Home > Adding value? Reflections on payment by results for people with multiple and complex needs.

Revolving Doors Agency. [Revolving Doors] (2015) Adding value? Reflections on payment by results for people with multiple and complex needs. London: Revolving Doors Agency. 16 p.

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This briefing from Revolving Doors Agency highlights a number of challenges in applying ‘payment by results’ (PbR) approaches to services for some of the most excluded individuals in society, and raises a series of key considerations for commissioners and policymakers seeking a more outcome-focused approach.

 

It considers how a range of different PbR schemes have been applied to services working with individuals facing multiple and complex problems, including a combination of poor mental health, offending, substance misuse, and homelessness.

 

It highlights concerns that applying PbR approaches may drive a focus on short-term outcomes rather than long-term recovery, and lead to clients with more complex problems being ‘parked’ as providers target easier cases to achieve their results. 

Reflecting on the experience of a wide range of PbR schemes, including the Work Programme and ‘Supporting People’ PbR pilots, the briefing provides 18 key considerations for commissioners and policymakers who are looking to develop a more outcome-focused approach to funding services for this group. Considerations raised include:

  • Involving service users in setting outcomes, ensuring the range of outcomes selected accurately reflects their priorities and needs
  • Understanding the long-term investment required to support the recovery journey, and measuring ‘distance travelled’ rather than simply chasing short-term results.
  • The need for appropriate pricing and resourcing, acknowledging that savings for this group come from effective, personalised and intensive support that can reduce the use of costly emergency and criminal justice services and promote long-term recovery, rather than processing people more effectively towards a single outcome.
  • Taking a ‘whole system’ view, and pooling resources with partners around shared outcomes that enable funding of targeted interventions for this excluded client group.

The briefing concludes by urging caution in applying ‘payment by results’ to services for people facing multiple and complex needs, and recommends that commissioners and policymakers explore alternative ways of promoting a greater focus on outcomes, while learning from the varied experience of existing schemes.

 

The briefing is the latest in a series released through our SPARK project.

Item Type:Evidence resource
Publication Type:Report
Drug Type:Alcohol or other drugs in general
Intervention Type:AOD disorder harm reduction, Rehabilitation/Recovery
Source:Revolving Doors
Date:February 2015
Pages:16 p.
Publisher:Revolving Doors Agency
Corporate Creators:Revolving Doors Agency
Place of Publication:London
EndNote:View
Accession Number:HRB (Electronic Only)
Related URLs:
Subjects:A Substance use, abuse, and dependence > Natural history of substance use > Recovery
HJ Treatment method > Treatment outcome
J Health care, prevention and rehabilitation > Treatment and maintenance > Treatment factors
MP-MR Policy, planning, economics, work and social services > Financial management
T Demographic characteristics > Substance user
VA Geographic area > Europe > United Kingdom

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