Only the brave succeed when focusing on outcomes

The need for health and social care systems to focus on outcomes, rather than activity, was one of the key shifts we identified as crucial to a sustainable future NHS – the NHS@75.

‘An outcomes focus is one of the key shifts essential to ensure a sustainable future NHS’

With the HSJ/PwC CCG Barometer in March showing that 63 per cent of clinical commissioning groups are likely to re-contract a significant amount of services under an outcome based contract in the next 12 months, learning the lessons from early adopters is critical. 

This was the topic of our lively workshop at the NHS Confederation conference in June.

• The NHS at 75: Engaging with new digital demographics
• The NHS should make the most of responsible citizens
• Comment on the Barometer: CCGs must hold their nerve

That first step

We started with the same first step every commissioner wanting to shift toward an outcome based approach needs to take.

‘Outcome based commissioning is not just a technical exercise’

That is gaining a clear understanding about what matters to patients, carers and the public from their perspective, rather than that of providers of the services.

A hip replacement might be successful if it helps someone to walk the dog, or play golf, which places a premium on the process of recovery, rather than the operation itself.

Delivering outcome based care requires organisations from across the health and care economy to work together in a more joined up way. 

As one delegate at the workshop highlighted, outcome based commissioning is not just a technical exercise. If commissioning for outcomes is not going to actually transform ways of working at the front line and improve the way that patients experience care, there is not much point embarking on the journey.  

Essential engagement

Engaging providers, including GPs, in a meaningful way, is therefore critical in making the transition to an outcome based approach.  Business intelligence and evidence on the cost of preventative interventions and securing outcomes is needed to underpin these decisions. 

‘How the system can be transformed to deliver patient outcomes should be top of commissioners’ agenda’

There are challenges in terms of measurement, which needs to extend well beyond the activity based data currently recorded by providers and commissioners and include social care as well as health, although technology and data analytics will increasingly offer us the tools to deliver and measure individual, personalised outcomes, in real time.

The key challenge for commissioners will be how to balance personalised outcomes for individuals with those of the whole population, managing the risks involved, and delivering this within increasingly tight budgets. Using standardised quality of life measures are likely to be key in this regard.

While the discussion raised as many questions as answers, the direction of travel clearly points towards a more patient centred approach.

Working together on how the health and care system can be transformed to deliver the outcomes that patients and the population want should be top of the agenda for commissioners and providers across the country. 

Janet Dawson is healthcare lead partner and Dan Burke is a director of PwC