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.
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:
- 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?
- 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.
