Outcome-based commissioning. Simply a pipe dream?

Outcome-based commissioning has taken a front seat in Health and Social Care commissioning since 2014’s introduction of the Care Act. Understandably, commissioning for outcomes is what everyone wants but very few can evidence that they’re actually doing it.

This is because the challenge facing the public sector, which is plain for all to see, is demand rocketing while needs become more complex, as costs rise and funding is squeezed. To compound the problem, teams are stretched and under resourced (time and staff). These pressures stifle innovation and proactive change, such as outcome-based commissioning, because resource is focused on the day-to-day challenges.

These challenges could make this shift an unattainable objective. This is because in order to embed outcome-based commissioning, public sector organisations need to factor a number of considerations:

  • How are you currently measuring quality from your provider base? – very few have the ability to do this
  • Are you working with all the available providers in your area? (especially SMEs) which is important if you’re trying to prevent spot purchasing and to really be able to find the best providers to meet an individual’s need
  • Can you reward providers for outcomes and quality services delivered? – unlikely if there isn’t a trackable audit trail and consistent, repeatable commissioning process
  • Are providers aware of the required outcomes and the individual’s preferences on each requirement that goes to market? – possibly but unlikely if this is spot purchased
  • Financially how are providers paid? Based on task and time or based on the outcomes delivered? – our guess is the majority of providers across the country are paid on the basis of task and time only
  • Are your commissioning team selecting the most appropriate provider based on their capability to meet the needs of the individual or because they have a relationship with a provider and they select them because they know them? – local knowledge is strong amongst commissioning teams but when they’re firefighting to fulfil packages, they may select a provider based on their available capacity rather than ability

What’s clear is that to implement an outcome-based approach, is that it takes a wholesale change of the way public sector organisations source, deliver and manage Health and Social Care services. Many are dancing around the edges with change, perhaps to simply be compliant. However, in order to meet the needs of the individual, which is the most important role government has, requires a long-term plan with incremental steps to implement and achieve such transformation.

Find out how a group of councils in South London are making the transition to outcome-based commissioning for SEN placements.