Achieving more for less

Mike Wright is Development Director at KeyRing, which supports vulnerable adults in their communities through networks of members supported by volunteers. KeyRing helps members to become full citizens of their neighbourhood and less reliant on paid support. The charity works with local authorities all over the UK. In this post, Mike talks about the charity’s experiences of outcomes-based commissioning. 

Some things work better in pairs: Lennon and McCartney, Jonathan and Charlotte, gin and tonic, outcomes-based commissioning and letting go. Some experimentation might be needed to get to the right combinations and the resultant mix could be a taste that takes time to acquire. But are not the results worth the effort?

Outcomes-based commissioning is, to state the obvious, about commissioning outcomes—only outcomes. It is, rightly in my view, hailed as a way to achieve more with less. Say what you want to achieve, with how much, and then tap into a massive and eclectic resource of providers to come up with solutions. It also lends itself to payment by results, reducing the risk to the purchaser.

I am delighted that there are many who recognise that doing the same for less will not provide a long-term solution; we need  different conversations with strategic thinkers in Local Authorities. Some exciting and truly innovative solutions are emerging where this is happening.

Yet, concurrently, sometimes in the same Local Authorities, I am seeing procurement exercises with ever longer lists of required outcomes coupled with ever more prescriptive inputs. As well as what we should do, more Local Authorities are directing what we should be—part of a consortium, specialists, generalists. Most mention a desire for ‘innovative solutions’, whilst allowing no scope to propose anything new. The combined resources of Local Authorities and providers required to undertake these exercises is enormous and seeing them miss the chance to be the catalyst for better ways of working hurts on many levels.

Reaction to KeyRing’s unique yet proven Living Support Network model illustrates both the above approaches. In Walsall, we have refined the model to provide a ‘Network Plus’ option to facilitate people’s move out of residential care. Their support, involving KeyRing and other care providers, and their lives generally are greatly improved, whilst the cost of their care is significantly reduced.

Then we have Local Authorities that have been more than pleased with the outcomes we have achieved for a decade and longer. Yet now, in response to the financial squeeze, they say they cannot pay for the cost of having input from volunteers (a vital element of how we reduce people’s dependency, and so the cost of their support). They will only pay a given hourly rate for inputs, although the lifetime cost of achieving outcomes will end up being far higher.

I worry that outcomes-based commissioning is rapidly heading the way of the social model of disability—cited routinely, but applied very rarely;  most funding is still in labelled streams, most services work with ‘client groups’, and ‘disabled’ people are recipients of money and support, not ‘earners’ of money to spend as they see fit.

What a difference the route money takes makes to who decides how it is spent (and on what!). Personal budgets are a step in the right direction, which then begs the question, ‘why are Local Authorities procuring at all?’

At the end of the day, providers and commissioners need to trust that ‘we’re all in this together’ and, genuinely, we all want the best solutions.

Download When the going gets tough for free from NPC’s website. This is the fifth and last in a series of blogs focusing on the changing world of commissioning which run throughout this week.