12 - A model of outcomes-based commissioning

Summary

Summarising an effective approach

We have come on a long journey through the stages of commissioning and the key ingredients that make any commissioning practice a greater success regarding good outcomes and experiences for people and their communities. In this concluding chapter, I bring together the priority aspects in a model for good commissioning. Although all the individual model components require in- depth understanding and practical knowledge, I would suggest the model can act as a simple memory aid when considering new commissioning projects or programmes – commissioners can ask: have all the aspects of the model been considered adequately and employed appropriately?

This model is more effectively applied to larger commissioning projects. A proportional approach will be needed for smaller commissioning projects.

The aim is to strive towards outcomes- based commissioning. I suggest that today, compared with ten years ago, what constitutes good commissioning has significantly changed. It is now a difficult balance between achieving quality outcomes for people and achieving sustainability in a resource- challenged environment. This means embracing change and innovation to tailor solutions for improving local outcomes. What this will look like will be quite different from area to area, but the focus for commissioners is to achieve good or improved outcomes for the population through defining, planning, and contracting health and care services.

The model

The model (shown in Figure 12.1) includes three output pillars. These pillars are essential – each one must be in place to support the aim of outcomes- based commissioning. The foundation for these pillars is provided by enabling bricks. You could remove a few of the enabling bricks, but the model would be less ‘stable’ and potentially less likely to succeed or to stand the test of time.

The output pillars

The output pillars of outcomes- based commissioning are Access, Quality, and Sustainability.

Access

The Access output pillar ensures that services, care, and support are accessible to those who need it. Here, commissioners are looking to ensure that services are provided at the right time, in the right place, and for the right people. Access as an output seeks to reduce avoidable health and care inequalities.