Tackling Health Inequalities using Outcome Based Accountability with a focus on BME communities David Burnby This presentation is based on the intellectual property of the Fiscal Policy Studies Institute (FPSI), Sante Fe, New Mexico, USA and is made available by permission of the owners for use free of charge by government and non-profit/voluntary sector organisations. For information about licensing arrangements for other uses, please consult Outcome Based Accountability and OBA are trade marks of the FPSI.

Fiscal Policy Studies Institute Santé Fe, New Mexico (publications)

Simple Common Sense Plain Language Minimum Paper Useful Outcome Based Accountability™

Outcome Accountability is made up of two parts: Population Accountability about the well-being of WHOLE POPULATIONS for neighbourhoods – districts – regions - countries Performance Accountability About the well-being of CLIENT POPULATIONS for projects – agencies – service providers

Outcome Accountability Common Language Common Sense Common Ground

The Language Trap Too many terms, Too few definitions, Too little discipline Benchmark Target Indicator Goal Result Objective Outcome Measure M odifiers MeasurableCore UrgentQualitative PriorityProgrammatic TargetedPerformance IncrementalStrategic Systemic Measurable Systemic Objectives! Targeted Incremental Results! Priority Strategic Outcomes! Qualitative Performance Measures!

Definitions Outcomes Indicators Performance Measures

Definitions “A condition of well-being for children, adults, families or communities.” OUTCOMES Children born healthy Children succeeding in school Safe communities Clean environment Prosperous economy Positive statements of well-being that people can understand Not about regen-speak or government jargon “A condition of well-being for people in a place......”

Definitions A measure which helps quantify the achievement of an outcome. INDICATORS Infant mortality rates Diabetes rates Mortality rates from cancers All age, all cause mortality rates Mortality rates from Coronary Heart Disease How would we recognise these outcomes in measurable terms if we tripped over them?

Definitions A measure to evaluate how well a programme, agency or service system is working. PERFORMANCE MEASURES Three questions: How much did we do? (quantity) How well did we do it? (quality) Is anyone better off as a result? (quantity and quality of effect) Performance measures tell us how well service providers are working as opposed to the impact on whole populations (i.e. outcomes)

From ends to means... From talk to action... ENDS OUTCOMES “A condition of well-being for children, adults, families or communities” PERFORMANCE MEASURES “A measure to evaluate how well a programme, agency or service system is working” MEANS INDICATORS “A measure which helps quantify the achievement of an outcome” Population Accountability Performance Accountability

Population and Performance Accountability All people in Wakefield from Asian communities WHOLE POPULATION OUTCOME: All Asian people in Wakefield enjoy good health and well-being INDICATOR Coronary Heart Disease* Targeted Diabetes programme PERFORMANCE MEASURE % increase in early diabetes diagnosis Contribution Means End *The rate of CHD amongst Asians aged over 65 in Wakefield is 50% GREATER than the England/Wales average

Outcome, Indicator or Performance Measure? 1.Safe Community 2.Crime Rate 3.Average Police Response Time 4.Healthy and Successful Adults current smoking rate 6.Teenage Conception Rate 7.% uptake of influenza immunisation (over 65s) 8.Achievement of 5 A*-C grades at GCSE Outcome Indicator P. Measure Indicator P. Measure If the question is “How are we doing as a community on education attainment?” Indicator P.Measure If the question is “How good is XYZ school at raising educational attainment?” ?

The Leaking Roof Inches of Water Time Experience Measure Story behind the baseline (causes) Partners What Works? Action Plan (Strategy) Forecast Fixed? Not OK

INDICATORS Measures of the outcome 1.All age, all cause mortality rate current smoking rate 3.Healthy life expectancy at Age 65 BASELINES Where we’ve been Where we’re going Where we want to be STORY Behind the baselines The causes, the forces at work What’s driving the baselines? PARTNERS With a role to play Public, Private and Voluntary Sector Community groups Residents WHAT WORKS What would it take to turn the curve? Best practice Best hunches ACTION PLAN What we propose to do, how and by when Data Development Agenda (Pt 1) Data Development Agenda (Pt 2) OUTCOME “All Adults are Healthy and Successful” POPULATION All Adults in Wakefield

Flipchart Template NB One piece of paper!

The Linkage between Population and Customer Outcomes Extract from Community Strategy Thriving Local Economy (NI152) Working age people on out of work benefits Healthy and Successful Adults (NI 123) 16+ current smoking prevalence Stronger Communities (NI 4) % people who feel they can influence decisions Extract from Service Improvement Plan Number of clients enrolled Number of courses run Number of nicotine patches issued % clients completing programme & clients completing training courses % clients saying they were treated well Number of clients smoke free on completion of programme after 12 months CUSTOMER OUTCOMES POPULATION OUTCOMES Contributory Relationship Alignment of Measures Appropriate Accountability Smoking Cessation Programme % of clients smoke free on completion of programme after 12 months Population Accountability Performance Accountability ENDS MEANS

The OBA™ Journey – From Talk to Action DESIRED OUTCOME Choosing the INDICATORS Drawing the BASELINE (and the CURVE TO TURN) The STORY BEHIND THE BASELINE Choosing the PARTNERS Deciding WHAT WORKS The ACTION PLAN REVIEW PROCUREMENT PERFORMANCE MEASURES How Much? How Well? Better Off? (CLIENT OUTCOMES) Contributory Relationship ENDS (POPULATION ACCOUNTABILITY) MEANS (PERFORMANCE ACCOUNTABILITY)