The next @WeCommissioners live Tweet Chat at 8pm on 6 May is on the subject of Commissioning for Quality & Outcomes. This is the current version of the pre-chat blog.
First a quick recap on commissioning: “Commissioning in the NHS entails decisions about needs assessment, resource allocation, service purchasing, monitoring and review.” Nuffield Trust, 2014.
Secondly, what is meant by quality and outcomes: In the NHS Next Stage Review, 2008, quality is defined by Lord Darzi as care which is "clinically effective, personal and safe". Outcomes are the results of support activity or interventions for the person, not the activity itself; these can be measured or defined in a range of ways, including Patient Reported Outcome Measures (PROMS). This specifically means outcomes for people in terms of how their health and wellbeing is safeguarded, improved or how they are affected by a specific procedure, course of treatment or other intervention.
The Commissioning Cycle has a number of stages where quality and outcomes are important to incorporate:
Historically, NHS services have been paid for through agreements and contracts based on the quantity of what is provided; more recently, the introduction of quality into these agreements has seen improvements and now there is a greater move towards payment based on outcome rather than quantity of service provided. Yorkshire & The Humber Joint Improvement Partnership has some useful information and resources on outcome-based commissioning aimed at commissioners of adult health, wellbeing and social care services. The approach to commissioning for outcomes is not exclusive to healthcare and commissioners of social care services are also moving further in this direction. A seminar in January 2014 ‘Commissioning For Better Outcomes’ by the President of the Association of Directors of Adult Social Services (ADASS) describes how this works in this area.
The National Institute for Health & Care Excellence have produced a national Clinical Commissioning Group Outcome Indicator Set. These are intended to “support CCGs and health and wellbeing partners to plan for health improvement by providing information for measuring and benchmarking outcomes of services commissioned by CCGs”
There are a number of tools at different stages of the commissioning cycle that are used to ensure a quality and outcomes focus to commissioning, specifically through the annual commissioning elements relating to contracting. Requirements for quality and outcomes are specified to commissioners through the Standard NHS contract. Once commissioners have identified the quality standards and outcomes that are to be achieved by a provider, it is through the contract that these are formally agreed. Following this, there should be a robust and planned process for regular monitoring of performance against these standards to ensure they are being met. For some standards where they are met, providers can receive additional payments from commissioners and for some where they are not met, commissioners can impost financial penalties. These details are all specified within contracts.
NHS Confederation Briefing ‘Two sides of the same coin: Balancing quality and finance to deliver greater’