When you are designing or commissioning a new service where do you start? Do you start with an idea of what the service should look like and build a specification around that? Or do you start with the change you would like to achieve and build a service that you know will achieve that change?
You might be surprised how many times people start with the service they want and look for the evidence that it works later. In Local Government this is known as policy based evidence making. Unfortunately, it’s an approach that is all too prevalent in spending public money.
We spend a lot of time talking to organisations that are at different stages in evidencing their impact. Some are at an early stage of design and want to ensure that there is an evidential basis for the approach they are taking. Many others meet us and tell us “it’s useful to talk to you now as we’re just starting to look at the outcomes we want to measure.”
If you are only beginning to identify the outcomes you are likely to achieve once the service is operating, then it will be a matter of luck whether or not it is effective.
One of the key tasks we set organisations, as part of our Quality Mark for Evidence, is to identify the National Outcomes Frameworks they can best influence. This isn’t down to an obsequious belief in Government policy. We do this because there is an evidence base behind the individual outcomes set out in the National Outcome Frameworks.
We know that helping people give up smoking, increase exercise and improve their diet will improve their health. We know this because there is a weight of research that has demonstrated this is the case. Equally we know that being in a secure tenancy, not being in financial hardship and not being socially isolated are the foundations you need to improve health and wellbeing.
In designing or commissioning a service you need to focus on any of these simple outcomes and demonstrate the thing you are building will have an impact on them. If you don’t start from this position you are making something with the best of intentions but might not be effective.
Recently we talked to one such set of commissioners that not only designed a service but had already put the service out to tender before they started considering outcomes. This raises two questions: –
- How do they know the service works?
- How can the people tendering for the service know they can do it?
Through discussion we raised the obvious outcomes contained within the full range of National Outcome Frameworks. These are the outcomes that we know improve health and wellbeing because years of research tell us they do. Unfortunately, the commissioners felt that the service, as designed, was unlikely to have traction with the basic outcomes.
This creates an ongoing problem for commissioners, the people delivering the service and most importantly the people using the service. The commissioners must now seek to develop proxy outcomes that do not relate to the real world, the people delivering the service will constantly fear that they will be responsible for the lack of effectiveness and the people accessing the service have no real reason to expect their health or wellbeing to improve.
In a time of limited access to public funding these sort of things can be avoided if you start from a clear idea of what you want to achieve.
Feel free to innovate in the way you deliver services but retrospectively creating evidence that innovation works does not help anyone.