Nic Adamson DAAT Partnership Manager Payment By Results – A partnership perspective

Introduction This outlines Worcestershires approach to procuring an outcome focused treatment system. It incorporates payment by results. The process was supported by RichardTamlyn from the Centre for Public Innovation.

Context The service had never been subject to procurement The system had several components, none of which worked effectively together The system was very blocked, the Willy Wonka factory of treatment. Planned discharges are low Lack of emphasis upon PSI System not resilient to change

The vision An integrated drug and alcohol service Recovery orientated model For adults and young people Outcome focused delivery Focused on positive and sustainable behavioural change Main outcome, sustained recovery Including payment by results

Procurement exercise Describe the key outcomes your service will achieve Outline the key performance targets you will use to achieve these outcomes Tell us how many people will engage with your service each year, and of these, how many will achieve proposed performance targets

Year one Allocating the costs Total budget = 4million For year one 25% by results For year two 30% by results For year three 40% by results Calculations made to divide the outcomes across domains, looking at activity and intensity. Critical to get it right!

MILESTONE MANAGEMENT What are milestones and how do they help? Interim actions or accomplishments User rather than service focused A logical sequence of If… then… MILESTONES 1.Enrol in project Attend 1 st session 50 3.Drug free (1 month) 40 4.Demonstrate new skill 30 5.Complete as planned 25 PERFORMANCE TARGET Drug free and using skills 10 at 3 months OUTCOMES Drug and crime free

Tier 3, Adult Drugs Funnel Performance Target: 265 people will achieve 4 weeks drug free and be planned discharged Milestone 1 Milestone 2 Milestone 3 Milestone 4 Milestone 5 Recovery plan agreed & identified Demonstrate improvement against TOPs, (reduction in days of use, criminal activity and improvement in life quality Achieve identified goals Achieve drug free/occasional use Sustain substance free for 4 weeks & planned discharge Payment point: £ per outcome, up to a maximum payment of £327, Evidence: Halo, Case file Audit, TOP's data, skills consortium requirements

Domains of outcomes Young people – tier 2 and 3 funnels Adult drugs – tier 2 funnel, tier 3 PSI and a prescribing funnel and needle exchange funnel Adult alcohol – tier 2 and tier 3 funnels Family services funnel

How will payment be managed?

What were the key considerations? Payment by results – year one is a test year, clear that future years will vary Lot of work to spread the risk across domains Ensure that outcomes are not process driven Ensuring outcomes are internally driven, rather than affected by extraneous factors such as housing availability Ensuring accuracy of base line data and achievability of outcomes Ensuring all parties are clear on what is required Involving all staff

What do we hope to acheive? Focused service delivery Shift to outcome focused commissioning Shift to partnership commissioning Value for money A focus on behavioural change rather than treatment processes Service issues highlighted early Positive outcomes for service users Transparency between provider and commissioner, supporting audit process A service based on hope and strengths rather than problems and weaknesses

Lessons learned? Still learning Shared risk Wait till year two to introduce fully Allow for transformational change Make sure outcomes are fair