Transforming the market for social care paper 4: changing the currency of commissioning from outputs to outcomes

This paper examines the desirability and feasibility of a shift in both procurement and delivery of social care from an approach based on output volumes – such as hours of care provided per week – to one based on meeting outcomes agreed with the service user. At its core is a project managed by the Institute of Public Care during 2007/08, involving five local authorities and one provider, and taking home care as its focus.

Establishing the context of a changing market, in which individuals are increasingly purchasing their own care under the personalisation agenda, the paper first discusses the rise of the outcomes-based philosophy and its success in those relatively small-scale or specialist services, such as addiction treatment, where outcomes are easily measured, before examining the prospects for its widespread adoption in mainstream services. It sets out the drivers for change – specifically the weaknesses in home care as it stands – and the obstacles faced, such as the complexity of defining outcomes and agreeing how to measure them.

The paper then describes the six ‘mini-projects’ undertaken by the local authorities and provider, detailing the specific motivation behind each, the project task agreed upon, the results recorded and the action points arising, before summarising the implications for other authorities and providers.

Drawing on findings from the project as a whole, the paper then provides a step-by-step guide to existing care processes, from initial enquiry through care planning and service delivery, to monitoring and review, illustrating where and how the outcomes-based approach could effect beneficial change. Finally, an example of implementation is set out in table form, comparing and contrasting the traditional approach with ones based on personalised care, and outcomes-based care, for a hypothetical service user.