What is outcomes based commissioning in social care?

What is an outcome?

An outcome is the result or consequence of a particular action, process, or event. In social care, an outcome refers to the changes, improvements, or benefits experienced by individuals or communities as a result of receiving care or support services.

Often with a specific aim, outcomes in social care may include specific factors including improving health and wellbeing, increasing independence, reducing social isolation, and creating a greater quality of life.

What is outcomes based commissioning in social care? 

Aiming to meet the needs of your local community, commissioning is the process of identifying, purchasing, and monitoring social care services within your local authority. Often completed by using the commissioning cycle model, commissioning in local government helps individuals get the care and support they need more efficiently to enable them to reach their independent living goals safely and reduce the demand for social care services and care homes.

Outcomes based commission however, goes one step further by defining, planning, and paying for health and care services based on the achievement of agreed outcomes, instead of more traditional models which are based on units (e.g. hours of care per week).

Unlike older approaches focusing on activities and actions, outcomes based commissioning focuses on what a service achieves. It uses a population health approach to concentrate on delivering a well-led, sustainable and diverse market which is inclusive to all by focusing on what matters to the individual.  

The aim of outcomes based commissioning therefore gives people the opportunity to build upon their strengths, often using a strengths based approach to reduce their dependency on GPs and the NHS, and instead increase their independence for as long as possible whilst delaying future care needs.  

Why is outcome based commissioning important? 

 

Outcomes based commissioning is important as it has been a part of health and social care policy for many years. Instead of focusing on inputs or processes like more traditional commissioning models, focusing on outcomes enables a shift in social care delivery to focus on the actual results achieved for individuals and communities. This, in turn, ensures that resources are directed towards activities that have a tangible impact on people to optimise resource allocation and budgets whilst ensuring high-quality care is always delivered.

This modern approach to commissioning is essential therefore to provide a clearer purpose for individual care by focusing on what matters to them. By measuring these outcomes, commissioners can assess the quality and effectiveness of social care services to identify trends as well as gaps for improvement to initiate better strategic commissioning and continuously improve outcomes.

Focusing on outcomes also promotes accountability among service providers to ensure they are held accountable for both the outcomes achieved as well as the services delivered. As a consequence, this encourages providers to be more responsive to the needs of the community to deliver services that are effective in achieving positive outcomes.

Local authorities can better understand its capacity and potential both now and in the future to make better use of their resources without overspending. This is important as it helps local authorities strategically commission their care to co-produce plans with nearby communities so no resources are wasted.  

Outcomes based commissioning importance and guidance

In the Adult Social Care Outcomes Framework (ASCOF) 2023 to 2024 the UK Government set outcomes-based priorities that focused on 6 key objectives: 

1. Quality of life  
2. Independence  
3. Empowerment  
4. Safety  
5. Social connections  
6. Continuity and quality of care  

These 6 objectives from the ASCOF aim to ensure that local authorities concentrate on maximising quality of life by commissioning social care which helps maintain independence, where appropriate, and empower individuals by offering good quality information and advice over the care they can access. This helps local authorities to concentrate on care which is important to the individual rather than assuming what they want.  

It also helps local authorities ensure both safe and appropriate care is delivered to every individual who needs it so no one is left without the care and support they require. By ensuring the correct care is delivered to the residents in your local area, local authorities can also be certain they deliver high-quality and sustainable care across the care market with professionals who are appropriately qualified for the care needs your community desires, despite the current challenges across health and social care.  

Outcomes based commissioning is important therefore as it focuses on your communities’ needs to drive improvements in the quality, effectiveness, and efficiency of social care services to lead to better outcomes across the community.

Outcomes based commissioning – How does it work? 

Unlike an output, an outcome looks at the impact services can have on a person’s life and is the result of the care delivery an individual receives.  

Outcomes based commissioning therefore helps local authorities to ensure they are delivering person-centred care that helps improve quality of life and improve transparency across the care market.  

For this to be effective, local authorities and care providers must work together to assess their care community’s needs. This can be summarised in a 6 step process: 

1. Define population and scope  
2. Describe desired outcomes and associated indicators  
3. Set the budget  
4. Decide the duration of contract  
5. Design the commercial structure  
6. Engage with the population 

This 6 step process highlights that one of the most important stages is the first step where local authorities need to establish the care needed in a specific area. The process helps local authorities monitor each service user and their progress accordingly to compare their progress to their care plan. Outcome based commissioning is often made possible by using different technological tools to remove potential admin burdens and provide local authorities with real-time information as their community’s needs change.  

The range of information collected can also be used to: 

• Plan and implement improvements based on the evidence provided  
• Make evidence-based decisions about care delivery and outcomes  
• Use increased knowledge to better support providers to deliver quality care  
• Improve care delivery transparency for the circle of care 

Collecting information digitally empowers care providers and local authorities with access to real-time and transparent overviews of how an individual is progressing in their care plan. By being able to access a real-time overview of an individual’s care delivery, local authorities can easily monitor outcomes and progress to spot in advance when changes to a care plan may be necessary before something more critical takes place.

 What are the benefits of outcomes based commissioning in social care? 

 

Outcomes based commissioning has the potential to deliver many benefits to your community and the wider care circle. Even though the benefits experienced could differ depending on whether you are a local authority, care provider, or a service user, some of the main benefits overall include: 

• Improving the quality of life for individuals by bettering the services they receive  
• Increasing service capacity so services can be made available to more individuals in need
• Reduces the overall cost of care packages being delivered  
• Delivers more transparent services  
• Allows more proactive and preventative care rather than reactive care  

Outcomes based commissioning in social care – What are the physical health benefits?

Encouraging a more holistic approach to care, outcomes based commissioning offers several benefits that help improve an individual’s physical health. Some of the main ones include:

• Better comprehensive care plans that address all aspects of a person’s health
• Better management of existing or long-term health conditions
• Promotes preventative measures including healthy lifestyles, early detection of health issues, and proactive risk management
• Reduces avoidable health inequalities by improving the access to health and social care services
• Reduces avoidable hospital admissions and readmissions which in turn avoids more costly treatments and hospitalisations
• Promotes more adaptable and flexible social care delivery to cater to all needs even when demands change

Outcomes based commissioning and mental health – what are the benefits?

As well as offering benefits in physical health, outcomes based commissioning provides multiple benefits improving not just an individual’s mental health but the wider care circle too. Some of the main examples include:

• Better comprehensive care plans that address all aspects of a person’s health including the wider social determinants of health to address social, emotional, economic, and mental wellbeing
• Proactively prevents escalation of mental health problems through promoting early intervention services
• Enables individuals to feel reassured and comfortable knowing their care needs are being best supported
• Offers reassurance to loved ones by enabling them to understand that their loved ones will consistently receive high-quality continuity of care even when needs change
• Promotes engagement from individuals and their loved ones in their care planning and decision-making process
• Helps normalise discussions about social care support to reduce stigma and promote acceptance and understanding to allow individuals to live at home safer for longer
• Reduces stress and burnout among care workers, providers, and commissioners by allowing more effective time management and resource allocation to improve outcomes further
• Boosts morale and job satisfaction by providing a sense of fulfilment and purpose in social care workers and providers
• Increased confidence in care providers and social care workers from loved ones by seeing evidence of the effectiveness of the care being provided

What are the challenges in implementing outcome based commissioning? 

Shifting towards an outcome based commissioning approach requires a big cultural change, and sometimes some of the parties involved may not want to shift because they may not see or understand the benefits.

For outcomes based commissioning to be successful, all parties must work together and be realistic on their timescales to ensure the best outcomes.  

For all parties to collaborate successfully it is important to be aware of the challenges that may occur and how they could impact the various parties involved, some of these include: 

1. Moving to outcomes based commissioning will mean both commissioners and providers will require new levels of delegation, autonomy, and trust  
2. Admin burdens will be common at first such as: how, when, and where will data be collected and analysed or what kind of reporting is required? 
3. Different objectives may incentivise or disincentivise different groups e.g. if an objective is to reduce an overall care package this may have a direct impact on external provider’s income and they may feel disincentivise to change their ways of working to reach that specific outcome 

Coproduction and outcomes based commissioning – What are the benefits?

One way that makes overcoming the challenges and resistance to outcomes based commissioning easier is by combining both coproduction and outcomes based commissioning approaches. Here stronger multi-disciplinary teams can be developed to remove any anxieties surrounding the cultural change as well as offer opportunities for shared learning to better implement outcomes-based approaches across your local authority as well as with neighbouring local authorities.

Some of the biggest benefits include:

1. Enhance service designs – e.g. by combining coproduction and outcomes based approaches individuals, their families, and local authorities can all be involved in the design and planning processes for their social care package
2. Better tailors services to meet the specific needs and preferences for those who will use them
3. Enables more effective and responsive service delivery
4. Better focus on achieving outcomes that are meaningful and relevant to individuals and their loved ones
5. Better shared learning opportunities to foster creativity and innovation in the delivery of social care services
6. Strengthens relationships with multiple stakeholders within the community to foster a collaborative and collective approach
7. Acknowledges and respects the cultural diversity and unique identities of individuals and communities more effectively
8. Offers better sustainable and long-term improvements in service quality, effectiveness, and outcomes

Here the integration of coproduction and outcomes based commissioning in social care can lead to innovative, flexible, and responsive services that empower individuals, build social capital, promote cultural sensitivity, and foster sustainable partnerships for both improvements in outcomes now and in the future.

How can technology help deliver the best outcomes-based commissioning? 

As already discussed for outcome based commissioning to be successful everyone involved should know from the start what the objective is for each individual, without knowing that local authorities can’t use technology to its full potential.  

There are many ways technology can help with outcomes based commissioning. One of the most beneficial ways is to use digital platforms to gather real-time information to track qualitative measures of service delivery against individually defined outcomes. Through easily gathering this information without the need for retrospective input of data, issues and concerns can be identified much sooner allowing for immediate changes to care packages.

Here At The Access Group, we know that the concept of monitoring progress towards outcomes is understood easily, however, understanding how it works in relation to individuals’ care pathways tends to be less documented. That’s why we offer a wide range of digital tools to help streamline the commissioning process to cater to your community’s every need.  

1. Streamline the commissioning process 

 

One way digital tools can help deliver better outcomes is by streamlining the commissioning process altogether. At The Access Group, our CM’s Outcomes Assessment Platform allows you to combine quality aspects of visit monitoring with evidence of service user improvement and deterioration to help you make changes immediately when necessary.   

Our InForm supports providers in undertaking assessments to allow care and support workers to raise questions about goals to capture responses from service-users in real-time.  

This information can easily be added on our mobile app which can also be used offline so data can be updated whenever and wherever support workers are. Our Wellbeing Portal allows us to then track service users and their family’s feedback directly so commissioners can track the direct impact the care delivery is having on service users. These scores can then be collected and analysed through our CMBI Business Intelligence to raise alerts and allow care plans to be adjusted when needed.  

Our software helps streamline outcomes based commissioning by being able to track every step of the commissioning process and be able to easily send alerts when things aren’t working as well for service-users to ensure all decisions made are still related to what matters to them so they can reach their goals.  

2. Improve compliance  

 

With outcomes based commissioning concentrating on individual needs, it can be difficult to keep track of every case accordingly. Care needs can change quickly and adjustments need to be made to accommodate that.  

Some individuals may need different care providers and it is imperative therefore local authorities can find fully compliant providers quickly, efficiently, and safely. If the process is long and if it relies on manual processes there is the risk that the level of care delivered will decrease and so will outcomes. For example, when brokering end-of-life care, it is imperative care can be placed quickly and efficiently, to avoid any time delays and ensure the individual receives the appropriate care. 

Digital platforms therefore offer a great solution to this issue by offering the opportunity to digitally transform your commissioning process. Our Access Adam Care Commissioning platform allows local authorities to have full visibility of the provider market to better facilitate the needs of the community by automatically processing invoices, and adjusting to any care needs when they happen. Through automating workflows, our care commissioning technology allows trends to be spotted earlier so individuals can receive additional care they need when they need it immediately.  

If this results in care providers changing, our in-built measurement tools eliminates the need for time being spent manually checking providers and instead allows you to filter and adjust your needs accordingly so the most compliant providers which match your request, show up on our platform with a quality scoring measurement to aid your choice.  

Here our commissioning platform helps streamline the management of caseloads and through integrating with case management systems, such as Access Mosaic, it allows faster placements to happen to support all outcomes regardless of the size of your local authority. Discover our webinar describing the benefits of this integration today. 

3. Improves care quality

 

Regardless of what commissioning approach is used, the care quality has to be consistent and risks must be mitigated.

Digital technology makes this easier by helping collect, store, analyse, and report on data to improve care delivery both now and in the future.  

We want to make sure at the Access Group that local authorities have all the support they need to deliver their responsibilities under the Care Act, whilst sticking to budgets and delivering high-quality care. It can be difficult to manage and deliver it all, especially with limited budgets year on year. That’s why our Access PAMMS technology has evolved into a powerful commissioning toolkit to help increase care quality and mitigate risks of provider failure.  

With our Access PAMMS technology we have a suite of solutions which can help your local authority transform its provider assessment process and deliver valuable market insight to predict both the demand now and in the future accurately.  

Our Quality Assurance module, for example, is a tried and tested solution to enable providers to work collaboratively to increase care quality. The platform easily brings together evidence from providers, care workers, and service users themselves onto one centralised platform both in person and virtually.

To improve care quality further, you must also think and consider how to mitigate risks. Our Access PAMMS Risk Profiler brings together a range of intelligent data to highlight providers at various stages of risk. Here you can keep a watchful and insightful eye over the provider market and offer support to providers when they need it to prevent provider failure and disruption to the service user.  

Both our demand modelling technology and our social care landscape provide local authorities with the opportunity to monitor activity levels so accurate predictions can be made about future demand.  

This helps local authorities to understand their customer behaviour better and manage unexpected events with minimal disruption, as well as what neighbouring local authorities have available to make use of each other’s resources instead of overspending.  

Here being able to track data and combining forecasting techniques with artificial intelligence Access PAMMS Suites present all this information onto dashboards to make it easier to monitor service user behaviour and make changes when needed.  

4. Improves independence

Ultimately one of the biggest benefits outcomes based commissioning can achieve, when implemented correctly, is enabling individuals to remain independent in their homes for as long as possible.  

Often in most cases, individuals do not want to lose their independence and move into care homes, nor do they want to go into hospital.  

Outcomes-based commissioning can help individuals delay those future care needs by concentrating on what is important to them, as long as it is safe to do so.  

Investing in digital telecare and technology enabled care is one way this can happen. Here our reactive alarm functionality and our digital monitoring of day-to-day life combine to help ensure individuals can remain independent in their homes for as long as possible as well as offer reassurance to loved ones.  

At Access Technology Enabled Care our technology goes further than most technology enabled care as instead of sending alerts out when an individual has fallen, our technology can track day-to-day behaviour and send alerts out when things changes before anything critical takes place.  

Here through offering both preventative and proactive care individuals can remain independent to allow service users to achieve their goals, as well as reduce pressure on the NHS by reducing and preventing hospital admissions and delaying future care needs.  

Learn more about how the power of technology enabled care can transform social care today.

Summarising the importance of outcomes based commissioning in social care 

This article has summarised what outcomes based commissioning is and why it is important in social care. Through explaining how this type of commissioning works compared to traditional methods I have been able to highlight how it benefits providers, care workers, and service users better by focusing on what matters to the individual.  

The article has also explained how outcomes based commissioning can be a cultural shift for some of the parties involved and because of this, some challenges may occur. It is crucial therefore that all parties work together to achieve the best outcomes and to put the individuals of your community at the heart of every decision that gets made.  

I have explained at The Access Group how we have a variety of local government software which can help your local authority deliver the best outcomes based commissioning depending on your community’s needs.  

Whether your local authority wanting to streamline the process altogether to make working collaboratively with other parties easier and avoid data duplication, or it’s to improve care quality for both now and in the future whilst mitigating risks, we will have a digital tool to help you.  

Discover how technology can streamline how you commission your social care services today by watching our social care commissioning webinar.

For more information on our local government software contact us today and we can help cater our digital tools for your community’s needs so you can deliver more proactive and preventative care to best met your community’s needs.