Over the last couple of weeks we have been working with a unitary authority to help to identify ways savings can be made in services providing housing-related support to vulnerable people. These services are expecting a 10% cut in funding next year, and up to 20% over the next 3 years. That’s a staggering amount of money to take out at once. Efficiency savings will contribute to some of these savings (and providers have certainly highlighted areas in which there is plenty of opportunity to reduce administration and duplication), but we’ve had to be quite blunt and emphasise that trimming processes and activities isn’t going to add up to the savings required – decommissioning some services entirely is looking more and more likely.
This realisation hasn’t been easy for any of the providers involved, and understandably so – every service is providing valuable support to those most in need. However this is the world we are now in, and in this project, this means we have a duty to help the Council make the decommissioning decisions in a way that mitigates the impact on the most vulnerable in society.
Our starting point in these discussions with the Council and providers has been to look at which services are achieving the most significant impact on outcomes for the services users they are working with, but this has proved easier said than done. Huge amounts of data is collected by the Council about each service provided, however unfortunately this is predominantly output data such as number of units of support provided, number of people through the system, duration of support etc. Many providers collect their own data on the impact they are making using tools such as journey travelled by each client, but this is not done consistently by each provider or across the programme, which is now making it more difficult for the commissioning authority to make informed decisions about which services are having the most impact on improving outcomes for their residents, and so now more work is needing to be done to provide this picture. In part this is due to historic practices (‘we’ve always collected this information’) but it is also a result of the way in which the services were originally commissioned – on an output basis, not based on outcomes achieved for the clients.
The Council is putting in place plans to move to a more strategic commissioning approach which focuses more on these outcomes and gives providers more flexibility to do what they need to achieve these outcomes (we heard a maddening example of a lady that needed a replacement battery for her wheelchair but this wasn’t permitted under the contract so instead weeks of support was provided to get her around the city), but that doesn’t help achieve savings of the scale required for next April. Without this vital data on absolute and relative quality of service across the programme, cuts are likely to keep being made across the board, which is a blunt instrument that does a disservice to many providers and their clients.
For me this has served as a powerful reminder of making sure that any contract or service level agreement focuses on specifying and measuring the things that matter most to service users, and that officers monitoring services and contracts should have this same focus on outcomes, not outputs.