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PbR – a healthy proposition?

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Last week I posted apoll to try to gauge attitudes to payment by results by those sufficiently interested in the subject to read this Blog. For reasons that I go into in a comment on that post, the poll bombed. Most people either weren’t interested or were very wary about voicing an opinion, even in an anonymised format.

I offered five possible answers to the poll question ‘What do you think of PbR?’:

  1. A great opportunity for my organisation and to make a real difference.
  2. I’m wary, I think it is mainly to do with privatisation by the back door.
  3. I like the focus on outcomes but I’m not convinced it will work in practice
  4. I worry about the impact on 3rd sector organisations.
  5. I’m undecided – let’s see what happens in the pilots.

As you can see, at least three of the possible answers acknowledged that it is hard to form a definitive view of PbR at the moment with so few results-funded schemes in operation. So what does the future hold for PbR? I thought I’d use the structure of the poll to set out my prognosis.

A great opportunity for my organisation and to make a real difference

Well, PbR is an opportunity for me –  I am an independent consultant who is currently working on PbR projects from commissioner, provider and research perspectives. I am enthusiastic about PbR because I believe that it provides a great opportunity to make a huge impact on entrenched social problems. PbR can force a complete re-design of existing piecemeal practice, and deliver a more co-ordinated, rational approach which is put in place from a programme’s inception. I wrote an article for this week’s Drink and Drug News calling on the drug treatment field to get on board with PbR because I think it has the potential to make a recovery-focused treatment system a reality. There are plenty who disagree, here’s a piece by Huseyin Djemil published just today.

Back door privatisation

Actually, I do think PbR is about privatisation too. I know it started under the last Labour government but the Coalition Government, particularly the blue part of it, has been quite explicit about re-balancing the economy away from the public sector. I think some members of the government advocate PbR because they believe that ‘business acumen’ (Crispin Blunt, talking about PbR at the Probation Awards) can make a real difference to public services and others because they think that private sector workers are more likely to vote their way at the next election.


Outcome-focused, but will it work?

In my view, the brutal focus on outcomes which PbR brings is a necessary evil. But I agree that there are a lot of practical problems – ‘cherry picking’ clients with the lowest level of need, and ‘parking’ those who need intensive work but have already failed and therefore don’t contribute to a premium payment are the two most frequently discussed. But there are posts on this Blog about the difficulties in attributing outcomes, the challenge of measuring re-offending results post-riots, and whether PbR could perversely stifle innovation. There is certainly a real need for everyone involved to work hard at establishing best practice in these areas, not least government departments and commissioners.

Impact on Third Sector organisations

I think that this, too, is a real concern. There is an inherent tension in many PbR schemes between the need for a large scale programme which produces a big enough cohort to measure results and delivers economies of scale and the fact that many initiatives are best delivered by a coalition of small organisations who are trusted by their communities and can build effective local partnerships. The experience of many small Third Sector organisations in the work programme PbR venture does not seem promising. If you Google the horrible term bid candy, it returns 2,950 UK hits, most of which feature the words ‘voluntary sector’ in the title.

Let’s wait for results from the pilots

As a researcher, I have to agree with this point of view too and this option is probably the one that I would have chosen in the poll. The gap between a great idea and its successful implementation can be huge and I don’t believe anyone who says they are totally confident about the benefits of the PbR revolution, or anyone who guarantees its swift demise.

However, the great challenge of PbR – particularly for organisations who provide services in the re-offending, employment, supported housing and drug treatment fields – is that they cannot afford to wait and see. I think most organisations take the same view as Labour MP Graham Allen recently expressed on early intervention – that currently PbR is the only game in town. At the moment, many organisations are putting what they they really think of PbR to the back of their minds and getting on with the business of designing services and writing expressions of interest.

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