Provider considerations fordelivering an outcome basedcontractCroydon CCG and London Borough of Croydon

2

Contents

Introduction and Background

Introduction 4

Commissioning for Outcomes: Aims and Benefits 5

Characteristics of Outcome Based Contracts 6

Framework: Core Competencies and Capabilities

Overview 8

Core Competencies 9

Capability Statements 10

Framework Assessment

Framework Assessment: Summary 20

Appendix

Resources used to inform the development of theframework

22

Framework: Capabilities Summary 23

▪ Introduction to Outcome Based Commissioning (OBC) inCroydon

▪ An indicative framework that may be expected of providersdelivering Outcome Based Contracts

▪ A self-assessment for providers to consider their current‘maturity’ to identify areas for development

▪ Invitation to tender or PQQ for services

▪ The exact requirements or criteria against which providers’proposals may be considered and evaluated

▪ A preferred delivery model for providers

▪ Final framework for provider competencies and capabilities– as the implementation of OBC evolves framework mayneed to be further built upon and refined

What this document is:

What this document is not :

Introduction and Background

4

The NHS and Local Authorities are currently facing a number ofsignificant challenges. Funding pressures will continue over the comingdecade, as demand across the system continues to rise. Meeting thesechallenges will require the system to commission and deliver servicesdifferently alongside achieving improved outcomes for their populations.

As a result commissioners will need to change the way that they pay forand manage health and care services with an aim to encourage;increased integration, generate efficiencies and improvements inpatient/ service user outcomes and experiences.

One of the ways that Croydon CCG and London Borough of Croydonplan to respond is by reviewing the way that they contract for services.The CCG and Council are currently exploring opportunities tocommission services that specifically focus on outcomes for peopleover 65 via a capitated budget approach. This means a budget could beon a per head of population basis, with incentives for achievingspecified outcomes, necessitating providers to collaborate and plan forpopulation healthcare management.

Outcome Based Commissioning (OBC) rewards both value for moneyand delivery of better outcomes that are important to patients. Inparticular, OBC aligns incentives to outcomes relating to an entirepathway, population group (for example 65 and over in Croydon) orservice. It is expected that this approach will enable and promote newdelivery models that can address some of the challenges and requireproviders to both improve quality and manage demand.

Implementing OBC would therefore require providers to adopt differentorganisational forms and ways of working. It is recognised that in orderto transition, providers would also need to consider the current stateagainst future competencies and capabilities. This document sets outthe competencies and capabilities that providers would need todemonstrate when delivering outcome based commissioning. Inaddition, it enables providers to self-assess themselves against

these elements in order to consider their current maturity andareas for development.

This document, and associated self-assessment tool, has beendeveloped collaboratively by the Council and CCG with the support ofthe PwC Alliance. It has used evidence drawn from good practiceexamples in the UK and abroad as well as insight from local andnational sources.

The framework presented in this document is indicative of thecompetencies and capabilities that may be expected of providersdelivering Outcome Based Contracts.

This document does not seek to set out the criteria against by whichproviders’ submissions could be evaluated for the delivery of servicespursuant to an outcomes based contract, (if it is determined that such acontract is let). Such criteria and the commissioners’ detailedrequirements would be set out in the appropriate OBC documentsinviting proposals from potential providers.

As OBC implementation in the health sector in particular (social carehas had more experience of contacting on an outcomes basis) is stillevolving, the provider competencies and capabilities identified mayneed to be further built upon and refined. Thus, this framework shouldbe seen as an initial guide.

Introduction

5

Commissioning for Outcomes: Aims and Benefits

Potential benefits of Outcome Based Commissioning:

Delivering health and care services that meet patients needs

• Services are focused on delivery outcomes that are meaningful topatients/carers

• Ability to build a different relationship with the public and patientsinvolving them in maximising value as well as campaigning for moreresources

• Improved patient and service user experience by promoting serviceintegration and reducing fragmentation

• Placing greater emphasis on prevention with incentives to work inpartnership

Improving health and care services through innovation,collaboration and integration

• Releasing innovative potential in providers, with clinicians takingresponsibility for maximising value from the allocated budget, anddelivering the outcomes the people of Croydon want

• Facilitating a culture of collaboration and integration betweenproviders across the health and social care economy

• Delivering better value, sustainable services, and removing barriersto a more integrated approach.

Realising efficiencies in the system

• Using a contract duration that promotes investment in prevention,quality improvements and working practices to deliver savings andefficiencies over the longer term

• Reducing duplication and transaction costs across organisations

• Reducing the number of KPIs to those that are necessary – with afocus on outcomes

Traditional healthcare commissioning in the NHS has tended tofocus on processes: numbers of appointments, attendances,operations and procedures. But, with static funding levels, growingdemand and unexplained variation in clinical care betweenproviders, services need to be commissioned differently. Outcomesbased contracts are an approach to commissioning that rewardsboth value for money and delivery of better outcomes that areimportant to patients/ service users.

Applying an OBC approach to working with clinicians andstakeholders across a health care economy, and engaging patients/service users to find out what outcomes they want, outcomes basedcontracts transfer appropriate risk to a provider (or providers). Italso creates the circumstances and incentives that allow them toinnovate and profit from success - provided they can manage costsand deliver the outcomes required. To deliver these outcomes andmake the efficiency savings necessary to stay within the allocatedbudget, providers must collaborate, problem solve, and deliverefficient, integrated services.

The approach is based on the premise that there are opportunitiesto improve efficiencies within the current system. This belief isconsistent with results obtained elsewhere, for example in the USwhere they spend more on healthcare (e.g. Geisinger, PACE), andSpain where they spend less (e.g. Ribera and many others). In allof these places, capitated and outcomes based contracts and/orintegrated delivery has led to improved outcomes for service usersat roughly 80-85% of benchmarked costs.

6

Characteristics of Outcome Based Contracts

In response to increasing challenges and pressures healthcaresystems across the world are considering different ways to commissionand deliver services.

Examples from healthcare systems have emerged nationally andinternationally. The development of this framework has considered thecharacteristics of these to inform the core competencies andcapabilities presented in this document :

Another element for consideration is the development of deliverymodels and mechanisms to manage the delivery of larger, longer-term contracts covering a pathway or population group. Each modelhas benefits and drawbacks that providers and commissioners needto consider when designing future contracts. The short summarybelow sets out some of the most commonly referred to models:

Examples of contracting delivery models:

• Alliance Contracting: Typically a commissioner led contractingmechanism which aims to incentivise collaboration between anumber of providers, who cooperate to deliver a particular serviceor an interrelated set of services. Providers enter into linkedcontracts with commissioners and are evaluated collectively. Eachparty maintains internal controls with shared risk/reward.

• Joint Venture: Providers jointly create a new vehicle to facilitateprovision of integrated care. The agreement specifies nature,responsibilities, governance but the organisations maintain theirindividuality.

• Prime Contracting: A single provider assumes all responsibility andleads integration of a whole pathway through subcontracts withother providers. Commissioners hold a single contract with primecontractors. The prime contractor may be an existing provider or abroker or integrating organisation.

• Prime Provider: A main provider provides the pathway or service.The provider sub-contracts parts of the pathway, where needed.Commissioners hold a single contract with this provider who alsoprovides the majority of the care pathway.

• Full integrated care contract: A single entity assumes allresponsibility and leads/provides Services for an entire carepathway.

Characteristics of organisations and systems delivering outcomebased contracts:

• Multiple organisations involved in delivering health and careservices covered by a single contract covering a pathway or adefined population group

• A focus on integration and collaboration between organisationsproviding services resulting in more multi-disciplinary working

• Ability of a provider to manage and co-ordinate the care ofindividuals along the full length of clinical and social care pathways

• Proactive management of population groups to inform earlyintervention and prevention

• Integrated IT solutions to support collaboration and sharing ofinformation

• Treating and supporting patients in different, more appropriate,settings as a result of improved co-ordination and flexibility withinthe contracts

• Increased involvement and engagement of patients/ service usersin the design, delivery and improvement of new and existingservices

• New funding and contracting arrangements, such as capitated,incentivised budgets/payments and, longer-term contracts, are useddepending on the scope of the contract

Framework: Core Competenciesand Capabilities

8

Framework: Overview

Core Competencies and Capabilities

The framework defines the skills and attributes that providers will need todemonstrate when delivering outcome based contracts to better meet theneeds of their populations:

• Core competencies describe the overarching ability of providers tomanage and deliver OBC contracts and the range of health and socialcare services included within them. Competencies can be considered inthree key areas: Technical; Relational; and Developmental.

• Capabilities are the specific functions that enable delivery of co-ordinated care and underpin the core competencies. Some of thecapabilities relate more to some competencies than others but strengthshould be demonstrated across them all. Eight capabilities have beenidentified per the diagram opposite.

Focusing on providers competencies and capabilities, rather than resources(e.g. number of staff), reflects a different relationship between commissionerand providers that is in line with moving to delivery health and social carethat is less fragmented and engages clinicians, practitioners and the publicmore.

Attainment of the competencies and capabilities should mean that providerswill be able to demonstrate high standards of professional care.

As set out, an outcome based approach to commissioning will require new ways of working between providers of health and care services todeliver better outcomes for patients and service users across a pathway or population group. To respond providers will need to adapt and developcapabilities as well as potentially operating on a different scale. This framework is designed to give providers some insight into what may beexpected.

National Standards

Alongside the framework it is expected that providers will adhere to national requirements and measures of care (e.g. Care Act 2014, NHSConstitution, CQC guidelines, London Quality Standards). Similarly providers should be able to demonstrate adherence to other requirements suchas health and safety and, equality and diversity. These specific measures have not been included as part of this framework.

9

Framework: Core Competencies

Core competencies describe the capabilities required by providers/groups of providers to manage and deliver outcome based carewhich provides value for money. There are three overarching competencies that provider organisations will need to collectivelydemonstrate to support the delivery of an outcome based contract: Technical; Relational; and Developmental. These competencies willhelp ensure that the organisations will collectively have the appropriate capability and capacity to deliver co-ordinated care services thatare both safe and effective and, demonstrate a high standard of professional care.

Technical

Having the right infrastructure, systemsand processes to support the planningmanagement and, delivery of healthand care services within the contract.

Technical capabilities should enablethe ongoing improvement inperformance and patient care as wellas an ability and commitment todelivering safe and effective careservices. It should also enable theeffective management of populationsand groups within the contract.

This will include demonstratingeffective population healthmanagement systems and competencyin IT, data management and analysis,finance and risk management andactuarial skills.

Relational

The ability to engage and work with thepublic, patients and partners to define,deliver and measure health and careservices to support the delivery ofoutcomes.

Providers will be able to facilitategreater integration between serviceproviders through effective leadershipand governance.

Through the delivery of the contractthere will be positive engagement withcommissioners, regulators and thethird sector.

Organisations will have the appropriateprofessional teams in place to deliverimproved outcomes for patients andservice users.

Developmental

An ongoing commitment and ability todeliver transformational change acrossthe health and care economy that willimprove services for patients andservice users. These changes willrealise improvements in quality andcost.

Providers will work with service users toidentify areas of change that will meettheir needs and to influence othersacross the care economy to changeand adapt.

Plans will be in place to support thedevelopment of the professionalworkforce across organisations.

Professional Care: The ability of the organisations to collectively have the appropriate capability and capacity to deliverco-ordinated care services that are safe and effective.

10

Framework: Capability Statements

To demonstrate the three competencies, key capabilities need to be displayed. Eight capabilities have been identified and each of these canbe broken down into a number of statements that relate to the core competencies.

The eight capabilities are presented on the following pages along with their supporting statements. These statements provide further detailabout the capabilities that providers will need to consider when thinking about managing and delivering an outcomes based contract for healthand social care services.

It should be possible to consider the maturity of an organisation to respond to the requirements of OBC using these statements and providescores against both capabilities and competencies.

References: How the statements relate to thecore competencies:

• D = Developmental• R = Relational• T = Technical

Statement with a (P) (e.g. T1 (P)) relate toprofessional care

Statements: Each capability includes a number ofstatements that provide further detail about thecapabilities that providers should consider whenthinking about managing and delivering anoutcomes based contract.

Summary: A summary statement providing anoverview of the capability

11

To realise the potential benefits of outcome based commissioning providers will have a compelling vision and clear strategy for managing anddelivering care across whole system pathways and/or for a defined patient group. The vision and strategy will be aligned to the needs ofcommissioners and set out a commitment to delivering clinical, patient and service user outcomes.

The vision and strategy will underpin service integration and collaboration as it has been developed and is shared by organisations across the localhealth and care economy.

1. Strategy and Vision

Ref Statement

D1 We have a clear and compelling vision for the delivery of co-ordinated health and care services for the over 65s population in

Croydon. This is supported by a commitment to the delivery of clinical and patient outcomes that add value.

R1 Our vision is shared across, and can be communicated by, all organisations involved in delivery of health and care services for the

over 65s population in Croydon.

D2 We have a single strategy, aligned to the vision, setting out how health and care services will be managed, delivered and improved

for the over 65s population in Croydon. It is clear, through the strategy, how each organisation will support its delivery.

D3 The organisations responsible for delivery have the appropriate capacity and capability at all levels to plan, manage and deliver their

care services to realise the shared strategy and vision.

D4 Systems and processes across the organisations (e.g. performance management) are aligned to the delivery of the strategy and

vision. All organisations are able to identify the role they play in supporting its delivery.

R2 Leaders – both clinical, financial and managerial – across all organisations understand and are able to articulate the strategy and

vision.

T1 The strategy sets out how the organisation(s) will understand, plan and manage future health and care trends (for example future

demand) relating to the over 65s population in Croydon.

T2 The strategy sets out how the organisation will address health and social care inequalities in the defined population.

12

There is an emphasis on excellent clinical and managerial leadership supported by robust governance that enables organisations across thesystem to continually develop and improve outcomes for patients/ service users. Leaders in organisations will have the ability to lead changeacross organisational boundaries that challenge traditional ways of working. They will also champion and role-model the culture of collaborationand integration. Governance structures will be appropriate and proportionate to enable effective delivery and shared decision-making.

2. Leadership and Governance

Ref Statement

R3 Leaders demonstrate and role-model a shared set of values and commitment to co-ordination across a number of organisations in order

to support mutual trust and collaboration to improve quality and performance.

R4 Leaders from across organisations are aligned behind a shared vision and strategy to drive improvements in clinical and patient

outcomes for the defined population. This vision spans traditional organisations and boundaries, focusing not just on treatment and

support but also prevention.

D5 Leaders have the ability to influence and manage across organisational boundaries in order to manage and deliver transformational

change across the whole health and care economy.

D6 Ability to determine the appropriate organisational form for the delivery of the defined outcomes. This would include the ability to draw

on, and secure, capabilities from across a range of organisations to deliver patient-centred care.

R5 Leaders have a proven capability to lead and manage complex service redesign and transformation for the defined population across a

health and social care economy.

T3 A clear governance structure is in place that allows for effective decision-making and management that breaks down the traditional silos

that exist within health and care delivery. All organisations involved in the delivery of health and care services in scope of the contract are

able to input to and inform decisions and, there is an appropriate balance of executive and non-executive input into decision making

processes.

T4 Clear and embedded financial governance and accountability for delivering defined outcomes as well as from a cost perspective.

T5(P) Clear accountability and management for the delivery of safe and effective services across all organisations involved in delivering the

contract.

T6 Conflicts of interest are managed effectively to support decision-making impacting all organisations involved in the delivery of the

contract.

13

Clearly understood management processes are in place which enable co-ordinated delivery and alignment across multiple organisations deliveringhealth and care services. Processes will ensure that patients are involved in shaping the delivery of care services, organisations comply withregulatory requirements and there are effective systems to manage risk and support communication and learning.

3. Processes

Ref Statement

R6 There are processes in place across organisations to involve patients, carers and members of the public to shape and influence the

development and delivery of health and care services for the over 65s population, as well as to support shared decision making.

T7(P) There is an effective system of controls for managing and evaluating clinical risk and patient safety across clinical and social pathways

relevant for the defined population. These will include:

Systems and processes for monitoring and acting on patient feedback

Arrangements for monitoring quality and safety issues – including safeguarding

Systems to respond to issues and improve patient and service user care across pathway

R7 Ability to regularly share information and communicate across all organisations in order to improve collaboration and performance of the

care economy. This will include:

Processes to share learning in relation to quality and safety to all organisations

A culture of open and honest communication

Ability to demonstrate how consultation with organisations informs decision-making

D7 Robust project and change management systems and processes to support the delivery of complex, whole system, change to drive

efficiencies and improve patient care. This is both within and across organisations.

R8(P) A clear and understood process to manage conflict and dispute resolution across organisations delivering health and care services

within the contract.

T8(P) Process in place to support integration so that hand-offs across/between organisations in the management and delivery of health and

care services are minimised whilst still supporting clear accountability along with defined roles and responsibilities.

14

Technology is used to support the delivery of outcomes and ensure that care is centred around the patient. Integrated data systems will be in placethat enable patient and performance information to be measured, monitored and shared across different provider organisations. These will besupported by robust information governance arrangements.

4. Technology

Ref Statement

T9 IT is integrated across all systems and organisations (primary, community, acute and social care) with information shared on a real-time

basis. Information is visible to all, appropriate, health and care professionals regardless of setting.

T10 Systems are able to provide a single view of the patient and help avoid duplication of efforts and incompatible plans of care. This needs

to enable users to read information, update data in whichever system is appropriate. For example; a single assessment and master

data management to ensure consistency of information.

T11 Patients have the ability to access their care records if required.

T12 Reporting and risk stratification systems in place to identify high-risk patients and provide a joined up view of information relevant to a

patient to the Health or Care professional, as well as supporting effective population health management.

T13 Robust and appropriate information governance arrangements are in place to ensure that; information can be shared across

organisations and, patient consent can be recorded and used to provide access to records at the right time for Health / Social Care

Workers. This will include a Nominated Caldicott Guardian and SIRO and supporting policies and procedures.

D8 Focus on continually improving systems and technology across organisations delivering services in order to support the improvement of

services for patients within the defined population.

T14(P) Ability to capture information to support and demonstrate the delivery of outcomes for over 65 population and informs clinical decision

making.

T15 Systems to support predictive analytics to support population health management. This will mean that individual and population needs

can be modelled and planned for.

15

Performance requirements and expectations are understood by all organisations involved in the delivery of the contract that reflect the agreed rolesand accountabilities. Performance measurement, analysis, reporting and improvement processes across organisations and information is used tosupport ongoing improvements in the delivery of health and social care for the defined population.

5. Performance Management

Ref Statement

R9(P) Performance management processes are aligned to the delivery of outcomes for patients/service users and support innovation.

Providers are incentivised accordingly.

R10 Performance management processes are aligned to the vision and strategy and supports collaboration across organisational

boundaries on the basis of improved outcomes for the over 65 population.

T16 Performance expectations – including goals, metrics and measurement tools - are aligned across organisations and each organisation

is clear on their, and others, contribution to performance and, in particular, outcomes for patients and service users.

T17 Roles, KPIs, and management information are well defined and consistently applied across organisations.

T18 Single reporting arrangements in place across organisations to capture performance in line with contracts.

T19 Ability to capture and report evidence of performance against agreed outcomes in a timely manner, as well as financial and managerial

matters and experiences of patients and service users.

D9 Use performance information to support decision-making to identify areas for improvement , innovation and redesign in order to achieve

improved value for health and care services.

T20 Delivery and performance is supported by robust Business Intelligence (BI) that is routinely captured and reported. BI is used effectively

to track performance against outcomes and to identify areas for improvement in the delivery of health and care services from

organisational staff and patient perspectives.

16

Appropriate financial and risk management controls are in place to identify and mange safety, reputational, demand and financial risks (includingtax risk) and mitigate them through early action and identification. There is an ability to identify the cost base along a whole health and social carepathway and/or population group as well as share risk and systems to manage payment allocations to organisations involved in delivering thecontract.

6. Financial and Risk Management

Ref Statement

T21 A detailed understanding of the cost base across the whole health and social care pathway/population group to help identify

efficiencies and reshape services within the agreed financial envelope.

T22(P) An ability to identify and reduce/balance unwarranted variation across a pathway or defined population which may indicate suboptimal

performance. This will include the management of risks such as winter pressures.

T23 Clear and transparent processes to manage risk that enables risks to be identified at an early stage and be dealt with or shared

collaboratively

D10 Ability to make informed and transparent investment and disinvestment decisions across the pathways/services within scope of

contract. There should be certainty about how these decisions will be made and funded before, or at an early stage, of contract

delivery.

R11 Effective financial and contract management processes to manage funding and payments to delivery partner organisations against

agreed indicators and/or outcomes. This will mean that:

Funding arrangements are fair, proportionate and do not cause undue financial risk for another organisation

Clear contractual/legal documentation is in place

Requirements of partner organisations have been taken into account

There is a clear rationale for allocation of resources and market share

There is agreement about how risks and savings will be shared across organisations

D11 Systems in place to identify future population and demographic changes that may impact on future contract values and manage

financial envelope accordingly.

R12 A clear and robust approach to support the (re)allocation of resources and investment in the improvement of services irrespective of

the current setting of care.

R13(P) Clear accountability across organisations delivering the contract regarding clinical safety and risk. This should be supported by

effective governance arrangements and risk management processes.

17

Organisations are able to identify, recruit and retain an appropriately skilled workforce across a number of organisation to deliver the high qualityhealth and social care services. There is an ongoing commitment to workforce development and an ability to flex the workforce to meet changingdemands. There is an emphasis on joint working that is supported by a culture of collaboration, quality and patient care.

7. People and Culture

Ref Statement

R14(P) There is a shared and embedded culture, values and behaviours, across organisations delivery services for the over 65s population

that reflects the needs of patients, carers and citizens. This can be evidenced by staff across all organisations. This is supported by

the appropriate training, development and people policies. Systems are in place to continuously assess the organisational culture and

take action for improvement where necessary.

D12 An ability to manage and support the workforce delivering the services during periods of significant change and transformation (both

before and during the contract). This will include effective engagement to trade unions and staff and, the adherence to policies and

requirements such as TUPE.

D13 There is a commitment and ability to flex and tailor the workforce across pathways and population groups to meet the changing needs

of patients and service users as well as to respond to changes in demand.

D14 Staff are actively encouraged to work across traditional organisational boundaries. This includes organisations directly involved in

contract delivery and also complimentary services/organisations who are involved in supporting the patient/service user group

D15 There is a clear organisational development strategy and plan that relates to all organisations delivering services in relation to the

contract. This includes a patient centred workforce strategy that is inclusive of partner organisations and reflects plans for multi-agency

and multi-disciplinary workforce development. There are also plans to support the wellbeing of staff.

R15(P) Organisations delivering services for over 65s have the appropriate capacity, skills and capabilities to deliver safe and effective

services that support the delivery of patient outcomes. This is supported by a recruitment and retention plan to ensure that suitably

qualified and experienced staff, will be sourced and retained, to deliver, safe and high quality health and care services.

R16 There is extensive evidence of widespread collaboration and informal and formal sharing across organisations, supported by effective

systems and processes, all with the aim of supporting improved patient/ service user outcomes.

D16 Consistent and timely performance and development assessment across all staff that is aligned to the overarching strategy and vision,

supporting high quality healthcare.

18

Outcome based commissioning will require providers to be able to access resources from and collaborate with a range of organisations in order todeliver co-ordinated health and care services to a defined population group or across the agreed health and social care pathways. Theserelationships will need to be sourced, managed and supported by robust agreements. Innovation should run across organisations and theirdifferent skills should be drawn upon to inform decision-making. There should also be a commitment to ongoing development across allorganisations and a focus on delivering patient/user-centred care through improved collaboration.

8. Sourcing and Collaboration

Ref Statement

R17(P) Overall sourcing strategy supports the delivery of safe, effective and co-ordinated health and care services. All providers should

have the appropriate capacity and capability at all levels to deliver care services and are agile in responding to changes to traditional

delivery models.

R18 Capacity and capability to manage or collaborate with a range of organisations in the delivery of outcome based contracts. This will

include an ongoing commitment to improvement in respect of contract and supplier management capabilities.

D17(P) Ability to promote innovation across organisations in order to drive improvements in performance and quality for health and care. This

should include mechanisms to learn from each other, share good practice and collaborate to create new solutions to complex

problems.

R19 Sourcing and management practices ensure variety to meet patient/service user, commissioner and contractual objectives. This

includes the utilisation of, public, third and private sector organisations to address the holistic needs of the population group and local

demographics.

R20 Sourcing strategy should allow, where possible, new market entrants but should not restrict supply and should support multiple

providers within parts of the contract. This will facilitate and maintain appropriate levels of choice regarding treatment and setting of

care.

D18 Ability to effectively collaborate with existing and new organisations to introduce further innovative service models to respond to

changing needs within the population but also support improved outcomes for health and social care.

Framework Assessment

20

Framework Assessment: Summary

To support organisations to consider their current position against thecompetencies and capabilities an assessment framework has been produced.

Maturity Model

The framework uses a Maturity Model as its basis which is a method toconsider how well established an organisation is against a number ofcapabilities. Outcome based commissioning is a new approach so it isnot expected that provider(s) will be leading in all areas. In some areasthey will be emerging. This assessment allows them to recognise areaswhere there is the need to develop or transition, for example throughcreating partnerships or alliances with others.

Scoring and Assessment

The assessment supports organisations to consider their perceived currentlevel of maturity against each of the statements, briefly describe why a ratinghas been selected and note any key evidence considered in reaching theconclusion on rating.

The assessment is designed to be a self-assessment that can be completed insmall groups or workshops so that information is drawn from a range ofsources, perspectives and experiences within individual organisations. Whilethere may be an intuitive sense of your organisations capability in each area,the most accurate self-assessment will come from in-depth discussion andtangible evidence. All of the capabilities listed are interconnected so it isimportant to get the whole picture where possible.

Outputs and Next Steps

The assessment will provide automated outputs to demonstrate performanceagainst both competencies and capabilities. This will help inform developmentor transition plans. The completion of the assessment guide is not meantto be a one off exercise and repeating completion of it at appropriate timeintervals will help track progress and development.

Appendix

22

Resources used to inform framework design

• The Merlin Standard: Promoting Supply Chain Excellence (http://www.merlinstandard.co.uk/)• Outcomes Matter: Effective Commissioning in Domiciliary Care - LGiU (http://www.lgiu.org.uk/outcomes-matter-effective-

commissioning-in-domiciliary-care/)• The NHS Standard Contract: A guide for clinical commissioners; NHS Standard Contracts team on behalf of the NHS Commissioning

Board (http://www.england.nhs.uk/wp-content/uploads/2013/02/contract-guide-clinical.pdf)• Grafton Group Clinical contracting considerations (http://www.pwc.co.uk/en_UK/uk/government-public-sector/healthcare/assets/pwc-

grafton-group-contracting.pdf)• Accountable Care Organisations in the United States and England (http://www.kingsfund.org.uk/publications/accountable-care-

organisations-united-states-and-england)• Accountable Care: Focusing accountability on the outcomes that matter (http://d2qq2w1ozyf295.cloudfront.net/app/media/384)• Pennine MSK Partnership A case study of an Integrating Pathway Hub (IPH) “Prime Contractor”

(http://www.rightcare.nhs.uk/downloads/Right_Care_Casebook_oldham_IPH_april2012.pdf)• PwC Supplier Relationship Management (http://www.pwc.nl/nl_NL/nl/assets/documents/pwc-supplier-relationship-management.pdf)• Prime providers and capitated budgets: will they enable new models of care? (http://www.kingsfund.org.uk/sites/files/kf/chris-ham-

capitated-payments-payment-reform-Jan13.pdf)• Delivering integrated care: a prime contractor model

(http://www.practicaldiabetes.com/SpringboardWebApp/userfiles/espdi/file/September%202011/MoC%20Laitner.pdf)• Pennine MSK: A whole system approach (http://www.healthcareconferencesuk.co.uk/presentations/downloads/Alan_Nye1.pdf)• Clinical and service integration: the route to improved outcomes (http://www.kingsfund.org.uk/publications/clinical-and-service-

integration)• Monitor: Risk Assessment Framework (http://www.monitor.gov.uk/raf)• Monitor: Enablers and barriers to integrated care and implications (http://www.monitor-nhsft.gov.uk/home/news-events-publications/our-

publications/browse-category/guidance-health-care-providers-and-co-23)• Insight from NHS Cambridgeshire and Peterborough CCG Integrated Older People’s Pathway & Adult Community Services

Procurement, Bedfordshire MSK and Oxford CCG Outcome Based Commissioning Business Case.

A number of resources have been used to support the design of the framework. These include of examples of outcome based delivery in both theUK and internationally and insight from the private sector and other parts of the public sector. Insight has also been provided from the CCG, CSUand Local Authority.

23

Framework: Capabilities summary

1. Strategy and vision: To realise the potential benefits of outcomebased commissioning providers will have a compelling vision andclear strategy for managing and delivering care across wholesystem pathways and/or for a defined patient group. The vision andstrategy will be aligned to the needs of commissioners and set outa commitment to delivering clinical, patient and service useroutcomes. The vision and strategy will underpin service integrationand collaboration as it has been developed and is shared byorganisations across the local health and care economy.

2. Leadership & Governance: There is an emphasis on excellentclinical and managerial leadership supported by robust governancethat enables organisations across the system to continually developand improve outcomes for patients/ service users. Leaders inorganisations will have the ability to lead change acrossorganisational boundaries that challenge traditional ways ofworking. They will also champion and role-model the culture ofcollaboration and integration. Governance structures will beappropriate and proportionate to enable effective delivery andshared decision-making.

3. Processes: Clearly understood management processes are inplace which enable co-ordinated delivery and alignment acrossmultiple organisations delivering health and care services.Processes will ensure that patients are involved in shaping thedelivery of care services, organisations comply with regulatoryrequirements and there are effective systems to manage risk andsupport communication and learning.

4. Technology: Technology is used to support the delivery ofoutcomes and ensure that care is centred around the patient.Integrated data systems will be in place that enable patient andperformance information to be measured, monitored and sharedacross different provider organisations. These will be supported byrobust information governance arrangements.

5. Performance Management: Performance requirements andexpectations are understood by all organisations involved in thedelivery of the contract that reflect the agreed roles andaccountabilities. Performance measurement, analysis, reportingand improvement processes across organisations and informationis used to support ongoing improvements in the delivery of healthand social care for the defined population.

6. Financial and Risk Management: Appropriate financial and riskmanagement controls are in place to identify and mange safety,reputational, demand and financial risks (including tax risk) andmitigate them through early action and identification. There is anability to identify the cost base along a whole health and social carepathway and/or population group as well as share risk and systemsto manage payment allocations to organisations involved indelivering the contract.

7. People and Culture: Organisations are able to identify, recruit andretain an appropriately skilled workforce across a number oforganisation to deliver the high quality health and social careservices. There is an ongoing commitment to workforcedevelopment and an ability to flex the workforce to meet changingdemands. There is an emphasis on joint working that is supportedby a culture of collaboration, quality and patient care.

8. Sourcing and Collaboration: Outcome based commissioning willrequire providers to be able to access resources from andcollaborate with a range of organisations in order to deliver co-ordinated health and care services to a defined population group oracross the agreed health and social care pathways. Theserelationships will need to be sourced, managed and supported byrobust agreements. Innovation should run across organisationsand their different skills should be drawn upon to inform decision-making. There should also be a commitment to ongoingdevelopment across all organisations and a focus on deliveringpatient/user-centred care through improved collaboration.