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.
Further Resources:
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