Outcome-based commissioning

What is it about?

In the United Kingdom, the concern with outcomes was largely abstract and non-operational until it was given new impetus by the move to strategic commissioning in the period after 2004. From this time onwards, a series of initiatives, in particular by central government but also in local government and local health service agencies, has explored how outcome-based approaches can be used in the making of government policy, its translation into the procurement of public services, and even (sometimes) in the management of services, whether in-house or outsourced. In this way, the UK government has committed itself, centrally and at local level, to the highly ambitious course of steering its interventions through their expected impact on outcomes, not simply through programmes of action. In this chapter, we explore the extent to which these government initiatives were really committed to outcomes, the implications that outcomes-based approaches have had for service commissioning, procurement and delivery and whether there is any evidence that an outcomes-based focus actually works, in terms of improving outcomes.

Featured Image

Why is it important?

The interviews in the study reported here provided examples of effective and innovative outcome-based commissioning, but the general consensus was that performance is far too patchy across sectors and local areas. This was often blamed on lack of sufficient investment in the development of commissioning. Another intrinsic problem with outcome-based commissioning, which was raised frequently during interviews, was the difficulty of establishing a link between interventions and outcomes – the attribution problem. Nevertheless, some respondents felt that the underlying problem was actually a mindset still focused on inputs, outputs and processes; concentrating more on what services are delivered, and how, than on the results they achieved.

Perspectives