What is the Outcomes Framework?
The Outcomes Framework is a set of indicators to monitor the health and care outcomes of adults and children in Stockport. The framework provides an overview of how the NHS is performing locally and helps partners in making decisions about local services.
The outcome based, whole population approach to commissioning services for Stockport is in development. The ambition is that the whole budget for health and social care will be available to providers subject to delivering improvements in outcomes for the population.
The creation of a new approach to commissioning and breaking down traditional organisational boundaries will enable clinicians and other practitioners to develop the best models of care focused on individual and population outcomes, unencumbered by competing organisational priorities. To address the challenge effectively changes in the way services are delivered is underway.
To achieve an outcomes-based model of commissioning, along with partners, we have embarked upon identifying outcomes that matter most to people in Stockport.
Commonly, outcomes have been considered in the context of disease groups. However, defining optimal heath in this way undermines the ‘whole-person’ holistic approach and retains focus on providers.
In support of Stockport Togethers’ whole population approach, and in view that the responsibility to deliver true patient outcomes is shared amongst multiple providers, all stakeholders agreed that the outcomes should be organised differently to traditional approaches.
Developing the Outcomes Framework for Stockport
In order to ensure that different views from across the system were taken into account, key stakeholders, including patients and the third sector, led the development of the Outcomes Framework through their involvement in Expert Reference Groups for key segments.
Stockport Together adapted the Bridges to Health model of segmenting populations which describes eight population groups which have been condensed into four broader groups each with its own definition of optimal health and priorities among services.
The Expert Reference Groups considered what outcomes were important for people within that segment. A total of 28 clinical and social outcome measures and 14 personal outcomes were finally selected for inclusion in the Outcomes Framework.
The clinical and social outcomes tend to describe clinically relevant outcomes for an individual, such as improved health status (reductions in disease incidence, complications and/or exacerbation).
Personal outcomes describe the holistic health status of a person such as their confidence in managing their own health and wellbeing.
In summary, work completed to date has included:
- Stockport’s population profiled into four segments according to health and care need (Health, Long Term Conditions, Dementia and/or Frailty and End of Life Care)
- 28 Clinical & Social Outcome Measures (CSOM) prioritised by population segment and assessed by expert reference groups
- 14 Personal Outcomes prioritised by population segment
- 3 years of baseline data for the clinical and social outcome measures using linked acute (SUS) + GP (Primary Care) data
- An agreed approach to measuring and baselining Personal Outcomes
- A strategy for financially incentivising outcomes including alignment to contractual payment systems
- A model to predict the risk associated with attaching money to outcomes
- Engagement with +100 key stakeholders
As part of the Phase 3 of this approach, we will progress:
- Embedding within strategic joint commissioning plans (including CCG, Council, Joint Strategic Needs’ Assessment (JSNA) and wider partners);
- Distributed leadership of the outcomes framework going forward, redesign of the governance and alignment with business as usual processes for adoption and delivery;
- Improved communications approach to ensure the principles are accessible and relevant for all;
- Aligning contracts, where appropriate, with outcomes focussed measures aligned with the Outcomes Framework;
- Testing and refining a process for performance monitoring based on measuring outcomes for each segment.