1. Developing an outcomes based framework for children’s commissioning
Sheila McFarlane
Southern Derbyshire CCG/Derby City Council
22 November 2017
The three things I would like you to take away from this presentation are:
An understanding of what an outcomes based framework is
How we are developing it in Derby City and Derbyshire
What we hope it will deliver for us in terms of improved services
I would like to acknowledge COBIC and CORC
Supported by COBIC and CORC

2. ‘I’ statements Service user’s expectations
I only have to tell my story once.
I am able to access information and support in a format that suits me at the time I need it.
I know who to contact and am confident that they will support me to get the right help quickly.
I know that those who care about me will be involved at the right time.
I feel that I am listened to and am involved in decisions about my care.
I feel safe and can trust the people who are helping me.
I trust that all those caring for me will work together to get me the right support when I need it.
I am confident that the support I get will make a difference to me.
I feel that I am being treated as a person and all my needs are considered.
Where my care is not working for me I am able to try alternative options.
I know that I can get the help I need whoever I am and wherever I am.
I will be supported through the transition to adulthood in a way that is appropriate for me. From consultation with young people on Integrated Behaviour Pathway July 2013
Form foundation of framework
Expanded to 26 outcome goals
Inter
YP who and what service to set a goal / service user outcome eg Improved, Maintained, Declined
My experience integrated delivery outcome listened to - voice at the centre
How well did I achieve
Standardised measures - validated ASQ, SDQ, Chi SQ (experience) prof and child reported triangulation
From YP person voice at the centre 9/10 show improvement
Improved
Maitained
Declinined

3. Phase 1
Work to establish what children, young people and their families want from services and how they want to be treated
Engagement
Service user expectations
Series of engagement events with commissioners, providers, clinicians and managers
Vision
Put the goals of children, young people and parents./carers at the heart of service provision
Collaboratively develop the outcomes based approach to commissioning children’s health services
To make sure that children and young people, their parents/carers can plan their care with services that work together to understand their needs to achieve the outcomes important to them.
Draft framework
Strategic Outcomes (based on CYP plans)
User/patient outcome goals – their hopes and aspirations for the future
Integrated delivery outcomes – how services need to be shaped to help achieve the goals
COBIC Strategic outcomes
The 5 Strategic Outcomes are an amalgamation of the 3 priority outcomes from the Derby City Council CYPs Plan and Derbyshire County Council CYP Services. They are the agreed consequences that should be seen at the population level if individual outcomes are improving. Services who are working towards the achievement of individual outcomes will contribute towards the achievement of population outcomes.
Integrated Deliver Outcomes
How children, young people and their parents/carers expect an outcome focused organisation to deliver services to help them achieve their goals. The users of the service do not have control over these elements of their experience whilst accessing the service.
User / Patient Outcomes
The results which matter most to the children, young people and their parents / carers who are accessing services, and the impact that this has on whole populations. The service user can contribute towards the achievement of their own outcomes by accessing and working with the service.

4. Phase 2 deliverables CORC
Engagement CYP, providers, commissioners
Refined fit for purpose ‘Outcomes Framework’
Outcomes, indicators, performance management
Improved knowledge of key stakeholders of outcome based commissioning
worked case examples
toolkit of appropriate progress measurement tools
performance data dashboards illustrating data analysis and reporting
CORC Outcomes – in local strategic context - CYP goals and service impact
Indicators to measure progress towards achieving outcomes
Examples draft worked example to illustrate the framework if we have time
Phase 2 aim
building a framework which pieced together the 3 elements developed in phase
Baselining where Southern Derbyshire services are in terms of measuring CYP Outcomes.
Workshops with staff and CYPs to consult on ID and UP statements, measures and strategic indicators
Understanding what is realistic locally
Research into different measures for different types of work, links to other projects
Phase 2 WORKSHOPS n = 151
ACTIVITY
Mapping and baselining 34 participants
CYP engagement (Common Room) 17 participants Prioritised outcomes
Refine the Outcome Goals
Indicators and measurement tools
Strategic Workshop reflect back
Approved the framework for testing
Agreed need for worked case examples
Testing the performance framework
Agreed the UPO/IDO/SOs with KPIs
Agreed methodology for assessing impact
Agreed the components of a dashboard for consideration in Phase 3

5. The outcomes framework in outline
User/patient outcome Goals
What children and young people want to achieve with help from services
Integrated delivery outcomes
Children and young people's expectations of service delivery
Service level indicators
How well the service helps children and young people achieve their goals.
Strategic Indicators
How well we are improving the health and quality of life of our population
Track outcomes from individual through service to population level

6. 3 Key Elements Individual case notes and reports Service Dashboard
Did we achieve what set out to achieve?
Who am I?
What are we working on together?
How well is our service helping CYPs and how good is their experience?
User / Patient Outcomes
How good was the experience?
Integrated Delivery Outcomes
Strategic Outcomes
How well are we improving the health and quality of life for our population?
Partnership / Commissioning Dashboard

7. Basic information is collected about service users
Worked Example
Basic information is collected about service users
Who am I?
I am Joseph
I am male
I am 10 years old
I am white British
I am feeling anxious all the time and do not like school

8. Agreeing a goal What do I want? Worked Example
I don’t want to go to school because I am always in trouble and I feel really anxious during class when I don’t understand things
I want to make more friends
What does Joseph’s teacher want?
I want Joseph to behave better in class and stop disrupting the other children
I would like Joseph to improve his school performance

9. Agreeing a user-patient goal
Worked Example
Agreeing a user-patient goal
Based on what Joseph wants, what his teacher wants for him, and what his school is able to offer, we can collaboratively agree on what we will work on with Joseph
What Joseph Wants
What Joseph’s teacher wants for him
What can the school offer?
Collaborative User-Patient Goal
I do not want to go to school because it makes me anxious when I don’t understand my lessons, and I’m always in trouble
Better understanding and performance on test and assignments
It is important that Joseph keeps attending school
Joseph’s teacher can give him extra support to increase his confidence and help him understand his lessons
The school’s educational psychologist can help with his anxiety and behavioural problems and help him feel more confident about making friends
Improve understanding of lesson material
Reduce anxiety around attending school/learning
Improve behaviour during class time
Increase confidence and reduce anxiety around making friends
I want to make more friends
Less disruptions and acting out in class
DRAFT

10. What type of goal has been set?
Worked Example
What type of goal has been set?
Each goal can be aligned with one of 26 statements from Southern Derbyshire CYP about what outcomes are important to them. These statements each fall under one of the 4 key categories below
I have transitioned successfully into adulthood
I am safe with those who care for me
I have improved my educational attainment
I have improved my health and wellbeing
DRAFT
Joseph’s goal is to Improve his Health & Wellbeing and therefore improve his educational attainment

11. How will progress be measured?
Worked Example
How will progress be measured?
We want to make sure Joseph is achieving what is important to him so his teacher and educational psychologist discuss with Joseph how to measure his progress toward his user-patient goals
User-Patient Goal
Chosen Measure
Improve my understanding of my lessons
School Attainment Level
Feel less anxious about going to school
RCADS General Anxiety Subscale
Me and My School Questionnaire
Behave better during class time and not disrupt my classmates
Number of behavioural incidents and detentions
Feel more confident making friends
Goal Based Outcome Ratings
The best way to measure progress may vary depending on the type of service, and the type of work being done. However, whatever measurement is used should be evidence-based, practical, and meaningful for the goal of the child or young person

12. DRAFT After 1 term… Worked Example How do I feel now?
I understand what is happening in class better and I don’t get as anxious.
I have not been in detention for 4 weeks
At break time I felt confident enough to talk to some new friends.
DRAFT

13. DRAFT Measured progress Worked Example
User-Patient Goal
Chosen Measure
Progress
Improve my understanding of my lessons
School Attainment Level
My attainment scores have improved since last term
Feel less anxious about going to school
RCADS General Anxiety Subscale
Me and My School Questionnaire
My score on the RCADS general anxiety subscale has improved
My score on the Me & My School questionnaire has also improved
Behave better during class time and not disrupt my classmates
Number of behavioural incidents and detentions
I have had fewer behavioural incidents and detentions than last term
Feel more confident making friends
Goal Based Outcome Ratings
My goal based outcome score has gone from a 0 to a 7
DRAFT
Based on what was measured, Joseph has made positive progress toward his user-patient goals

14. What happens to Joseph’s Data at the Service Level?
Worked Example
What happens to Joseph’s Data at the Service Level?
Who is our School giving extra support to ?
What do they need help with?
DRAFT
Are they improving?

15. Worked Example
What happens to Joseph’s Data at the Commissioning Level?
Are South Derbyshire services helping to improve health and wellbeing?
DRAFT

16. Phase 2 Learning Partners – powerful vision and strategic commitment
Wide variation in experience of outcomes working
CYP feedback – importance of using measurement tools
Need to rationalise and align data collection and flow to all levels

17. Project phase 3 Implementation April 2017 – September 2018
Move towards commissioning for outcomes support to commissioning and service staff to have the confidence to make the cultural shift needed
Test the framework
Voluntary and community sector
SEND
0-19 public health nursing
Learn and roll out

18. Work with VCS Data Gap Analysis Self Assessment (against CORC BPF)
Agreeing Data Specification with CCG Data Manager
5 services moving forward to collect and flow data

19. Next Steps VCS in data collection period
VCS due to report and flow data end of Jan early Feb
Key learning and feedback March 2018
SEND – 2 mainstream, 2 Enhanced Resource, 2 Special Schools, focusing on EHC Plans
Light touch (0-19, Eating Disorder) due to start Jan 2018.