describe
coping strategies to deal with these.
80
132
Demonstrate significant progress at TOPS reviews.
88
67
Care planned discharge.
51
58
Make initial contact with relapse prevention.
16
31
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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.

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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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Questions?

• E Mark.napier_at_publicinnovation.org.uk
• W www.publicinnovation.org.uk
• T 020 7922 7823
• Twitter _at_cpiorg