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Tags are what WordPress calls is keywords. I attach a small number of tags to every post to help people navigate between content with the same keywords. Tags may be people (David Gauke say), organisations (The Howard League, Revolving Doors Agency), themes (women offenders, homelessness) or specific items (heroin, cocaine, ROTL). If you’re looking to research a particular issue, they can be invaluable.

Payment by Results

The 9th Commandment of Payment by Results: Thou shalt join up commissioning

If successful recovery from addiction can only be achieved by a coordinated approach across the health, drug treatment, criminal justice, housing, social care and ETE (employment, training and education) sectors, which government departments should pay for which outcomes? Ideally the Ministry of Justice, Department of Health, DWP and Supporting People should all contribute to a pooled budget. But of course that’s not the way that departmental budgets work – indeed, there’s evidence that, despite the Community Budgets initiative – departmentalitis has actually got worse over recent years in the face of largescale and repeated cuts in expenditure.

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Payment by Results

The 8th Commandment of Payment by Results: Thou shalt share the fruits of thy labours

By focusing on outcomes, commissioners allow providers to design the service in any which way they choose – safe in the knowledge that they will only have to pay out if that service is successful. This “Black Box” approach has become increasingly contentious since the advent of the Work Programme and the introduction of large private companies into the delivery of public services. One of the key reason underlying the choice of the Work Programme contract areas was the desire to introduce direct competition between providers…

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Payment by Results

The 7th Commandment of Payment by Results: Thou shalt promote innovation

Payment by results is supposed to be all about innovation. The central idea of PbR is that commissioners set their outcomes and only pay up if the provider achieves them. This leaves providers free to deliver the service in any way they see fit.
The freedom from constant monitoring and reporting on targets, milestones, KPIs etc. enables providers to approach entrenched social problems with new ideas and fresh approaches and also frees up considerable resources currently dedicated to the collection, polishing and submitting of data. But…

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Payment by Results

The 6th Commandment of Payment by Results: Profit shall not be thy God

One of the most controversial aspects of payment by results in the UK has been the way the funding model has been used to outsource public services and open the market up to private providers, typically the sort of global companies who deliver the Work Programme. Many people are opposed in principle to the idea of public services generating profit for multinationals. On the other side of the argument are those that see the introduction of business sense and commercial acumen as a key way of reducing cost and driving innovation. But is financial profit the only measure of success?

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On Probation

The 5th Commandment of Payment by Results: Thou shall not pay for deadweight

Payment by results is about driving improvement, so no self-respecting PBR scheme will pay for results that will happen anyway, known in the jargon is “deadweight”. The proportion of deadweight in a PbR funded initiative varies markedly across different spheres of operation. Despite all the adverse publicity about reoffending rates which has accompanied the debate about the Rehabilitation Revolution, 65.8% of those supervised in the community and 53.1% of those released from prison do NOT re-offend in the first year. However, when we look at the Work Programme…

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Payment by Results

The 4th Commandment of Payment by Results: Thou shall not covet milestones

The introduction of milestones exacerbates the problems of complexity highlighted above, requiring even more time and resources from commissioners and providers and even more onerous data collection systems. But even worse is the fact that as soon as you have indicators, people start focusing on them, instead of the intended outcomes.
Which takes us straight back to the culture of micro-management by targets which PbR is trying hard to leave behind.

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Payment by Results

The 3rd Commandment of Payment by Results: Thy metrics shall be simple

Complexity is almost always the enemy of effective PbR because it inevitably results in unintended consequences. Concern about possible unintended consequences results in worries about gaming the system which, equally inevitably, results in additional measures being taken to address these concerns which involves further complexity which…, well, you get the picture. In this post, I want to make the case for simple, robust measures to assess how effective PbR schemes are in meeting their outcomes.

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Payment by Results

The 2nd Commandment of payment by results: Thy outcomes shall be few

Most payment by results pilot schemes are targeted at entrenched social problems. These problems – troubled families, long term unemployment, re-offending and drug dependency – are complex by nature. They require a coordinated response which addresses a wide range of issues. PbR funded interventions are a natural commissioning approach to tackle complex problems. However, PbR schemes quickly run into trouble when the outcomes themselves become complex.

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