Evaluation of NHS and Social Care Outcomes Frameworks for Monitoring Quality, Performance and Accountability in Integrated Care Systems

Evaluation of NHS and Social Care Outcomes Frameworks for Monitoring Quality, Performanceand Accountability in Integrated Care Systems
Outcomes Based Healthcare March 2019

• This report describes the output of an in-depth evaluation to assess the technical integrity of indicators used across 5 publicly available health and social care outcomes frameworks:
• The NHS Outcomes Framework (52 indicators)
• The Incentives Framework for ACOs – DRAFT (subsequently re-released in August 2018 as the Incentives Framework for ICPs - DRAFT) (41 indicators)
• The Quality and Outcomes Framework (77 indicators)
• The Adult Social Care Outcomes Framework (35 indicators)
• The CCG Improvement and Assessment Framework (69 indicators)
• This evaluation was carried out by Outcomes Based Healthcare, in partnership with Centene UK, between December 2017 and February 2018 to support Greater Nottingham’s transition to an ICS, but is applicable to any ICS.

Integrated Commissioning for Better Outcomes: a commissioning framework 2018

Integrated Commissioning for Better Outcomes: a commissioning framework 2018
LGA NHS Clinical Commissioners 11 April 2018

• A practical tool for council and NHS commissioners to support improving outcomes through integrated commissioning.
• The framework covers four areas: building the foundations; taking a person-centred, place-based and outcomes-focused approach; shaping provision to support people, places and populations; and continuously raising the ambition; and includes annexes giving further resources plus background on NHS and local authority contexts.
• Annex B: Guidance and tools for market shaping
• Annex D: Person-centred, place-based and outcomes focussed
• Annex E: Health and local government working together: the evolving policy landscape

The following principles for the framework have been agreed: 

• A focus on the benefits for the ‘3 Ps’: people, places, and populations, with the individual person at the heart of the approach. 

• A focus on outcomes over ‘episodes of care’. 

• Recognition that integrated commissioning needs to happen at multiple levels: with individuals and their families and carers; with communities; and across larger populations. 

• Awareness and acknowledgment that commissioning is about more than procuring services, it is about a wide variety of activities which improve the outcomes and the lives for people, places and populations. 

• Awareness that language matters and that words and concepts can have multiple meanings. 

• A belief that understanding and respecting our differences (of history, culture, legal responsibilities, and ways of working) enables us to work better together.

Consultation on new NHS England mandate

A consultation on the Government's mandate to NHS England to 2020
Department of Health, 29 October 2015

• A new mandate to NHS England will take effect from April 2016. The mandate sets direction for the NHS, and helps ensure the NHS is accountable to Parliament and the public.
• The new mandate will be based on the priorities this Government believes are central to delivering the changes needed to ensure that free healthcare is always there whenever people need it most. The priorities for the health and care system as a whole are: 
• Preventing ill health and supporting people to live healthier lives. 
• Creating the safest, highest quality health and care service
• Maintaining and improving performance against core standards while achieving financial balance
• Transforming out-of-hospital care, ensuring services outside hospital settings are more integrated and accessible. 
• Driving improvements in efficiency and productivity 
• Supporting research, innovation and growth
• Proposals directly affecting CCGs include: 
• New outcome measures at local CCG population level will complement the national NHS Outcomes Framework.
• CCG allocations will be set for three or more years. 
• A new scorecard, developed by The Kings Fund, will provide transparency about comparative quality of care and outcomes for different CCG populations to support work on reducing variations in quality of care and outcomes at a local level.
• Transforming out-of-hospital care through joined up care across all service levels incorporating a vision for a 7-day NHS and transformation of out-of hospital care using whole system approaches to ensure people get the right care in the right place at the right time. For 2016/17 this would also mean the continuation of the Better Care Fund.
•  New mental health access and waiting time standards to be embedded and expanded and crisis care to be improved for people of all ages. 
• A consultation on the mandate will run from 29 October 2015 to 23 November 2015. Find out more and respond to this consultation here.

How to measure the performance of local health systems

Measuring the performance of local health systems
Kings Fund 12 October 2015

• Following a review of approaches to measure the performance of health services within CCG areas, the Kings Fund makes a number of recommendations including:
• a radical simplification and alignment of existing NHS performance frameworks including merging of the three national Outcomes Frameworks into a single framework covering the NHS, public health and adult social care. 
• a small set of headline indicators are selected to present key performance information to the public with a larger set of indicators should be available to enable patients and the public to drill down into population groups and medical conditions of particular interest to them and to support commissioners and providers in quality improvement.
• a reduction in the national bodies involved in assessing performance
• a wide variety of data should be made available for the purpose of transparency

Follow progress on CCG five year plans

Levels of Ambition Atlas
NHS England

• As part of strategic planning for 2014/15-2019/20, CCGs set out five-year ambitions on seven outcomes indicators from the NHS Outcomes Framework, quantifying the improvement they could achieve for their local population,. This resource enables CCGs to view their outcomes baseline and trend data and compare data with like-CCGs. 
• It has been updated with 2013/14 data.

Levels of ambition atlas for local commissioners

Levels of Ambition Atlas
NHS England

• The Levels of Ambition Atlas is an interactive planning tool based around the NHS Outcomes Framework that enables local commissioners (CCGs and Local Authorities) to
• View their outcomes baseline and trend data for each of the ambition indicators at both CCG and Local Authority level
• Compare themselves to other local commissioners 
• View disaggregation of outcomes 
• Access the source data for all of the above.
• The atlas includes data to support Better Care Fund planning,
• See the latest  NHS Outcomes Framework indicators data on the NHS Outcomes Framework summary dashboard

Updated LA information packs

Local Authority information packs updated
NHS England 11 February 2014

• Compilations of high-level comparative information on the NHS, the Adult Social Care and the Public Health frameworks for local authorities. The packs provide Health and Wellbeing (HWB) partners with a quick and easy-to-use summary of their current position on outcomes.
• An interactive version of the CCG information is available from CCG Outcomes Tools

Adult Social Care Outcomes - ambitions, data and definitions

Adult Social Care Outcomes Framework 2014/15 
DH, November 2013, updated August 2014

• This report describes how the ASCOF should be used as a tool to support local improvement in care and support; provides a national commentary on adult social care outcomes in 2012/13; sets out the ASCOF for 2014/15; and outlines a forward look for the framework for future years
• The ASCOF measures how well care and support services achieve the outcomes that matter most to people. It aims to supports councils to improve the quality of care and support services they provide; give a national overview of adult social care outcomes in 2012 to 2013; and looks at how the framework will be developed in future.
• See how the local authorities are achieving these outcomes on the Adult Social Care Outcomes website. This website presents data on outcomes for adult users of local authority funded social
  care and support, including carers, for each local authority area. 
• Benchmark local authority areas against England, region and comparator LAs
• ASCOF handbook of definitions 2014 to 2015 published August 2014

Ambitions for the health service - NHS mandate and Outcomes Framework 2014/15

A mandate from the Government to NHS England: April 2014 to March 2015
NHS England, 12 November 2013

• The ambitions for the health service for April 2014 to March 2015 as based on the NHS Outcomes Framework

The NHS outcomes framework 2014-2015
DH, 12 November 2013

• The outcomes and corresponding indicators that will be used to hold NHS England to account for improvements in health outcomes, as part of the government’s Mandate to NHS England.

Public Health Outcomes Framework

Public Health Outcomes Framework Data Tool
Public Health England, Updated quarterly

• The tool allows you to:
• Compare one local authority against other authorities in the region
• Benchmark local authorities against the England average
• Indicators domains available 
• Health protection
• Improving the wider determinants of health
• Healthcare public health and preventing premature mortality
• Health Improvement

Developing skills across community care

Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values: A mandate from the Government to Health Education England: April 2013 to March 2015
Health Education England, 28 May 2013

• This mandate provides details of the strategic objectives of the Government in the areas of workforce planning, health education, training and development for which HEE and the LETBs have responsibility. It aligns with the mandate for NHS England and the Francis Report as well as the requirements of the NHS, Public Health and Social Care Outcomes Frameworks.
• This mandate aligns with the Education Outcomes Framework (EOF), which sets out the outcomes we expect from the reformed education and training system. 

Adult social care outcomes framework published

Adult Social Care Outcomes Framework 2013 to 2014
DH, 29 April 2013

• A tool  used to set priorities for care and support, measure progress, and strengthen transparency and accountability.
• The four domains are:
• Domain 1: Enhancing quality of life for people with care and support needs
• Domain 2: Delaying and reducing the need for care and support
• Domain 3: Ensuring that people have a positive experience of care
• Domain 4: Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm

NHS England business plan to 2016

Putting patients first: the NHS England business plan for 2013/14–2015/16
NHS England, April 2013

• This plan describes an 11 point NHS scorecard which NHS England will introduce for measuring performance of key priorities, focused on receiving direct feedback from patients, their families and NHS staff.

1. Satisfied patients
2. Motivated, positive NHS staff
3. Outcomes Framework – Domain 1 Preventing people from dying prematurely. (Improvement areas 1.1 – 1.7 of the Outcomes Framework )
4. Outcomes Framework - Domain 2 Enhancing quality of life for people with long term conditions. (Progress against Improvement areas 2.1 – 2.6 )
5.  Outcomes Framework – Domain 3 Helping people to recover from episodes of ill health or following injury. (Progress against Improvement areas 3.1 – 3.6 )
6. Outcomes Framework – Domain 4 Ensuring that people have a positive experience of care. (Progress against Improvement areas 4.1 – 4.9 )
7. Outcomes Framework – Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm. (Progress against Improvement areas 5.1 – 5.6 )
8. Promoting equality and reducing inequalities in health outcomes
9.  NHS Constitution
10.  Becoming an excellent organisation
11.  High quality fi­nancial management

•  Builds on earlier plan published Dec 2012
• Appendix 2 is a description of deliverables against key accountabilities across the NHS Mandate

CVD outcomes strategy

Cardiovascular Disease Outcomes Strategy 
DH, 5 March 2013

• Advice to local authority and NHS commissioners and providers about actions to improve cardiovascular disease outcomes in line with the NHS and public health outcomes frameworks.

Innovations aligned to outcomes

Catalogue of potential innovations 
Innovation Health & Wealth, March 2013

• A catalogue of innovations aligned to the five domains of the NHS Outcomes Framework.

Quality Premium update

Quality Premium: 2013/14 guidance for CCGs Final
NHS Commissioning Board, March 2013

• Guidance supersedes that published in December 2012
• The ‘quality premium’ is intended to reward CCGs for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities.
• The four national measures, all of which are based on measures in the NHS Outcomes Framework, are: 
• reducing potential years of lives lost through amenable mortality 
• reducing avoidable emergency admissions
• ensuring roll-out of the Friends and Family Test and improving 
• patient experience of hospital services
• preventing healthcare associated infections
  

How local authorities are improving health outomes

District Action on Public Health
District Councils’ Network 11 February 2013

• Information on district services and illustrative local authority case studies to demonstrate to member organisations, Health and Wellbeing Boards and CCGs how the activities of districts councils will improve health outcomes across the Public Health Outcomes Framework.

CCG Outcomes Indicator set

CCG Outcomes Indicator Set 
NHS CB, 18 January 2013

• The CCG Outcomes Indicator Sets (formerly known as the Commissioning Outcomes Framework) provide clear, comparative information for CCGs, Health and Wellbeing Boards and local authorities about the quality of health services and associated health outcomes.
• An  ‘at a glance’ table setting out the CCG Outcome Indicator Set has been published alongside the 2013/14 NHS planning guidance.

CCG and LA Outcomes benchmarking

Outcomes benchmarking support packs: CCG and LA level 
NHS Commissioning Board, Jan 2013

• The CCG level packs provide a detailed analysis of NHS outcomes and other relevant indicators. 
• The Local Authority level packs present high level comparative information on the NHS, the Adult Social Care and the Public Health Frameworks.
• Five Minute Digest: CCG outcome indicators - this article from Pulse gives a basic overview of how the new CCG outcome indicators will work (Subscription to Pulse required) 

Adut social care outcomes framework

Adult Social Care Outcomes Framework
DH, 23 November 2012

• A clear focus for local priority setting and improvement, and by strengthening the accountability of councils to local people.