The 1972 Munich Olympics launched Olga Korbut on the world stage. Half of Britain fell in love with the diminutive gymnast with the gamine looks and the playful, definitely anti-Soviet disposition. I too liked Olga, but I loved her compatriot, Ludmilla Tourisheva; with her regal countenance, she had an elegant approach which made you think she had just stepped off stage at the Bolshoi. Tourisheva won 9 Olympic medals in her career but my abiding memory of her is at the 1975 World Championships at Wembley. At the end of a typically graceful routine on the asymmetric bars, as she performed her dismount, the entire apparatus collapsed to the floor behind her. She spotted her landing perfectly, turned and left the stage without even a glance behind her.
Payment by results has a Tourisheva-like focus on outcomes. A central plank of its rationale is that by focusing payments on outcomes without describing how these are achieved, it frees up providers – and the voluntary sector in particular – to work in innovative and exciting ways. It doesn’t matter to the commissioners how outcomes are achieved, just that they are.
However, my recent experience of developing plans for PbR initiatives, specifically when calculating potential payment metrics (using a combination of hard evidence, past performance and many backs of envelopes) is that, sometimes, PbR has a strong gravitational pull towards a safety-first approach. Initial ideas may be ambitious, involving far-reaching partnerships with a wide range of specialist providers. However, once detailed plans are worked up, trustees and Senior Management Teams are honour-bound to consider the risks to an organisation’s survival if it does not deliver the predicted/hoped for results.
The flavour of discussions can often change. How can we make sure that we get the clients who actually want our service and can benefit from it? Can we really trust our partners? What happens if they have recruitment problems in the first six months? Are we sure this approach will work in rural areas too? Confidence and the willingness to experiment can evaporate fast once you start worrying about gambling with an organisation’s future – and the jobs of all its staff.
The whole point of payment by results is its focus on outcomes. For many of us, that is its main attraction. Although all commissioning should be outcome-driven, we know that in practice most projects are much more likely to be measured by targets that are easy to count. We record attendance and action plans rather than long-term changes in behaviour. If we can get the outcomes right and find a relatively inexpensive way of measuring them that allows staff to focus on their work and not bean-counting, then we can make a real difference to thousands of individuals, their families and the local communities where they live.
Perhaps the challenge of PbR is to recreate the spirit of those Russian gymnasts. Commisioners will require a Tourisheva-like focus on outcomes. But it would be great if providers can emulate Korbut’s sense of adventure and innovation. Sometimes, it feels that developing a truly ambitious PbR programme designed to tackle an entrenched social problem like generational unemployment involves the sort of audacity that Korbut showed when she was the first to stand up on the 4cm diameter top bar and perform a back somersault. As the commentator says: ‘imagine the tolerance for error’.