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David worked with us to introduce the OBA approach to our senior clinical leaders and managerial staff. This invaluable session struck a chord with us in terms of how we can make a big impact on improving the health and social care for our population with the scarce resources we have at our disposal.

Steve Brennan ,Chief Finance Officer
NHS North Kirklees CCG

Strategy vs. Lottery

When I’m asked to comment on service specifications for social care contracts, my experience is that they inevitably focus on quantity (or outputs) rather than impact on service users. Many public bodies have not moved on from the very basic commissioning principles designed for buying office supplies or building materials and there is rarely a recognisable alignment between the services being purchased and the commissioner’s strategic priorities.  There’s little point in spending six months writing a strategic plan unless you ensure alignment between your desired outcomes and the services you’re buying. All too often, services are funded for no other reason than they’ve always been funded (or because the people who work there are nice people and they try hard). This is the lottery (as opposed to strategy) principle; buy enough services and somebody, somewhere is bound to be better off. In times of austerity and diminishing budgets, we need to be smarter. I’ve recently published a short article making the case for commissioning for outcomes, in other words, ensuring that the focus is firmly on making people better off rather than just counting the amount of service provided. Based on Mark Friedman’s work, the paper articulates the need for a ‘performance partnership’ rather than the conventional purchaser-provider split and emphasises the need to align service user outcomes with strategic priorities.  You can download the article (it’s just 3 pages long) in the Resources section of this website under “Articles”.  (If you’ve not accessed the Resources section before, you’ll need to register).