Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. Involving patients in outcomes based
commissioning in community services
Dennis Berg, Policy Adviser, Monitor
Mark Drury, Head of Public Affairs, Oldham CCG
Matthew Smith, Assistant Director Improving Outcomes,
Cambridgeshire & Peterborough CCG

2. Oldham CCG
• CCG in northeast Greater Manchester
• Diverse borough with significant health inequalities
• 1st wave CCG, authorised without conditions
• Triple aim: best care, best health, best value
• Key themes: innovation and patient involvement
• 8 clusters of around 30,000 patients each

3. Community services
• Transferredfrom Oldham PCT to Pennine Care under TCS
• CCG vision is for more responsive services, led by and wrapped around the
GP clusters
• Specifications devised to reflect this model
• Split into 6 lots – 1 core and 5 specialist
• Tenders advertised through Supply2Health (since replaced
by Contracts Finder)

4. Patient involvement
• Delegated scoringof patient experience to patients, worth 12.5% of the
overall score – based NHS Patient Experience Framework
• Key challenges:
– Recruitment and selection for 6 panels of around 6 patients each
– Time requirement for patients
– Prior knowledge, experience and diversity
– Tight time window
– Staff support required

5. Recruitment and preparation
• Approach patients known to the CCG
• Match interests to lots (some patients scoringmore than one lot)
• Briefing notes explaining the process indetail
• Confidentiality agreements, etc.
• Sharing hard copies of the patient experience elements of bid submitted
to AWARD with scoring criteria

6. Scoring
• Patients scoredeach question at home
• Then facilitated moderation sessionto finalise 1 score for each bid
• Core lot also involved a Patient Experience presentation by bidders plus
supplementary questions
• Finalised scores addedonto AWARD
• The scores are the scores
• Feedback

7. Learning
In subsequent tenders we have revisedthe process:
• Involved patients more directly in devising the specifications
• Reduced the patient experience questions to 6
• Open recruitment (including Oldham 500) to increase diversity
• Participants in the Community retender acting as facilitator in
subsequent bids.

8. Cambridgeshire & Peterborough CCG
• Large CCG 913,000 patients, 107 practices
• 3 main acute hospitals, 2 main LocalAuthorities
• CCG has 8 Local Commissioning Groups leading on local service design,
patient and clinical engagement
• Financially challenged economy / hospitals / LocalAuthorities
• High bed occupancy, high delayed transfers of care, consequent
impact on A&E / flow
• Urgent & Emergency Care vanguard site

9. What did we do?
• Developed an Outcomes Framework for Older People Integrated Pathway
and Adult Community Services
• Outcomes Framework used as the main specificationfor procurement of a
new service for older people, integrating community services, end of life
care, older people mental health and unplanned acute hospital care, some
specific voluntary sector and primary care services
• £800m 5 year outcome-basedcontract won by UnitingCare as the
Lead Provider (owned by Cambridge University Hospitals FT and
Cambridgeshire & Peterborough FT)
• New service startedApril 2015

10. The Outcomes Framework

11. Structure and link to payment
• 7 High level domains
• Outcomes
• Outcome measures / indicators (mix of proxy measures and ‘true’ outcomes
• Technical specifications for each indicator
• Payment by Outcomes (PBO) – a percentage of the contract value is
linked to achievement of outcomes:
• Year 1 - 0% (preparatory year)
• Year 2,3 – 10%, year 4,5 – 15%

12. How we developed the Outcomes Framework
Early
engagement
100+ groups
– what’s
important?
Develop
‘wiki’
approach;
learning
from early
patient
feedback
Domain
teams
including
patient
input
Full public
consultation
(Outcomes
Fr. Mark 2
and Bidder
Proposals)
Work with
Health
Scrutiny
Committees
/ councillors
Workshops
with
stakeholders
to test
Outcomes
Framework
Mark 1
2013
Public
health-led
evidence
review
Data
capture/
baseline
work
Indicator
preparation
& phased‘go
live’
Final OF
Mark 3
issued to
bidders
Dialogue
with bidders
& external
expert
review
Work with
COBIC on
developing
OF
Autumn
2015
Oct 2014 -
Now
March –
June 2014
Winter
2013/14
Autumn
2013

13. What does the Outcome Framework mean for
patients and staff?
• One way of understanding the benefits of outcomes based commissioning is
to consider how it will improve quality of care and provide measurements
that give assurance that the quality of care has been achieved.
• Both the CCG and UnitingCare have spent time listening to the stories of
patients to inform the outcomes framework and service solution
• Mrs Smith is a 92 year old woman who lives alone. She has become
frailer and sociallyisolated over the previous 6 months following
falls and loss of confidence. She is used to being independent
and so does not call for any help.A good neighbour has
been doing some shopping but she is shortlymoving
out of the area.

14. What happens to Mrs Smith
• GP / MDT identifies frail people such as Mrs S at risk of complications/ avoidable admission.
• Mrs Smith is overdue for a medication review and she has now become housebound.
• Community matron visits her at home.
• Notices Mrs S is unsteady on her feet, appears socially isolated, needs ongoing social care
• Referral to physiotherapist for a walking aid and an assessmentof her risk of falling again.
• Mrs S referred to a voluntary organisation for befriending and support with shopping,and to
an occupational therapist for advice on safer home adaptions
• All changes made as part of an individual plan created by Mrs Smith & community matron.
• She had consented to the multi-disciplinary team (MDT) way of working and was
introduced to the MDT coordinator, who acted as her care coordinator, and who kept in
touch until the plan was implemented and then kept in regular contact afterwards.
• Mrs Smith feels less isolated, has contact numbers which work, uses her mobility
aids and has started to go out again, accompanied.

15. Measuring improvement
• Mrs S receives a short survey questionnaire which she completes with the help of her new
volunteer friend (Domain A patient experience indicators.). Her answers reflecther positive
experience;especially the way the team around her appeared well coordinated and
informed and involved her in planning.
• The community staff feelwell supported,appropriately trained, and work in a ‘learning’ and
open organisation with effective IT systems in place (Domain B safety and C organisational
developmentindicators).
• She did not suffera further fall and felt more confident(falls indicators pathway domain
1.1.3, 1.14),
• She was identified as frail and at increased risk of unplanned admission (pathway
indicator 1.3.1)
• She was seen by the physiotherapist, community matron and occupational therapist
within 5 days of referral (routine referral frail person pathway indicator 1.3.2)
• She had a Health and care summary and plan available 24/7 (pathway indicator
1.3.3)
• She was given lifestyle advice re smoking (healthy lifestyle pathway indicator
1.5.1)
• She did not suffera hip fracture (pathway indicator 1.1.7)

16. Learning
• Early engagement with patients shaped the framework – challenge is to
keep engagement to ensure it continues to evolve
• Outcomes-basedcommissioning as a concept isn’t always easy for patients /
carers to grasp – examples of what it means for individual patients, or stories
/ vignettes help
• Describingoutcomes can become very high level (‘motherhood and apple
pie’) or very technical (clinical measures or data definitions for proxy
measures) – needs to relate to people’s experience of illness / care
• LocalAuthorities can help; interested councillors reviewed our outcomes
• Envisage that the challenge will be to answer the ‘so what’ question
can the Lead Provider demonstrate what they have done to
improve outcomes as a result of measurement eg of patient
experience

17. Questions?

18. Contact details
Mark Drury: mark.drury@nhs.net
Matthew Smith: matthew.smith4@nhs.net
Dennis Berg: dennis.berg@monitor.gov.uk