The whole focus of outcomes based commissioning is that it will reward providers for improving
wellness, improving the care pathway, improving recovery across all care settings for a particular
patient population.
There really isn't a blue print for outcome based commissioning I know we'd all like to
think there was but there isn't.
It really is an experiment and for the NHS it's a very new experiment.
The theory of outcome based commissioning is still pretty elusive and the translation
of the conceptual into the granular is also pretty difficult for us to get right.
So what we've been doing is looking internationally to see whether we can learn lessons from those
who've actually done it, who've gone on that journey, and despite the fact that the NHS
is somewhat unique there are lessons internationally that we can draw from to help us build something
that is really practical and workable.
Some of those lessons cover how outcomes are measured, some cover how pricing and reimbursements
are implemented in a practical way and some cover, perhaps most importantly, will cover
the engagement of patients, carers and their families because that is at the heart of what
we are trying to achieve.
But for me, one of the most important things to appreciate and the lessons to be learned
from the international experience, is that change doesn't happen straight away.
If you implement one of these contracts you really can't expect the benefits to be realised
immediately or even within a year, or two.
It's a journey of change that the purchaser and the provider have to go along together.
And one of the key issues is the readiness of the provider to take on this new role of
managing a care pathway across the whole supply chain.
So, in the USA they have developed some tools for providers who want to take this role on,
to use to assess their readiness to take that journey and these tools are actually used
by purchasers as well to assess whether the providers are ready.
And the tools cover things like leadership and culture, the existence of clinical protocols,
operational protocols, business intelligence, analytics and so on.
Actually all the things you would probably expect you'd need in some kind of accountable
care-type contract arrangement.
The big thing for me though, and the one which I think is the really genuine barrier for
the NHS, relates to health information and electronic health records, and in particular
health information exchange between health and social care professionals, and patients
and carers, as the patient travels along that journey.
This isn't just about business intelligence, this isn't about just reporting metrics.
This is about a carer or a clinician sitting with the information that they need, that's
relevant to the decisions that they are currently taking about the patient's care, and embedding
that information within a clear clinical protocol and operational protocol, to manage the patient
population.
We are a long way away from that in the NHS.
There are very few examples of healthcare systems which have really got that in place
and almost none which involve social care.
So for me this is the biggest barrier and it's the journey that's going to take slightly
longer than one might reasonably wish it to.
Is it worth going on this journey?
It's quite a transformation that we are trying to achieve and it sounds terribly complex
to somebody who's used to the existing NHS and delivering care within that.
I think it is worth taking.
It's a big prize.
And I like to put myself in the position of a patient and how complicated the system feels
for them at the moment and how inefficient it is and how they can see the inefficiencies
and the sort of parallel universes that the various care settings and healthcare professionals
have to operate in, because of the way that we currently work the system.
So for me this is really about demystifying it for the patient, and if that means it's
a bit more complicated for the system to operate it, well, as I say, the prize is big.