Beyond targets the outcomes and accountability framework for health

1
Beyond targets the outcomes and accountability
framework for health social care

• Introduction

2
We want to create more locally-led, innovative
health and social care services, that put the
needs and wishes of public, patients, users and
staff at the heart of care

• A system with
• Outcomes rooted in what matters to public,
  patient, user and staff
• Freedom to the frontline (shift from central
  direction to local leadership)
• Clear accountability to parliament and country
• Sustained improvement across the board in both
  health and social care
• A stronger focus on prevention, safety and
  quality, better value and well-being
• Health and social care working together around
  individual and community needs

3
We need a new framework for outcomes and
accountability to support these goals
Benefits of current system
Drawbacks of current system

• Public, patients, users and staff not the main
  drivers of change
• Top down targets leave little headroom for local
  priorities
• Divert attention from non-target areas
• They can create antibodies, particularly with
  local staff
• Do not support a system based on devolved
  incentives and local decision making

• PSAs and targets have delivered dramatic progress
  in some areas (e.g. waiting times)
• Provides a national focus for national problems
• Ease of use
• Aligns local accountability with accountability
  to HMT

What is the right framework to support a
devolved, innovative system that improves on
current levels of performance?
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We have been developing a new outcomes framework
to improve performance, part of a new
relationship between the DH and the frontline,
and one where the needs of public, patients,
users and staff drive change
PCT/LA
DH
HMT/ LCs/ Taxpayer

• 1. Identify priorities
• PCT/LA Prospectus
• Social Care
• Local Area Agreements / Community plans

Establishes the INDICATORS to ensure right
things are feeding into prospectus
The new outcomes framework
Accountability

• 2. Deliver on priorities
• Contracts
• PBC framework
• Info. for choice
• Tendering
• Market-making
• Pathway development
• Campaigning
• Social marketing

Clear indicators for success
Outcome focused PSAs
A strong vision
Funding

• 3. Report on priorities
• Outcomes
• Health and well-being status
• Inequalities
• Experience
• Safety and quality
• Efficiency (technical allocative)

Regulator publishes the indicators to check
progress
Local Government and the SHA role will shift
away from are you delivering national targets
to are you meeting local needs?
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The framework starts with our objectives an
all-encompassing description of the desired
outcomes
Vision

• Fair and responsive health and social care
  services that
• Help you stay healthy, independent and well
• Give you the best possible care when you need
  help
• Are affordable for you and for the nation

Objectives
Better health and well-being for all helping
you stay healthy and well, empowering you to live
independently and tackling health inequalities
Better care for all the best possible health
and social care, offering safe and effective
services, when and where you need help and
empowering you in your choices
Better value for all delivering affordable,
efficient and sustainable services, contributing
to the wider economy and nation

• Outcome focused
• User centred
• Promoting equality

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The new approach will still include a few
indicators (encompassed in Public Service
Agreements - PSAs) that define national priorities
For illustration
Objective 1 Better health
Indicators
PSA 1
DH led PSA indicators
DH contribution to OGD led PSAs
Supports SofS accountability to
HMT Conversations within central government
Supports DH accountability to SofS / NHS CEO /
Perm Sec DH conversations with NHS and Local
Government
Objective 2 Better care
Indicators
PSA 2
DH led PSA indicators
DH contribution to OGD led PSAs
Objective 3 Better value
Indicators
Vfm accountability
DH led indicators
Key
Indicators supporting DSOs
Indicators supporting accountability to HMT
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The OHOCOS white paper commits to a single
outcomes framework. The framework includes the 5
health and 7 social care outcomes.
Vision
Health
Social Care
Services should be person-centred, seamless and
proactive. They should support independence, not
dependence and allow everyone to enjoy a good
quality of life, including the ability to
contribute fully to our communities. They should
treat people with respect and dignity and support
them in overcoming barriers to inclusion. They
should be tailored to the religious, cultural and
ethnic needs of individuals. They should focus
on positive outcomes and well-being, and work
proactively to include the most disadvantaged
groups. We want to ensure that everyone,
particularly people in the most excluded groups
in our society, benefit from improvement in
services.
A patient-centric NHS that uses available
resources as effectively and fairly as possible
to promote health, reduce health inequalities and
deliver the best and safest possible healthcare
Strategicoutcomes
S1. Improved health and emotional well-being
S2. Improved quality of life
S3. Making a positive contribution
S4. Increased choice and control
S5. Freedom from discrimination and harassment
S6. Economic well-being
H5. Equitable
S7. Maintain personal dignity and respect
Built around perception of the User
Focuses on service delivery
Align the outcome frameworks to create something
clearer and more powerful than the two separately
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These new objectives will be underpinned by a set
of 40 outcomes and indicators, rooted in public,
patient, user and staff experience and outcomes
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A PCT report card designed to engage patients
and citizens will publicly demonstrate
achievement against locally agreed priorities.
For illustration
Outcomes achieved
Funding allocation
07/08 Growth vs. benchmark
Improved health and well being
Avg.
Top Q
07/08 Growth vs. benchmark
Funding per capita 1,200 3.8
Avg.
Top Q
a1. people in 56 3.8 good health
Demographic (5) 1adjustment
a2. sub-indicator 67 2.8 on MH
Deprivation 27 2 adjustment
a3. people 91 (3) capable
Other factors 6 1
a4. people do 75 (2) things want to
b1. Life expectancy 78.4 1 good health
b2. Obesity rate 26 1
b3. Smoking rate 22 (0.5)
Etc.
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PCTs and LAs will be responsible for carrying out
a joint strategic needs assessment, which feeds
into Local Strategic Partnership discussion on
local and target priorities for LAAs

• PCTs and LAs take greater ownership for
  continuous service improvement, and are
  accountable to their local population
• They use the outcome indicators as benchmarks,
  allowing PCTs and LAs to rate their performance
  vs their peers, national and international best
  practice
• The PCTs and LAs will carry out a joint strategic
  needs assessment. PCTs and LAs will then develop
  their local priorities, which may involve local
  engagement to feed into Local Strategic
  Partnership discussion on local and target
  priorities for LAAs
• As well as public scrutiny, SHAs and Local
  Governments will continue to challenge areas of
  poor performance, but now on the basis of far
  better info on performance

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The new approach is designed to promote local
leadership and innovation, and is consistent with
the Local Government approach
Alignment with Local Government OGDs
Benefits of the new approach

• Indicators should as much as possible draw on
  public and patient insight work
• Sets an overall outcomes and accountability
  framework within which PCTs/LAs are able to
  identify local priorities
• Allows PCTs/LAs to better allocate resources to
  local need, and encourage innovation
• Increase PCTs/LAs engagement with and
  accountability to local populations
• Retains a performance challenge on PCTs/LAs

• Link health and social care at the outset (OHOCOS
  commitment)
• Consistent with the approach of supporting local
  priority setting in the new Local Government
  framework, Strong Prosperous Communities
• Works closely with new LAAs and the proposed
  Comprehensive Area Assessments
• Facilitates alignment of the new PSAs with OGDs
  (other government departments)

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We are in the process of launching a major
external engagement with key stakeholders, to
explore and build support for our new approach
What are we engaging on?
Who are we engaging with?

• The new framework how do we make this approach
  work?
• The outcomes have we captured the right 40
  outcomes across health and social care?
• The 40 indicators are they rooted in public,
  patients, user staff-reported experience and
  outcomes?
• How well is the public and SHAs able to assess
  performance?

• Intermediate tiers (SHAs, PCTs, LAs)
• Key partners (DCLG, HCC, CSCI, LAA negotiators,
  Monitor, etc.)
• Technical bodies (APHO, HCC, CSCI, IHI, etc.)
• Campaign groups (BMA, royal colleges,
  stakeholder groups, etc.)
• The public

How are we engaging?
When are the key milestones?

• Face to face meetings (especially with key
  partners)
• On-line engagement (interactive with discussion
  threads)
• Use of key summits (e.g. NHS confed, NSF, CSIP,
  social care with CSCI)

• Face to face already started
• Launch of website end May
• Summits on-going
• Metrics for 2008/9 finalised by end-June
• Local government 200 (NIS) sign off in September
• CSR settlement October?
• Formal consultation 3mths post CSR
• LDP/LAA process launches April 2008

To comment on our framework, please go to DHs
consultation web site http//www.dh.gov.uk/en/Cons
ultations/Liveconsultations/DH_075267