The London Quality Standards: A case study in changing clinical care

This report evaluates the introduction of standards to improve acute and emergency care in London hospitals | Nuffield trust

Image source: Nuffield Trust

Our evaluation draws on surveys and interviews with those responsible for developing the standards and the frontline staff responsible for making them a reality. We found that the introduction of the LQS worked well in making people aware of shortcomings in care, and drove real change in how people worked. Our initial statistical analysis did not show any evidence that they achieved consistent improvement in patient outcomes.

The most important factor in making the standards a reality was a bottom-up effort from clinicians. We saw some deficiencies in hospitals’ ability to manage complex changes, and evidence of a deep disconnect between frontline staff and top managers. The use of reconfiguration as a “stick” to drive the standards demotivated staff, and eventually came to be seen as an empty threat.

Read the full report here


Faulty by design: The state of public-service commissioning

How public services are commissioned underpins their success in healthcare, criminal justice, employment services and beyond | Reform

Image source: Reform
Image source: Reform

This report reveals that commissioning bodies are not delivering value for money in three key areas.

  • Commissioners are failing to focus on outcomes that matter to service users.
  • Fragmented commissioning bodies stand in the way of integrated services that meet users’ needs most effectively.
  • Devolution of commissioning to local areas is not happening in practice, with a one-size-fits all approach creating a postcode lottery across in healthcare, welfare-to-work and probation services.

Watch the interview about the report below:

Read the full report overview here

Read the full report here

Technology enabled care services

TSA, the industry body for technology enabled care, has published Putting people first: commissioning for connected care, homes and communities.


This report looks at how the care technology sector supports health and social care commissioners to commission technology enabled care services that meet the growing and changing needs of the entire system.  One of the themes included in the report is that commissioners need to ensure the commissioning approach focuses on outcomes and not inputs.

Clinical commissioning groups will be rated on sepsis care

Wise, J. (2016) BMJ. 355:i6361
Image source: Maurizio De Angelis – Wellcome Images // CC BY-NC-ND 4.0

Bruce Keogh, NHS England medical director, announced that a sepsis specific indicator will be included in the clinical commissioning group information and assessment framework alongside metrics on cancer, dementia, diabetes, mental health, learning disabilities, and maternity care.

Keogh made the announcement at the launch of a new public awareness campaign, led by Public Health England and the UK Sepsis Trust, which aims to help parents and carers of young children to recognise the symptoms of sepsis and to know when to seek urgent help.

A report into sepsis by the National Confidential Enquiry into Patient Outcome and Death, published last year, found that 45% of patients with sepsis who were admitted to hospital with no other obvious problem either died or were left with a disability.

Read the full article here

New resources to help commissioners embed social value

A new set of resources to help commissioners embed an outcomes based approach to their procurement of public services has been launched.

Following The Public Services (Social Value) Act 2012, commissioners are increasingly looking for positive social outcomes, which have a lasting impact and can be clearly demonstrated to stakeholders. At a time when budgets are tighter than they have ever been, maintaining public confidence and positive perceptions is a constant challenge for commissioners, which needs to be carefully managed if initiatives are to be delivered successfully and on time.

The resources from Social Enterprise Mark focus on an outcomes based approach to commissioning, and explain how asking for the Social Enterprise Mark/Gold Mark in commissioning criteria is an easy way of embedding social value within contract specifications and demonstrating consideration of the Social Value Act.

Further information:


CCGs warned over withholding payments from mental health providers

NHS England & NHS Improvement | Published online: 8 November 2016

Image source: NHS Improvement

This document provides technical guidance on how providers and commissioners can link locally agreed quality and outcome measures to payment. It has been developed to support mental health providers and commissioners to implement the new requirements under the 2017-19 local pricing rules. It is aimed at all those professionals in provider and commissioner organisations who need to work together to successfully link quality and outcome measures to payment – this includes clinicians, finance and contracting professionals and senior management.

Read the full guidance here

Outcomes-based commissioning – much promise, but is it something that CCGs can actually deliver on?

From Clare Allcock | The Health Foundation

Outcomes-based commissioning is all the rage in the NHS. Many clinical commissioning groups (CCGs) are seeing it as currently the only viable commissioning route to deliver on the vision set out in the Five Year Forward View; 2014’s HSJ ‘CCG barometer’ showed three-quarters of the 109 CCG leaders who participated thought it was likely or very likely they would re-contract a significant amount of spend under an ‘integrated’ contract covering a defined population.

Hang on. Let’s rewind. What are we talking about? ‘Outcomes-based commissioning’ describes an approach to health care commissioning based on outcomes (unsurprisingly), but also the use of a population approach, metrics and learning, payments and incentives, and co-ordinated delivery across providers. It’s these five components together which make up the concept – as such ‘outcomes-based commissioning’ can best be thought of as a brand name rather than simply a description.

So is it the panacea we’ve been looking for? A lot is said about international examples of success with the ‘Alzira’ model used in Valencia being oft quoted by Jeremy Hunt as something the NHS should be moving towards. Colossal claims abound: McKinsey have forecast a saving of ‘a trillion dollars’ in the United States over the next decade for the successful roll-out of an outcomes-based payment model in government health care spending. However if you dig a bit deeper you find that the evidence for outcomes-based commissioning reflects its relatively recent history in health care; while evidence exists, it is limited in scope and strength. And certainly in England, there are as many cautionary tales as there are success stories.

Read the full post via Outcomes-based commissioning – much promise, but is it something that CCGs can actually deliver on? | The Health Foundation.