Thursday, March 23, 2017

How should health services listen better?

OPM Group has been working with health organisations and patients for many years. We support patients to have a say in decisions that affect them and how services are designed for them. We support health providers with complaints analysis, consultation analysis, engagement activities, research and evaluation. Here is a summary of our services and examples of our work. We hope you will contact us to discuss how we can help your organisation to listen better.

Monday, March 20, 2017

Commissioning for Outcomes – The role of social finance

Can social finance help with the challenges that public commissioning faces?

This paper is intended as a provocation to government, commissioners, providers and investors to begin a richer conversation that doesn’t assume we already know the answers. OPM’s experts in commissioning for outcomes (Sue Goss) and in social finance (Chih Hoong) draw on their learning about systems leadership, experience of teaching commissioning programmes and our work in evaluating social investment experiments.

Monday, March 20, 2017

Commissioning for Outcomes – The role of social finance

Can social finance help with the challenges that public commissioning faces?

This paper is intended as a provocation to government, commissioners, providers and investors to begin a richer conversation that doesn’t assume we already know the answers. OPM’s experts in commissioning for outcomes (Sue Goss) and in social finance (Chih Hoong) draw on their learning about systems leadership, experience of teaching commissioning programmes and our work in evaluating social investment experiments.

Wednesday, December 7, 2016

Support for outcomes-based commissioning and the role of the GO Lab

Introduction

Outcomes-based commissioning (OBC) has attracted increasing attention as part of Government’s wider reforms to public services, set out in the Cabinet Office’s 2011 white paper. In the first blog of this series, I shared some of the learning and messages we have gleaned from our work with commissioners in this area, specifically in relation to the technical and cultural challenges and the potential for a wider approach towards outcomes that balances service user-defined and system-defined outcomes.

In this second blog, I share some of what commissioners have been telling us in terms of the support they need to enact OBC and also reflect on the implications for the Government Outcomes (GO) Lab. The GO Lab was established through a partnership between the Blavatnik School of Government at the University of Oxford and the Cabinet Office, as an independent centre of academic excellence for innovative public sector commissioning.

Support and resources

We have found that many commissioners are unaware of the range of support and resources available to support OBC. For example, across the successive cohorts of commissioners we have been working with as part of the Cabinet Office’s Commissioning Academy, we have found very low levels of awareness of things such as ‘rate cards’ and the Cost Benefit Tool for Local Partnerships. In the previous blog of this series, I reported that commissioners often articulate the technical challenges of OBC, which can include pricing outcomes, for instance. Yet resources like rate cards and the Cost Benefit Tool for Local partnerships are key resources in helping commissioners determine outcome pricing.

This is a clear sign that simply making something available does not mean that it will be used. Indeed, potential audiences may not even be aware of the existence of such resources, much less use them.

We must understand what commissioners need in relation to resources and support, and how they prefer to access these. Commissioners we work with describe utility of resources and support in terms of their specificity and bespokeness in relation to intended use. For example, there can be a preference for local data over published national statistics, for example, in relation to pricing outcomes. This desire for specificity has implications for replication and the usefulness of generic resources. There has to be some way of ‘translating’ generic resources and unpacking them for use in specific contexts – a process of ‘making it real’.

This is where we need to understand the importance of peer-to-peer learning and sharing within the commissioning world. Amongst the commissioners we work with, it is evident that ‘word of mouth’ is hugely influential. This peer-to-peer transmission of know-how is important as it helps translate how something should be done in a specific context.

GO Lab

Commissioners have told us that it would be desirable to have a central body responsible for evidence synthesis and dissemination to support better commissioning. This suggests that the GO Lab may have an important role to play. However, there is still a very low level of awareness of the existence of the GO Lab and its role among the commissioners we work with. The GO Lab needs to clarify its remit; ways of working; and strategy for engaging different types of commissioners. It has an urgent task of raising awareness among its intended ‘customer base’. To do so will require working collaboratively with other players to extend reach and meaningful engagement.

While there has been a lot of emphasis on the GO Lab’s role in relation to evidence on ‘what works’, there is another complementary perspective about the need for a hub that looks specifically at what types of commissioning models are appropriate in what circumstances (i.e. in essence a ‘what works centre’ for commissioning as opposed to a ‘what works centre’ for interventions).

Conclusion

With the challenges confronting public services and the attendant need for innovative responses, it is vital that we create spaces for commissioners and others to come together to share experiences and insights into effective ways of commissioning. This requires more than just pushing out information. This reframes the processes away from a simplistic knowledge creation and transfer model, to one that is based on knowledge co-creation.

Dr Chih Hoong Sin, Director, Innovation & Social Investment

Thursday, December 1, 2016

Commissioning for outcomes – challenges and opportunities

Introduction

In the UK, around £15bn of outcomes contracts has been commissioned in 5 years. Outcome contracting or outcomes-based commissioning (OBC) is not new, but its use has attracted increasing attention as part of the Government’s wider public services reforms, set out in the Cabinet Office’s 2011 white paper. It is aimed at building more accountability into commissioning and to create a direct financial incentive to drive outcomes while incentivising providers to find better ways of delivering services. However, as the National Audit Office reported, OBC is not the ‘magic bullet’ and is not suited to all public services.

Appetite for OBC

In our experience of working with a wide range of local commissioners and those in commissioning networks; we are aware that OBC is still highly variable. Commissioners are conscious of the challenges of OBC. The process of developing and procuring outcome contracts is technically challenging. Interestingly, while much has been written about the technical challenges associated with defining outcome metrics, identifying target cohorts, establishing causality between intervention and outcomes, setting appropriate outcome payment, and procuring OBC; there has been less attention given to the cultural challenges of developing and procuring outcome contracts.

Our engagement with commissioners indicates that they do not under-estimate the technical challenges of OBC, but largely feel that they can have access to in-house capacity and skills for analysing outcome, activity and financial metrics; or are able to lever in such expertise. However, technical expertise per se is insufficient.

The structure and organisation of the statutory sector can pose challenges. For example, it is hierarchical and, despite good intentions, still operates in silos. Developing OBC often requires ‘going against the grain’ of established practice. Breaking down silos, networking and influencing effectively, and being able to understand and navigate complex relational dynamics within a commissioning organisation can sit uncomfortably within settings that are more commonly characterised by deeply entrenched sets of institutionalised behaviours and bureaucracy.

Commissioners often talk about risk in the context of OBC. They hint at the need for a different attitude towards risk within the statutory sector, and also different ways of ‘holding’ and managing the risks. Risk assessment and risk management have become de rigor in many statutory services and organisations and, in these contexts, risk is conceptualised and understood in negative terms. However, risk management strategies can often reflect public opinion and market forces, rather than stem from any objective analysis of risk. There are also deep contradictions in relation to whether risks are managed at the individual or collective levels. The issue of ‘who holds what risks’ is highly pertinent in this context.

Outcomes for whom?

As I have written previously elsewhere, ‘outcomes’ are still largely system-defined. This is more than an issue of ‘who pays’ and ‘who saves’, but also recognises the fact that ‘the system’ (e.g. healthcare, social care, children’s services, etc) already collects a significant amount of data routinely, using broadly consistent techniques. It is therefore perceived to be more ‘cost-effective’ to use such existing data, particularly when such data are also key targets or KPIs against which organisational performance are assessed.

There is a paucity of evidence around the link between individual-level and system-level outcomes. There can be over-simplistic assumptions around the link between, say, achieving better individual wellbeing and resultant decrease in service use. Despite the rhetoric around person-centred care and user involvement, genuine involvement of service beneficiaries in defining outcomes is still rare.

Interestingly, there may be potential to reframe the way we look at outcomes. For example, while the Sustainability and Transformation Plans (STP) agenda has been criticized by local authorities and by those championing public consultation, the high level principles and vision underpinning it can be used to open up a wider discussion around “outcomes for whom?”. In our own work with commissioners, we have encountered colleagues in Clinical Commissioning Groups who have used the STP agenda to embrace a wider perspective on outcomes – in particular to involve service users in co-defining ‘what success looks like’, over and above any system-level benefits, even if these may not result in ‘cashable’ savings.

Conclusion

Looking ahead, we need to pay more attention to the needs of commissioners in terms of the support they require to enact OBC, with clearer guidance for thinking through where OBC may or may not work. The support should cover not only the technical aspects of developing and procuring OBC, but should also extend to include support for navigating the relational aspects of OBC, both internally and externally. It is also crucial to better understand how commissioners access support. From our experience, effective commissioning support is never simply about ‘pushing’ information and resources ‘out’ to commissioners. There should be a strong formative thrust aimed at helping commissioners translate and unpack resources and learning, and making these work in their specific local contexts. In addition, we know that peer-to-peer support and exchange can be critical in sense-making and practice improvement. This is where commissioning networks can play a vital role in encouraging and sustaining such exchange.

Dr Chih Hoong Sin, Director for Innovation & Social Investment

Monday, October 10, 2016

North London Waste Authority – Heat and Power Project

Background

The North London Waste Authority (NLWA) is responsible for arranging the disposal, recycling and composting of waste collected by seven North London boroughs. In order to meet future waste management demand and minimise the amount of waste sent to landfill, NLWA proposes building an Energy Recovery Facility to replace the existing plant at Edmonton EcoPark by 2025.

As part of the DCO pre-application stage for the project, NLWA conducted a public consultation on the proposed development to ensure that the community and other interested parties have a chance to understand and provide feedback on the proposals.

OPM Group worked with NLWA to provide robust and transparent consultation and engagement with stakeholders and the public.

What did we do

OPM Group’s role involved providing strategic advice on the approach to community consultation, supporting event and materials design, developing and hosting the consultation response website and conducting analysis and reporting.

We liaised closely with NLWA and its technical consultants to ensure that our consultation outputs allowed the project’s technical team to hear, act upon and respond to the issues raised by respondents.

Outcome

A summary of responses from the two phases of public consultation was made publicly available, along with NLWA’s response to the issues raised, so that those who participated can see how their comments have informed the next stage of development.

NLWA’s application has now been accepted by the Planning Inspectorate and is awaiting a decision.

Monday, September 19, 2016

City-Wide Partnerships – Belfast

Background

The city of Belfast has an important place-shaping role in Northern Ireland and was recently given additional powers by the Northern Ireland government. We were asked to work with the city to create an innovative partnership architecture for the whole city, working more closely with the private sector, with neighbourhoods and with partner agencies.

What did we do

Through facilitated sessions we worked with politicians, managers and partners to overcome its legacy of division and build a strong shared vision and agenda. What was striking was the incredible number of different partnerships that already existed, but also the complex history that led to each one, and the sensitivities involved in making changes. Belfast is a city where history is very important, and while there is widespread support for building a vibrant and growing economic, it is a place where the maxim ‘moving at the speed of trust’ is highly relevant.

Outcome

Working with the city’s diverse group of political leaders, we were able to map the links between deep seated problems and the obstacles to economic growth without blame or finger pointing – and to pinpoint the areas where new thinking was needed. By interviewing a wide range of partner organisations, we were able to understand the strengths and weaknesses of current partnership working; no-one wanted an unwieldy talking shop. Instead, leaders formulated an approach based on a network of partnerships – each focussed on a very practical problem – but with an central space for leaders to make the right linkages and build strong relationships. While progress would be gradual, to make the network effective we developed and ran a bespoke leadership programme, developing a cadre of managers from across the city to become ‘system enablers’ sharing data and evidence and working collaboratively to support the partnership network.

Monday, September 19, 2016

Toolkit for Change – Canterbury District Council

Background

In Canterbury District Council, Rob Francis, Richard Field and Sue Goss worked with the top fifty managers to develop commercial and entrepreneurial skills and inspire new ways of thinking that could lead to more creative service design.

What did we do

Drawing on research about best practice both in the local authority and elsewhere, we designed and ran three Toolkit for Change ‘challenge and creativity’ workshops  – incorporating best practice from other councils, communities and the commercial world, framed clearly within the core values of public service.

Lenses for reviewing public service included channel shift, new forms of ownership and public service delivery, asset mapping and unlocking the capacity within local communities / partners, creative thinking and ways of valuing public impact and investment. In between workshop sessions, managers and staff worked on ideas, challenges and possibilities culminating in preparation and presentation of business cases for change to a panel in the final session.

Outcome

Feedback on the process and benefits can be seen on this short video.

Monday, September 19, 2016

Health and social care integration in Kirklees

Background

We have worked to develop collaborative leadership across health and social care systems in a number of localities. In Kirklees we were asked to support the creation of a integrated mental health commissioning system as an exemplar from which the whole system could learn.

What did we do

A very senior group of leaders worked together over a number of sessions to develop a shared set of principles and goal – and a series of practitioner workshops began to flesh out what this would mean for front line services. Recognising that success would depend on the strength of relationships between staff in different organisations, we designed and delivered a ‘Skills for Systems Leadership Programme’ for the public health, social care and CCG senior teams – agreeing key health outcomes and providing the skills and techniques that enabled cross-organisational teams to develop shared approaches to changing behaviour and tackling long-standing problems.

Outcome

The programme built a strong network of organisations and individual leaders, a shared understanding of systems pressures and agreement about the way forward. The work included providing individual coaching and support to key leaders, facilitation and team coaching sessions for top managers and partnerships. The final stage of the programme was to create a dramatic ‘future scenario’ event for fifty or so participants including the voluntary and community sector, from which partner organisations developed a set of principles to guide future shared direction.

Monday, September 19, 2016

Repairing a dysfunctional partnership (client confidential)

Background

We were asked to step in when relationships between a County Council and Clinical Commissioning Groups broke down. Trust was low, meetings were fractious and unproductive and progress in health and social care integration had halted.

What did we do

Sue Goss began a painstaking process of meeting each of the leaders individually, listening carefully to their feelings as well as their account of what was going wrong. After hearing from everyone, she brought a leadership group together and shared a ‘problem tree’ – a visual representation of all the emotions, concerns, problems and issues that had been aired – and gained agreement from everyone to try and change things. A carefully structured awayday followed, in which leaders worked in pairs to listen to each other and build an understanding of the different perceptions and assumptions that had grown up. These were then shared in small groups and finally in the whole leadership group.

Outcome

Participants discovered that although they were often in rooms together, the pace and format of meetings and the size of agendas left little time to think and less time for meaningful conversations. The formal technical language of strategy and plans made it hard to express worries, and no-one felt their concerns were heard or responded to. What was striking was that this was a dysfunctional system with no “villains” – everyone was trying to do their best.

By creating space for the right conversations to take place, and the difficult work that had so far been avoided to be faced – it was possible to slowly build trust. Relationships slowly improved over a number of months – and while tensions didn’t go away, it was easier for them to be named, and dealt with. Leaders began to pick up the phone or go for coffee together, rather than sending prickly emails. This is work in progress.