There are a lot of criticisms that can be levied at the payment by results approach. Some commentators are opposed in principle, Laurence Demarco, the founder and director of Senscot (a network of Scottish social enterprises) was the latest to voice his concerns yesterday. Others are concerned about practical issues, many of them discussed in posts on this site – how do you agree bullet-proof outcomes, develop innovative approaches, and share out payments between multiple providers?
However, there are definite strengths to the approach as well. What I like about PbR is that it challenges all of us who say “We know how to tackle social problems, just give us the resources”, to prove our case. Take, for example, the latest paper from the Recovery Partnership (an alliance between Recovery Group UK, the Substance Misuse Skills Consortium and DrugScope) which was discussed at the Inter-Ministerial Group on Drug Policy this month. One of the concerns that the Recovery Partnership raised is the important issue of whether service user choice will be neglected under PbR commissioning arrangements.
One of the key tenets of PbR is that the government/commissioning body sets the outcomes but providers are free to design service provision to meet these outcomes in any way they choose. If those of us who work in the drug field are confident that service user choice is a key component of effective recovery, then let’s get on and design an approach that maximises that choice. If we want to introduce personalised budgets let’s do so. Because if we are right, we will achieve the right outcomes for our service users, meet the government’s targets, and get paid a premium in return.