Vision & Principles

 

Vision

Firstly, the market would be operated within an outcome-based commissioning framework.

The language of outcomes would firmly underpin the contracts. The distinctions between inputs, outputs and outcomes would be widely accepted.

Providers would take responsibility for stating what they will accomplish for the people they serve and take responsibility for showing evidence of those changes in behaviour and condition.

The key question would shift from ‘how many people did we get into treatment/service' to ‘how many people benefited and how does that compare with what was projected'?

Investors (commissioners) and providers whether private, public or not for profit, would see themselves as active partners, recognising their relationship as a symbiotic one - each party depends on the other for success. Finger pointing and adversarial tensions and competition would be severely reduced as mutual cooperation became the main mechanisms to integrate the system.

Funding decisions would clearly take into consideration past data on outcomes achieved and these decisions would be seen as fair and equitable.

Contracts would have modest increases to ensure that providers could put in place outcome monitoring systems that would gave them usable data to manage their services and to treat and support their clients.

 

Principles

Commissioners will need to be strong leaders who are value driven and innovative. They will need to challenge the conventional ways of doing things and explore diversity and new models.

They will need to use their financial muscle to bring about change, de-commission where necessary, stimulate markets and force value for money through outcome based commissioning.

They will need to be investors rather than funders who passively fund year on year. They will need to seek a return on investment (ROI) and have proof that they have delivered this for tax payers.

They must deliver high stands of efficiency through their own system by reducing bureaucracy, compressing time and reducing transaction costs for providers and partners.

They must increase the amount of funds they spend on innovation - what we call ‘buying change' and ensure that providers are rewarded for service design and research and development in to new and better products.

They must stimulate and manage the market both new entrants and old, ensuring an integrated pluralistic provision of services.

The must ensure that all services are based on user involvement and co-production of products and results.

They should collaborate through pooled budgets and contract for units of results that can be compared by across commissioning groups.

Investors will be audited on how well they invest and manage portfolios across a range of care groups. Investor targets will be developed by commissioners and progress against them recorded.

Finally, they must balance the then need for central funding and targets with local initiatives and mechanisms to make the best use of resources and meet local circumstances.

New public sector commissioning must be expressed through new ways of working:

  • Investors rather than funders

  • Outcomes rather than activity

  • Higher standards of efficiency

  • Needs led and evidence based

  • Market stimulation and management

  • Based on user involvement and co-production

  • Innovative and using modern technology

  • Ensuring new types of services, interventions and integration

  • Balancing central funding and targets and local initiatives and targets

  • Being transparent and honest about decisions

 

Our training and implementation work assists organisations in applying outcome thinking to both commissioning and to internal management.