Kirklees Better Outcomes Partnership (KBOP)

Project insights

1. Multi-year funding & introduction of a social prime

   Prior to the SIB, the service experienced significant budget reductions and contracts were awarded on a short-term basis. The Council team was severely constrained and limited resource was available for shaping services or contract management. Providers indicated that the legacy arrangements struggled to address long-term outcomes.

   The multi-year outcomes contract enables participants to pursue longer-term outcomes, most notably education, training and employment (ETE) outcomes. In a pioneering approach, this outcomes contract incorporates learning and adjustment of the outcome measure design (i.e., a flexible rate card) as well as adaptive service delivery. On the flipside, the adaptive nature of the outcomes contract has meant that providers must navigate changes to their operational processes, diminishing providers’ sense of stability associated with the funding security.

   A key innovation in the governance of the service is the introduction of a social prime (KBOP) replacing Kirklees Council in its provider contract monitoring role. The social prime brings a dedicated team funded by the social investor, whose sole responsibility is the management of the SIB service. The social prime brings more frequent and tighter performance monitoring; specifically, KBOP supports providers’ data collection and reporting obligations through an impact analyst. While the enhanced performance monitoring is more resource intensive for providers, delivery teams recognise the benefit of being able to swiftly ‘course-correct’ and test service innovations.

2. Co-designed outcome measures & transparent measurement

   Historically, the Key Performance Indicators focused on evidencing user numbers and throughput of service users rather than understanding long-term outcomes. Moreover, the ‘independent living’ KPI lacked clear, well-defined measures of success, allowing considerable provider discretion in determining the ‘success’ of the intervention’.

   The design of the outcomes framework features an iterative approach which incorporates learning and improves responsiveness to service participants’ needs. Importantly, the iterative approach was built into the contract and follows a pre-defined procedure. The process was highly collaborative and ensures that the indicators of performance are meaningful for service delivery at a person level.

   Alongside clear outcome definitions, the inclusion of education, training and employment (ETE) outcomes is the most significant change in service objectives. While providers’ views on the appropriateness of these outcomes for the cohort was mixed, research findings suggest that inclusion increased support workers’ awareness of considering long-term ETE outcomes much earlier in the participant’s support journey.

   A central shared data management system facilitates independent validation of the outcomes by Kirklees Council and tracks the sustainment of outcomes over time. A key benefit is enhanced transparency and insights though a drawback is the increased administrative burden for providers.

3. Streamlined referral process

   Participants were having to tell their story multiple times as the service lacked a coordinated approach to referrals and there was no shared case management system. There was limited transparency on the demand for, and performance of services offered by different providers. This resulted in service users sitting on multiple waiting lists, leading to delays in referral allocations and a limited visibility of service users who were re-entering the system.

   A streamlined referral process is enabled by a central intelligence system and by the social prime acting as a central referral hub. Referrals to the service can come from a diverse array of local teams, including Councillors and self-referral. Providers no longer handle referrals directly. The coordination of this process means that participants are no longer sitting on multiple waiting lists. Framing the referral process as an asset-based conversation is intended to overcome known issues with a ‘deficit’ model. A single point of contact is also expected to improve the visibility and accessibility of the service and the managed allocation process negates competition for referrals between providers.

4. Enhanced flexibility in service delivery

   Under the old fee-for service contracts, there were tight specifications on service intensity and length. The service specification was seen to prevent the adoption of more innovative, personalised approaches, and impeded the ability to address service gaps.

   Under the SIB, service providers describe greater implementation autonomy fostering the personalisation of services. Frontline staff have discretion in determining - in agreement with the participant - the type of support, i.e. virtual or face-to-face, and the frequency of support. Likewise, providers are granted autonomy in piloting new interventions and creating new staff roles which allow the service to be more responsive to participants. A key facilitator for enhanced flexibility is the personalisation fund which provides additional funding to support service delivery. The immediate availability of funding was seen in stark contrast to the bureaucratic and lengthy process in the resource-constrained public sector where funding – even for small additional items – can be challenging to access.

5. Dedicated resources for collaboration and shared outcomes focus

   Previously, the scarce contract management function of the Council limited the ability to establish an infrastructure for collaborative working between providers. Moreover, the requirement to evidence ‘service utilisation’ was understood to fuel competition for referrals between providers.

   Collaboration across providers increased under the SIB commissioning arrangement. Resources and best practices are shared across providers. Vital for building a collaborative infrastructure has been the facilitation and coordination role of the social prime. In addition to having a dedicated resource, the multi-year funding allows stakeholders to build trusting relationships. Unlike the preceding fee-for service contract, providers no longer need to compete for resources to deliver the service. However, it is important to note that providers still compete for contracts beyond the SIB. Emergent evidence indicates that the goal alignment through shared outcomes fosters a sense of commitment and collaboration across providers.