Purchasing and providing outcome-based care

1. Purchasing and providing outcome-based care LUCIANNE SAWYER CBE CSIP OUTCOMES NETWORK LEAD Introduce both of us Ask delegates to introduce themselves if 12 or fewer – if more apologise that we arent doing it at the beginning but say that the will have opportunity to do this in discussion groups This is about real experiences of setting up outcome focused services – the problems encountered, some of the ways they have been tackled, and some of the benefits of doing it this wayIntroduce both of us Ask delegates to introduce themselves if 12 or fewer – if more apologise that we arent doing it at the beginning but say that the will have opportunity to do this in discussion groups This is about real experiences of setting up outcome focused services – the problems encountered, some of the ways they have been tackled, and some of the benefits of doing it this way

2. We will cover: What is meant by ‘outcomes’ bean-counting v making a difference The difference between outcomes and outputs Whose outcomes are they? Purchasing to meet objectives Investing or purchasing? Different approaches Planning despite existing processes Providing for quality outcomes Measuring outcomes

3. So what do we mean by ‘outcomes’ ? Making a difference Its not – ‘5000 hours of care delivered – bingo we hit the target!’ But – ‘5000 hours of care delivered – so what?’ ‘Outcomes’ refer to the impacts or end results of services on a persons life (SCIE 2007)

4. ‘Outcomes’ or ‘Outputs’? It’s confusing – so lets be clear…. OUTPUT 40% more people are completing the substance abuse programme We have reduced the numbers going into long term residential care We met the target to get young people moved on into independent accommodation within two years OUTCOME More people are achieving abstinence and staying off drugs for at least 6 months More people are feeling confident that they can manage at home as the result of our service We work with our young people until we and they feel confident that they have the skills to manage on their own

5. Individual strategic Population outcomes Community outcomes Outcomes for specific interest groups, users or organisations Individual outcomes Go through these rapidly We are focusing on individual outcomes – when outcomes are expressed by service users in their own day to day language it is an excellent way of getting them involved in thinking and planning for their own services – it really is ‘person centred care’ Because we both believe passionately in ………………………..Go through these rapidly We are focusing on individual outcomes – when outcomes are expressed by service users in their own day to day language it is an excellent way of getting them involved in thinking and planning for their own services – it really is ‘person centred care’ Because we both believe passionately in ………………………..

6. Individual outcomes may be….. Maintenance - e.g. Feeling clean and comfortable is very important to me I want to feel safe at night I’m worried about my flat, I need someone to help with that Change – e.g. I’d like to be able to get around my home better I want to be able to make a snack for myself again I’m very lonely – could someone help me get out to the shop or to my church? Process – e.g. I don’t want a lot of different people coming into my home Its important to me that the staff respect my religion SPRU University of York

7. Basic concepts and principles Results matter Outcomes are about results for people Gains in health, mobility, skills etc. Prevention of deterioration Increased confidence, engagement, feeling in control Changes in behaviour Start with ends, work backwards to means Measure success by what is achieved for people – not by the number of people who get a service or the number of hours of care we provide People should be able to influence the choice of outcomes (whose outcomes are they?)

8. Commissioners need to be investors, rather than funders The Funder Invites submissions, often to a rigid specification, and selects from those applying Believes fairness means keeping a distance from proposers Considers grant or contract decisions the high point of the work Monitors for compliance The Investor Seeks to uncover all promising opportunities and encourages innovation Believes fairness means intense interaction with applicants Considers the initial investment only the starting point Asks: How can I help? Taken from Institute of Rensselaerville document

9. The commissioner’s role is……. Vital for delivering the government agenda Personalisation – choice and control Self direction But there’s also the bigger agenda White Paper outcomes or Every Child Matters How do we tie these two together?

10. Getting from small scale to larger scale leads to improved independence better independence levels for for the individual lots of individuals a series of change outcomes will contribute to improved well-being

11. But its not just Adult Services Housing, transport, leisure services, family etc. may all play a part when we are trying to achieve outcomes such as - Improved quality of life Making a positive contribution

12. So – how do we get to an outcomes approach? Different tools available – from UK,US and elsewhere Chosen largely on the basis of the kind of service involved and what your objective is. Are you aiming for a higher level strategic outcome or wanting to ensure that individual have a role in influencing or choosing outcomes? (some systems have devotees who pursue a particular course somewhat zealously!) Its important for commissioners to know what’s out there and to be in a position to decide what might be helpful to their particular aims, situation and area Most, but not all, of the authorities who have started down the road towards outcome-based home care have focused on individual outcomes. and have drawn on the work done by the Social Policy Research Unit (SPRU) at the University of York Individual budgets are another way of achieving outcomes

13. Expectations change – particularly of service providers. They need: Flexibility and autonomy to achieve outcomes – in place of tight service specifications Time budgets used flexibly, rather than rigid time schedules Details of service decided by service user and providers together “But can we trust the private sector?” Working together on an equal basis is key to success – ANDREW TYSON, Policy Director, In Control

14. Don’t under-estimate the amount of change needed The idea of outcomes is simple and common sense – but getting there is not easy! Local authorities are highly process driven Standing orders / EU procurement Some jobs will change Inappropriate IT systems can hi-jack the whole process of change – Issues related to charging service users will need to be thought through and adapted Concerns from Finance and Audit about the flexible use of time and loss of day to day control need to be addressed

15. What do we need for success? Leadership and commitment – from the very top – including elected members A project leader / steering group Involve everyone in the learning process – work together as equals. Shared understanding is essential Clarity about the effect on jobs Systems which support this way of working Enthusiasm! Outcomes Network has 160 members (fewer than 60 this time last year) 48 local authorities represented 9 health authorities 5 universities or colleges SCIE, CSCI, CSIP, policy leads in DH, DFES, etc. Small no. of independent providers – I would like moreOutcomes Network has 160 members (fewer than 60 this time last year) 48 local authorities represented 9 health authorities 5 universities or colleges SCIE, CSCI, CSIP, policy leads in DH, DFES, etc. Small no. of independent providers – I would like more

16. Quality – how do we achieve it? Starting point for quality – what matters to service users The expression by the service user – preferably in his or her own everyday language – of his or her aspirations for what the service will help them achieve (within an agreed budget) – finding out what they like or want may take time and only happen when the care worker has really got to know the user Between provider and the user – you agree how you can best achieve the outcomes he/she wants Providers should monitor and measure the achievements, having agreed with commissioners how this will be done

17. Some of the benefits: If a multi-disciplinary approach is needed, everyone is focused on achieving the same outcomes- the user experiences an integrated service A team approach in which everyone’s contribution is valued – including the user and carer Because the service user has chosen the outcomes and can vary the tasks and times, he/she feels more in control The provider knows they will be judged on what is achieved for the service user – so the relationship is strengthened

18. What is the impact on key provider jobs? Provider managers may initially miss the security of rigid prescription but with good support and real partnership they soon gain the necessary confidence – those who are used to working with people who fund their own services are more likely to adapt easily Care workers tend to like this way of working and adapt quickly – they have responsibility and are clear about what they are trying to achieve. Being able to be responsive to the service user’s wishes is one of the things which, research tells us, makes care work satisfying. There is evidence that retention rates improve markedly

19. The impact on relationships? The relationship between provider and user is strengthened- they are both trying to achieve the same outcomes, and responsiveness and flexibility depends on good communication between them The relationship between service provider and commissioners and care managers has to be good – partnership with high levels of trust on both sides is essential Care workers feel part of a team and are valued – their views are critical to the way the service responds Informal carers will also know what the desired outcomes are and can participate in helping to achieve them Evidence of higher satisfaction ratings

20. It it worth the effort? Happier, more satisfied service users – feeling that they are in control Staff are more engaged – improvement in staff retention Providers have evidence of what their service is achieving Commissioners are fulfilling policy requirements and know the extent to which their money is buying the outcomes they want