Christina Walters, Programme Director and Andrew Barber, Technical Consultant, Community Indicators Programme. Commissioning for outcomes is regarded as good practice. Christina explores a process for developing outcomes for commissioners and share the work being undertaken nationally to develop standard outcomes for services. Dr Christina Walters, Programme Director, Community Indicators Programme. Christina Walters is an independent consultant to the health care sector, through her company Hazel Health Consulting Ltd. The consultancy provides strategic insight and solutions to mental health and community health care providers, and their commissioners; currently facing challenges in developing and implementing quality indicators and outcome measures, clinical currencies and the national mental health payment system programme. Christina is the Programme Director of ‘Demonstrating the Value of Community Services’ - the national programme to develop quality indicators in community services, and is involved in developing national work on payment systems in community services. From 2012 until 2014, Christina was an Associate Director at the NHS Confederation, for the community services sector. After a research science career in Microbiology and Immunology and gaining a PhD in 1998, Christina joined the NHS. From 2007 onwards she developed the mental health care clusters, care packages and pathways and supported the national work development of PbR for mental health. Andrew Barber, Technical Consultant, Community Indicators Programme Andrew is an experienced individual having worked in both the public and private sector. His most recent career in the NHS has included performance improvement and information management roles with an aspirant community foundation trust. Previously, he has worked in performance improvement, planning and information management roles at a strategic health authority and three acute hospitals. In the private sector, working with PricewaterhouseCoopers, he gained significant experience undertaking performance audit and consultancy work for health and local government organisations. Andrew is also co-chair of the NHS Benchmarking Network.

1. DEMONSTRATING THE VALUE
OF COMMUNITY SERVICES
Summer 2014
Christina Walters, Programme Director
Andrew Barber, Technical Consultant
http://www.bridgewater.nhs.uk/demonstratingthevalueofco
mmunityservices

2. To demonstrate the value of community services
The programme will establish a set of quality indicators including outcome measures, which will;
• Provide evidence of the effectiveness and quality of community services
• Provide a clear picture of the community ‘offer’
• Support meaningful national benchmarking of NHS community services
• Contribute to the evidence base on clinical effectiveness to support development and
improvement
• Provide information in an accessible form on the quality and value
• Support meaningful national benchmarking of NHS community services
• Underpin the development of currency and payment systems for NHS community services
For whom?
For providers and the people using services,for commissioners and
regulators.
Vision
2

3. Commissioned in full by…
Aspirant Community
Foundation Trusts’ Network
Because:
• 18 trusts who are all on the
journey to becomingan FT
• Policy gap
• National regulatory
encouragement
• Self funding model works quickly
• Wide range of previous work to
incorporate
• Open invitation to others brings
sector and patient benefits
Who commissioned this?
3
Initiated by…
Bridgewater Community
Healthcare NHS Trust &
Southern Health NHS FT
With:
• An imperative to create a range of
common measures within a
framework to demonstrate the
quality of community services
• A range of locally developed
measures in existence
• A summit for potential
stakeholders
• A business case for funding

4. ‘Aspirant foundation trust’ network of community trusts:
Aspirant Community Foundation Trust Network (aCFTN):
Birmingham Community Healthcare NHS Trust
Bridgewater Community Healthcare NHS Trust
Cambridgeshire Community Services NHS Trust
Central London Community Healthcare NHS Trust
Derbyshire Community Health Services NHS Trust
Hertfordshire Community NHS Trust
Hounslow and Richmond Community Healthcare NHS Trust
Kent Community Health NHS Trust
Leeds Community Healthcare NHS Trust
Lincolnshire Community Health Services NHS Trust
Liverpool Community Health NHS Trust
Norfolk Community Health and Care NHS Trust
Shropshire Community Health NHS Trust
Solent NHS Trust
Staffordshire and Stoke on Trent Partnership NHS Trust
Sussex Community NHS Trust
Worcestershire Health and Care NHS Trust
Wirral Community NHS Trust
Who’s involved?
4
And:
Acorns Childrens Hospice
Alderhey
Barts
Berkshire
Central and North West London
Cumbria
Dudley Hospitals
Gloucester Care Services
Greater Glasgow and Clyde
Isle of Man
Leiccestershire Partnership
Northamptonshire Healthcare
North West London
Peninsula Community Health CIC
Pennine Care NHS FT
Pennine Acute Hospitals NHS Trust
QNI
Royal Wolverhampton Trust
Solihull
South Warwickshire FT
Southern Health NHS FT
St Georges
Suffolk Community
University Hospitals Soiuthampton
York Hospital FT
And…
NHS TDA
CQC
Monitor
HSCIC
FTN
NHS England
NHS Confederation
NHS Commissioning Assembly
Community Tariff Working Group

5. Time
Clinical frameworks’
Workstreams
Data and Finance
interface
Engagementof
participant trusts
Engagementof
commissioners
National alignment
& endorsement
Clinical services,
teams described
Formal links &
alignment of
programmes
Expressions of
interest from trusts
Links to
Commissioning
assembly
Scoping via
networks
Agreed series to
develop
Representation on
Programme
Executive
Developmentof
communications
Links to Local CCGs
Formal links &
alignment of
programmes
Design frameworks
Endorsement- at
each stage
Resources secured
for programme
Joint programme
learning events
Representationon
Programme
Executive
Build frameworks –
through workshops
Joint working to
achieve data
collection mandate
Active participation
- at each stage
Endorsement- at
each stage
Endorsement- at
each stage
Initial validation
with peers,
networks, experts
Joint working to
achieve currency
mandate
Ownership of
clinical frameworks
with local &
national value
Incorporation into
commissioning
frameworks
Incorporation into
quality metrics &
outcomes
frameworks
Piloting, wider
evaluation, revision
Sign off for national
use
Timelines – where are we?
5

6. • Community trusts
collaborate
• Clinically focused steering
group
• Agree definitions, scope
• Agree domains for an
indicators and outcomes
template
• Working groups define
indicators and outcomes
which map to care
• Information requirements
reviewed by sector
• CIDS, CYPHS
• Other assurance/outcome
frameworks
• Evaluate for utility across
sector – quality,
benchmarking, service
offer
• Develop as currency for
payment system
Clinical
evidence base
and consistent
approaches
Needs based
quality care
with focus on
outcomes
Clinical
information
recorded and
reported
Granular
costing based
on outcomes
not just activity
6Schedule of clinical workshops
What is the overall process?

7. What’s our scope? Our schedule of clinical workshops
7
Theme Workshop month - 2014 Theme Workshop month - 2014
Podiatry
COMPLETED – DRAFT IN PREP
March Speech and Language Therapy – Adults October
Safeguarding and Children in Care/LAC
COMPLETED – DRAFT IN PREP
April (joint with HV & SN) Dietetics October
Health Visiting
COMPLETED – DRAFT IN PREP
April (2-group event) Occupational Therapy –Adults October
School Nursing
COMPLETED – DRAFT IN PREP
April (2-group event) Dermatology November
Physiotherapy – Adults MSK
COMPLETED – DRAFT IN PREP
May (Adults MSK) Audiology November
Respiratory – Adults
COMPLETED – DRAFT IN PREP
June (Adults) IV Therapy During 2014
Physiotherapy – Adults – Community/
Neuro Rehab/General
COMPLETED – DRAFT IN PREP
June (Adults ‘non MSK’) Community Dentistry During 2014
Homeless & Vulnerable
COMPLETED – DRAFT IN PREP
July Prison Health During 2014
Falls
COMPLETED – DRAFT IN PREP
July Walk in Centres During 2014
Joint children’s therapies session:
Occupational Therapy
Respiratory
Speechand Language Therapy
Physiotherapy
July (Children) Continence Completed in draft form
Diabetes August Wheelchairs Completed in draft form
District Nursing September Tissue Viability Completed in draft form
Health Improvement / Promotion September Family Nurse Partnership On hold

8. WHEELCHAIR SERVICE
Service :
Purpose (Outcome) Statement:
Ref. Title Indicator description Threshold
WC01 Referrals screened
The percentage of referrals accepted that are screened within two working days of receipt of
the referral
95% Responsiveness
WC02 Referrals acknowledged
The percentage of referrers sent a written or electronic acknowledgement within five working
days of the referral being received
95% Responsiveness
WC03 Referrals assessed
WC03a: The percentage of referrals accepted classed as 'urgent' whose assessment takes place
within 10 working days
95% Responsiveness
WC03b: The percentage of referrals accepted classed as 'routine' whose assessment takes place
within 15 working days
95% Responsiveness
WC04 Tissue viability risk assessment
The percentage of assessments, including any prior nurse assessments, that include a
documented tissue viability assessment
tbc Safety
WC05 Voucher provision The percentage of service users registered with the service who have been offered a voucher tbc Equity
WC06 Wheelchair delivery
WC06a: The percentage of service users prescribed a wheelchair who received delivery of their
wheelchair within three weeks of their prescription being written (locally held stock)
tbc Responsiveness
WC06b: The percentage of service users prescribed a wheelchair who received delivery of their
wheelchair within six weeks of their prescription being written (standard manufacturer's
equipment)
tbc Responsiveness
WC06c: The percentage of service users prescribed a wheelchair who received delivery of their
wheelchair within 12 weeks of their prescription being written (bespoke seating)
tbc Responsiveness
WC07 Handover certificate signed
The percentage of service users who sign a handover certificate to confirm receipt of a
handover package (on or after delivery)
100% Safety
WC08 Friends and Family test score Friends and Family test score tbc Patient experience Social value
WC09
Community Equipment Patient
Experience Survey
tbc Social value Patient experience
WC10
Single point of contact for
repairs/concerns
tbc Equity Responsiveness
WC11 Completion of repairs WC11a: The percentage of repairs completed within 24 hours (for emergency repairs) 95% Timeliness
WC11b: The percentage of repairs completed within three working days (for non-emergency
repairs)
95% Timeliness
WC12 Clinical review
WC12a: The percentage of wheelchair and equipment provision for children that is reviewed
within one year of provision
95% Timeliness Safety
WC12b: The percentage of wheelchair and equipment provision for adults that is reviewed
within one year of provision
95% Timeliness Safety
Indicator type (max. 2)
Wheelchair Service - to address a person's enduring mobility problems through assessment and provision of a wheelchair and associated postural and pressure equipment
Outcome: Service users can access a range of environments whilst safety and comfort is maximised
Quality Indicators - what do the frameworks look like?
Overarching outcome(s)Type of care
Thresholds
Performance measures:
activity, responsiveness,
timeliness
Descriptive Measures – drawn from evidence base and good practice
Social value,
equity and
inclusiveness
measures
Quality measures:
outcomes,patient
experience, PROMS,
safety
8

9. 9
Process of indicators development
Expert
workshop
group
On the day + After the day
review and comment DRAFT 1
aCFTN + Other trusts
Web
site
DRAFT 2
DRAFT 3
6 - 8 weeks
4 weeks
8 weeks
Open accessreview and comment
Sector review and comment

10. Community
services
Group A
A1
A2
Group B
B1
B2
B3
Group C C1
Provider
Common care,
risk stratified or
population
groups
Commonly
applicable Quality
indicators &
Outcome measures
y
x
z
Local
services/te
ams – to
which they
apply
Local LocalNational National
How do we get products for national use?
Can A1 – C1 be
used as
Currency for
Commissioning?
From our clinical workshops

11. • It represents a move away from how services have
been commissioned in the past
• To date, the basis for commissioning services
predominantly input based, paid for through cost
and volume, block or a combination of both
• Often put on the “…too difficult…” pile
BUT…
• CQUIN schemes provide incentives for providers
through an agreed framework
• Outcome-based service specifications
Commissioning outcomes
11

12. • What do we mean by an outcome?
• How can we evidence outcomes?
Quantifying and agreeing outcomes
12

13. • What do we mean by commissioning based on
outcomes?
• How might this be different to current
commissioning?
• What are the barriers to including commissioning
arrangements based on outcomes?
• And how do we link payment to outcomes? Or is it
still on block…?
Commissioning outcomes
13