Outcome-based commissioning

Outcome-based commissioning is a shift from the historic tendency to express commissioning activity through the contractual requirement to provide outputs, such as the number of hours or type of service to be provided. It has proved difficult to measure the real benefits of services commissioned in this way.

This section contains resources to support outcomes-based commissioning and documents that provide a context for this shift in approach.

The White Paper Our health, our care, our say had four key outcome objectives:

• better prevention and early intervention for improved health, independence and well-being
• more choice and a stronger voice for individuals and communities
• tackling inequalities and improving access to services
• more support for people with long-term needs.

The task for commissioners is to break these general aspirations down into specific outcomes for local populations and then define what systems and services are required to achieve them. They also need to clarify which services are not working towards these outcomes.

World class commissioning focuses on 'commissioning for improved outcomes'. Improvements may be in:

• clinical and care outcomes
• health outcomes
• community outcomes.

The joint strategic needs assessment (JSNA) will analyse existing and future needs, current services and local priorities. Translating these into commissioning requirements will involve considering the outcomes that commissioners want to achieve on behalf of the community.

Guidance on joint strategic needs assessment (Department of Health 2008)
The guidance says outcomes can be expressed at four different levels, then discussed with providers to clarify the results commissioners want from investment in a service and open the door to innovative practice and ideas.

Outcome-based commissioning podcast (CSIP)
This podcast looks at elements of outcome-based commissioning, including investment, reinvestment and disinvestment, the need to tap into wider agendas, what can support this approach, such as joint working, and potential barriers.

Outcomes focused services for older people (Social Care Institute for Excellence 2006)
This study explores factors that support a shift to outcome-based services, such as local vision, leadership and investment, partnerships and whole system working, and establishing new services to instil outcome-based practice from the start.

Key activities in commissioning social care (CSIP 2007)
Appendix 6 offers a framework for developing an outcome-based home care contract that looks at finance and funding and identifies tasks, activities and issues at different stages in the process. This could be a starting point for frameworks for other services.

Configuring future services Developing a structured approach to delivering better outcomes for older people (Institute of Primary Care 2007)
This report suggests rethinking future provision should be based on whether the volume, nature and type of service currently delivered achieves expected service user outcomes. It sets out a process model for configuring future services for older people.

A guide to fairer contracting Part 2 (CSIP 2007)
This points out that adopting an outcome-based approach may mean radical changes in service contracting, including funding, assessment processes, legal documentation, and service specification, which might include both general and individual outcomes.

Collection of papers on domiciliary care (Change Agent Team 2004)
This document looks specifically at the potential of domiciliary care services to achieve outcomes. Chapter 4 explores what an outcome-based approach might mean in the domiciliary care context, barriers to this approach and what users want from services.

An approach to outcome based commissioning and contracting (Commissioning eBook 2006)
This paper explores a structured approach that commissioners can use to plan the delivery of outcome-based contracting while fully involving service providers.