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.

Share This Post

Share on twitter
Share on facebook
Share on linkedin
Share on email
This is the ninth in my series of 10 commandments for payment by results.

Thou shalt join up commissioning

The most exciting aspect of the payment by results approach is its capacity to strip out the bureaucracy of continuous performance monitoring which has increasingly bedevilled British public services over recent decades.

The focus on outcomes allows providers to tackle social problems in new ways and to channel all their energy into delivering services – rather than spending a large percentage of their time collecting, polishing and submitting data to the central government machine.

PbR schemes are mainly targeted at complex social issues which, unsurprisingly, require a coordinated and holistic approach.

Take the example of problem drug users who quickly become entrenched in a life of crime and petty graft.

Typically individuals who get into this situation require comprehensive and intensive help which addresses their drug dependency and related physical and mental health needs, tackles their offending behaviour and provides social support.

For long-term recovery, most require long-term help with accommodation, employment and training and after-care support. If one of these elements is missing, then progress is generally undermined and people relapse into a life of addiction.

If an effective programme of coordinated action can be established, there are a whole host of benefits not just to the individual, their family and the wider community but to a number of government departments.

A recovered drug user makes much fewer demands on the health care system and no longer needs (very expensive) drug treatment. S/he no longer needs to commit crime – saving on average tens of thousands of pounds to the criminal justice system. If s/he finds work, then not only does the DWP save on benefit payments but the Exchequer as a whole receives new tax and national insurance contributions.

Who pays?

Unfortunately, there’s a fly in the ointment.

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.

Recent history suggests that coordinated approaches are very difficult to develop successfully on a large scale; they either fail to coalesce and service users fall through the gaps or they are extremely expensive and involve considerable duplication of services (think: Drugs Intervention Programme).

Government departments acknowledge this issue and meet regularly together to discuss it but as yet they do not appear to have made much headway.

This remains a significant roadblock to progress – while the MoJ might be happy to pay for reduced offending it is unlikely to ever feel it should also pay for health and benefit outcomes and their colleagues in the DoH and DWP have parallel concerns.

BOGOF

Where next?

This is proving a major stumbling block.

One of the main aspirations of payment by results commissioning is that by facilitating new approaches, it will improve outcomes and result in substantial long-term savings.

Many PbR pilots are attempting to do this by co-ordinating services and reducing duplication.

The new reducing reoffending contracts currently being developed by the MoJ are likely to result in at least a couple of unintended consequences in this area of multiple outcomes:

  1. Many of the existing partnership relationships which Probation Trusts have developed with statutory partners whereby offenders get enhanced access to mental health, drug treatment and other services are potentially at risk under the new arrangements. The partnerships were created by statutory organisations working together for the public good. Will they survive when one partner is making financial profit from the other’s efforts?
  2. Many of the new providers may be delivering, for example,  both reducing reoffending and work programme contracts. They will of course co-ordinate these services for job-seeking offenders, creating a better, more streamlined service and, effectively, receiving double outcome payments from the public purse.

“Any day you get two for one is a good day” is a motto of mine.

However, we should all want the taxpayer to be getting the discounted deal, not the contractor.

 

The final post in this series will look at the Tenth Commandment of PbR:

“Thou shalt not implement in haste”

 

Browse and download a comprehensive resource pack on Payment by Results.

Check out my Marmite Infographic for simple explanation of key PbR jargon.

 

Share This Post

Share on twitter
Share on facebook
Share on linkedin
Share on email

Related posts

On Probation
Modelling cohorts for Transforming Rehabilitation

Last week the MoJ published modelled data for the 6 years from 2005 to 2010, showing the number of offenders in each PbR cohort and the 1-year re-offending rates among those offenders. The report provides an historical picture of probation performance in reducing reoffending aimed at those organisations interested in winning the new probation contracts. It presents performance on a Contract Package Area, rather than Probation Trust, basis and it looks specifically at the group of offenders for whom the new Community Rehabilitation Companies will be responsible.

On Probation
How is the justice data lab doing?

The purpose of the Justice Data Lab was to make it possible for small voluntary organisations to find out if their work with offenders made a difference to reoffending rates. It was launched as part of the Transforming Rehabilitation project as a way of government, commissioners and Prime providers having a way of comparing the impact of different providers delivering a range of interventions. Despite the strong publicity surrounding the launch of the Data Lab,

On Probation
Latest probation reducing reoffending rates

The latest MoJ reoffending rates show that probation trusts continue to reduce reoffending even under the pressure of the proposed wholescale changes under the government’s Transforming Rehabilitation agenda. This overall good progress does, however, conceal a considerable variation between trusts.

Commissioning
What is the state of the reducing reoffending market?

The IfG makes two very critical findings of the current commissioning of reducing reoffending services. Firstly, local commissioning is ineffective in most areas. Seondly, neither NOMS nor Probation Trusts has a systematic way of knowing whether commissioned services are effective.

Leave a Reply

Your email address will not be published.

Privacy Preference Center

keep informed

One email every day at noon