You know an idea has traction when the University of Oxford sets up a research centre to investigate it. This is the case for outcomes-based commissioning (aka Payment by Results), which is the focus of the new Government Outcomes Lab (GO Lab) based at the University of Oxford’s Blavatnik School of Government.
The GO Lab focusses on the interests and experience of government departments in procuring services in an outcomes-based way, rather than those of contractors (or suppliers, in WASH Results terminology) in providing them. It is a collaboration between Blavatnik School of Government and Her Majesty’s Government. The focus of the research centre is on outcomes-based commissioning that uses Social Impact Bonds (SIBs), a model in which external investors provide the initial investment for programme implementation which is repaid on achievement of outcomes. However, the GO Lab will also look at other models, presumably including that used in the WASH Results Programme in which the suppliers themselves provide the upfront investment.
The rationale for the GO Lab is as follows: “While numbers of, and funding for, outcomes-based approaches have increased over recent years, research has not kept pace with this speed of growth. Much is still unknown about whether outcomes-based commissioning will meet its promise….Through rigorous academic research, the GO Lab will deepen the understanding of outcomes-based commissioning and provide independent support, data and evidence on what works, and what doesn’t.” (GO Lab FAQ) .
So far, the GO Lab has organised three “Better Commissioning” events looking at outcomes-based commissioning in different sectors in a UK context, namely Children’s Services, Older People’s Services and promotion of Healthy Lives.
A quick skim of the interesting post-event reports suggests that outcomes-based commissioning is seen as a way of promoting a greater focus on outcomes by providers (who may not already think in this way), of prompting innovation in service provision and of transferring the risk of new approaches from commissioners to socially-minded private enterprises. Similar themes occur in Results Based Aid discussions, although I’d suggest that the international development sector places a slightly greater emphasis on incentivising delivery, value for money and accountability to commissioners.
One aspect of the GO Lab work that caught my eye is their interest in the creation of Outcomes Frameworks which were discussed at each event: “Developing an outcomes framework is a key part of any SIB or outcome based contract, but accessing data and articulating robust metrics that can be rigorously defined and measured is often seen as a challenge by commissioning authorities.” (Better Commissioning for Healthy Lives: a Summary Report, p 13).
This process of articulating appropriate metrics and identifying indicators has been a key area of learning within the WASH Results Programme and continues to be discussed. It was reassuring to see others grappling with similar challenges in different sectors, such as challenges of creating indicators that:
- are both unambiguous enough to trigger payment and reflective of the outcomes the programme is intended to achieve (Children’s Services Workshop Report, p. 5);
- reflect the context and needs of beneficiaries and are also able be aggregated at a higher level (and internationally in the case of the WASH Results Programme) (Healthy Lives Symposium Report, p.14 and Services for Older People Symposium Report, p.14 );
- reflect the sustainability of outcomes beyond the term of the contract.
During this, the outcomes-focused period of the WASH Results Programme, we will be following the progress of the GO Lab with interest, and hope to find opportunities to exchange learning with them, and others researching innovative funding approaches. Our team is particularly interested in contributing to, and benefiting from, learning around:
- independent monitoring and verification of outcomes-based contracts;
- creating outcomes frameworks that reflect sustained outcomes in areas such as behaviour change (e.g. handwashing behaviours) and institutional change (e.g. ability of district stakeholders to manage water systems);
- streamlining metrics and indicators while balancing needs of all parties: beneficiaries, service providers, commissioners and, in the case of international development programmes, national stakeholders and global commitments such as Sustainable Development Goals.
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