Emerging practice in outcome-based commissioning for social care

This paper is a progress report exploring the lessons learnt from a variety of approaches taken by councils to `outcome-based commissioning` in adult social care (sometimes called 'payment by results'). It considers some of the opportunities and risks that arise from taking this approach.

The paper puts the emerging practice in social care in a context with other developments within the public sector; explores current practices in social care from a small number of councils and looks at the advantages and risks in taking this approach. It suggests that this approach could deliver better outcomes for people at a lower cost if the transaction costs can be limited.

The paper draws on discussions with providers, commissioners and customers receiving services.

The development of thinking in local authorities in recent times has shown a new emphasis on interventions that either prevent or reduce someone's need for longer term care. This is supported by the evidence for the benefits from re-ablement for older people, the recovery model in mental health and the emerging progression model in learning disability services.

Outcomes based commissioning is, in part, a natural evolution of the way in which commissioning might take place when a council is seeking improved outcomes for its customers as a result of the resources it purchases or deploys.

The overall expectation is that if a provider can produce outcomes for customers that may reduce their need for longer term care they should be rewarded. At the same time if fewer people need longer term care this will reduce the overall costs to the council. The benefits can then be shared between commissioners and providers of services.