Transcript Slide 1

Can PBR drive improved
practice?
Fraser Battye
Children England Annual Conference
15th March 2012
This presentation is in four parts and makes one central
point: PbR can work well, but care is needed in its use
1. The intuitive and policy appeal of PbR
2. Models being tested
3. Early results
4. Considerations in using PbR
1. Appeal
2. Models
3. Early results
4. Considerations
The principle of linking results and reward in the public
sector commands widespread support...
1. Appeal
2. Models
3. Early results
4. Considerations
There is also a clear policy direction: PbR is a central
mechanism for public service reform
“...it is not enough to pay someone to
provide a service with the only recourse
being that if they fail they will not be reawarded the contract. In these cases it
makes sense to build in an element of
payment by results to provide a constant
and tough financial incentive for
providers to deliver good services
throughout the term of the contract.”
15 references
to ‘payment by
results’
PbR as an alternative to performance
management / targets and terror
1. Appeal
2. Models
3. Early results
4. Considerations
PbR is being trialled in a range of areas – including
children and families services
Smoking
Cessation (West
Mids)
Children’s
Centres Pilots
Peterborough
Prison (SIB)
Work
Programme
Families with
Multiple
Problems
1. Appeal
London
Reducing
Reoffending
Programme
Physical Activity
Programmes
2. Models
Drug
Rehabilitation
In all cases: an attempt to
make commissioning more
outcomes-focussed
3. Early results
4. Considerations
Different models of PbR are being tested; they differ on a
series of key variables
Results for...
Payments on...
PbR accounts for...
...populations
...outcome
...a %
increment
...individuals
...output
...the whole
contract
1. Appeal
2. Models
3. Early results
4. Considerations
Whatever the model, the theory is the same: incentives
matter, they alter provider behaviour and so user outcomes
PbR led to improvements in
smoking cessation services
Does PbR always create the
right incentives?
1. Appeal
2. Models
3. Early results
4. Considerations
Several key considerations underpin the enterprise of
maximising the benefits and minimising the risks of PbR
•
Defining the ‘result’ (outcomes / outputs)
•
Causal claims and attributing results
•
Data / audit requirements (transaction costs will go up)
•
The ‘payment’ (setting the level, staging the payment)
•
Balancing risk and opportunity (commissioner / provider)
•
Commissioner skills and provider capacity
 In design - think through the way that incentives might work
 In practice - evaluate, learn, refine
GHK specialises in policy analysis for government
and the third sector.
We have undertaken several PbR-related
assignments and produced two short papers:
‘Thinking
about...payment
by results’
‘Thinking
about...evaluation
and payment by
results’
For more information, please get in touch:
[email protected]
0121 2338900
www.ghkint.com