Milton Keynes Council
Joint Commissioning and Contracts Team
Outcome Monitoring Process Guidance
March 2013
Joint Commissioning & Contracts Team
Issue Date: March 2013
Review Date: March 2013
Introduction
The Contract Monitoring framework has been developed to monitor the performance
and impact of social care and health service providers in Milton Keynes. This is a
general framework covering a wide range of services from meals on wheels provision
to learning disability residential services.
The Outcome Monitoring process will form a part of the overall Contract Monitoring
Framework and will be returned to us on an annual basis.
The Joint Commissioning team are under increasing pressure to deliver and
demonstrate the impact of adult social care and health services. The Adult Social
Care Outcomes framework 2013/14 states that outcomes “…measure how well
support achieves the things we would expect for ourselves, our friends and relatives”
Outcomes Monitoring examines the impact support services have on users, ensuring
that their quality of life has improved, that they are treated with dignity and respect
and supporting them to keep well and remain independent for longer. Outcomes
information allows people to see the impact of services on individual users and in
turn communities against a set of measures making providers and local
commissioners responsible for the quality of care provided. Outcomes at community
level can be for example, people feeling safer and living healthier lifestyles whilst on
an individual level this can be related to a person improving certain aspects of their
lives e.g. attending training courses to enhance their employability skills etc.
Adult Social Care & Health Outcomes Framework
The alignment and cross over’s between the Adult Social Care, NHS and Public
Health Outcomes Frameworks 2013/14 aim to demonstrate joint contribution and
commitment to the improvement of health and social care outcomes. The
frameworks identify various overlapping and complimentary domains (see appendix 1
for table of all domains) all aimed at delivering outcome measures to demonstrate the
achievement of adult social care support. Overarching outcome measures under
these domains largely include:
Social care related quality of life:
ASCOF - service users managing their own support, in control of what, where and
when they receive support / service users supported to maintain a family and social
life and avoid loneliness and isolation
NHSOF – ensuring people feel supported to manage their condition / improving
functional ability in people with long term conditions / enhance quality of life for
carers, people with mental illness and dementia
PHOF - Successful completion of drug treatment / People entering prison with
substance dependence issues who are previously not known to community treatment
/ self reported wellbeing / Falls and injuries in the over 65s / Social connectedness
Joint Commissioning & Contracts Team
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Issue Date: April 2013
Review Date: March 2014
Permanent admission to residential and nursing homes, per 1,000 population:
ASCOF - Everybody has the opportunity to have the best health and well being
throughout their life / everyone can have access to support and information to help
them manage their care needs/ earlier diagnosis, intervention and re-enablement so
that people are less dependant on intensive services / care or support is received in
the most appropriate setting to enable people to regain their independence
NHSOF – Helping older people to recover their independence after illness or injury
PHOF - People in prison who have a mental illness or significant mental illness /
Hospital admissions as a result of self harm / Hospital admissions caused by
unintentional and deliberate injuries to under 18 year olds / Alcohol related hospital
admission / Falls and injuries in the over 65s
People who use social care are satisfied with their experience of care and
support services:
ASCOF –Service users feel they are respected throughout the care process / users
are aware of locally available choice of services / people know what they are entitled
to and who to contact when they need help
NHSOF – Patient experience of primary care / improving experience of outpatient
care / improving access to primary care services / improving women and their
families experience of maternity services / improving experience of care for people at
the end of their lives / improving experience of healthcare for people with mental
illness
The proportion of service users who feel safe:
ASCOF – Everyone enjoys physical safety and feels secure / people are free from
emotional abuse, harassment, disease and injury / people are supported to manage
risks and plan ahead
NHSOF – Reducing incidents of avoidable harm / improving safety of maternity
services
PHOF - People with mental illness and or disability in settled accommodation /
Employment for those with a long-term health condition including those with a
learning difficulty / disability or mental illness / Domestic abuse / reoffending / older
people’s perception of community safety
These overarching outcomes will be expanded and reflected in individual service
performance indicators. Whilst Service Performance Indicator data will provide
valuable quantitative information as to how the service is performing and what the
service outputs are, outcomes information will provide qualitative information about
the real impact services are making to service users and in turn the community. Due
to the complex and diverse nature of outcomes, we will need to give consideration to
how we can measure them and apply innovative approaches to how we support
service users in achieving them.
Joint Commissioning & Contracts Team
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Issue Date: April 2013
Review Date: March 2014
Defining Inputs, Outputs and Outcomes:
Input is defined as: “what is put in, taken in, or operated on by any process or
system:1” In terms of Adult Social care services, inputs will be the resources required
to provide a lunch club service for example, contract funding, staff time, equipment,
produce and the provision of accommodation etc.
Output is defined as: the amount of something produced by a person, machine, or
industry etc.2. In terms of Adult Social care services, outputs will be the number of
people who have attended the lunch club in any given month / year etc.
Outcome is defined as: a result or effect of an action, situation, etc3. In terms of Adult
Social care services, outcomes will be the effect of the outputs for example, the
impact of using the lunch club services on the service user such as enhancing social
inclusion, partaking in community activities outside of the lunch club service etc.
The Milton Keynes Outcomes Approach:
The Milton Keynes Outcomes Monitoring process has been developed to
demonstrate how services we commission have helped improve outcomes for
service users against the domains derived from the ASCOF, NHS and Public health
frameworks as below:




Enhancing quality of life for people with care and support needs
Ensuring that people have a positive experience of care
Safeguarding adults whose circumstances make them vulnerable and
protecting them from avoidable harm
Delaying and reducing the need for care and support
We are defining outcomes as: The changes service users make as a result of your
activities. These changes can take many forms and can take place in many different
areas of a person’s life. They can be recorded using measurable actions such as
registering with a GP or they can be less visible changes such as an increase in self
confidence.
The outcomes approach should become a daily part of working with service users; it
is about working to a constant cycle of recording, planning, delivery, review and
service improvement. This activity should result in service users “attaining” scores
and “maintaining” scores.
At the Start…
Recording: This involves working with a new service user to discuss their needs and
support issues. You can then agree and record their initial / existing scores against
various outcomes (select appropriate tool) before they begin using your service.
These scores can be used as a baseline to measure progress or ‘distance travelled’
1
http://oxforddictionaries.com
http://oxforddictionaries.com
2
http://dictionary.cambridge.org/
2
Joint Commissioning & Contracts Team
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Issue Date: April 2013
Review Date: March 2014
whilst receiving support form the service you provide. This will help service users
answer the question “what can this service do for me?
Example:
Employment
Service User
Reference
1
Start Date
1/1/13
End Date
30/9/13
Initial or
Existing
Score
Exit./Review
Score
1
3
In the Middle…
Planning: This involves analysing their outcome scores and delivering a tailored
support and service package to specifically meet their needs in order to enhance
their strengths and support areas of weakness.
Service Delivery: This involves delivery of the tailored support and care package to
the service user ensuring they are involved in how and when they receive support.
Service User Review: This involves re-assessing outcome scores either at the end
of their time with your service or at review stage to examine how if at all the service
has impacted the user (maintain score). This could be that the service user
maintains, improves or has deteriorated in their initial scoring against the outcomes
selected. If the score has deteriorated, it may be necessary to alter the support plan /
package to focus on these specific areas more. If scores remain static, it will be up to
the key worker / support staff and the service user to decide if this is a negative or
positive outcome. This will help service users answer the question “How am I doing?”
Service Improvement: This involves adjusting the service and support received in
order to yield better outcomes from the user
At the End...
Recording: This will involve either the final assessment before the service user no
longer requires support or the final assessment within the recoding year. This will
help service users answer the question “How did this service help me?”
Joint Commissioning & Contracts Team
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Issue Date: April 2013
Review Date: March 2014
The Outcomes Learning Cycle:
Attain
Score
Service
Improvement
Recording
Service User
Review
Maintain
Score
The
Outcomes
Monitoring
Approach
Planning
Service
Delivery
Although the Milton Keynes Joint Commissioning team have changed the way
services are monitored to a more outcomes rather than output focused approach, we
are not being prescriptive about how services capture this information. There are a
number of valuable outcome approaches adopted within adult social care and
support and it is up to the Provider to adopt the best fit tool for their service.
The below section shows a summary of some models used to capture outcomes
within adult social care services. There are many other valuable tools available.
Outcomes Tool:
The Outcomes Star
Description:
This tool has been developed to promote independent living and looks at changes
over time in relation to 10 areas that vary according to the specific star used. Each
area is scored from 1 to 10, with the lower scores being the crisis levels.
Headings:
General inclusions: 1. Motivation 2. Self care 3. Managing Money 4. Social Networks
5. Drugs and alcohol 6. Emotional and physical health 7. Physical health 8.
Meaningful use of time 9. Managing tenancy 10. Offending.
Further Information:
http://www.outcomesstar.org.uk/
Outcomes Tool:
Better Futures
Description:
Joint Commissioning & Contracts Team
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Issue Date: April 2013
Review Date: March 2014
Measures outcomes from housing support interventions. Recorded on a scale from
0-4 – with 4 being the crisis level. Users can be assessed at intervals to show
progress made.
Headings:
1. Accommodation 2. Health 3. Safety & security 4. Social economic wellbeing &
employment 5. Meaningful activity
Further Information:
http://www.ccpscotland.org/hseu/information/better-futures/Resources
Outcomes Tool:
Talking Points
Description:
Developed for use with adult service users and carers. This tool is used to improve
the service user’s quality of life by putting the user at the centre of a more
personalised approach.
Headings:
1. Feeling safe 2. Having things to do 3. Seeing people 4. Staying as well as you can
be 5. Living where you want / as you want 6. Dealing with stigma / discrimination
Further Information:
http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/
Outcomes Tool:
Adult Social Care Outcomes Tool (ASCOT)
Description:
This toolkit aims to measure improvements in outcomes for service users using a
variety of techniques such as questionnaires, interviews and observation.
Headings:
1. Changes over time 2. Current and expected situation in the absence of a service
3. expected gain from service use 4. Capacity of individuals to benefit from a service.
Further Information:
http://www.pssru.ac.uk/ascot/
Outcomes Tool:
REACH Standards in Supported Living
Description:
This is a tool developed for people with leaning disabilities to enable them to check
the quality of their own support and housing.
Headings:











I choose who I live with
I choose where I live
I have my own home
I choose how I am supported
I choose who supports me
I get good support
I choose my friends and relationships
I choose how to be healthy and safe
I choose how I take part in my community
I have the same rights and responsibilities as other citizens
I get help to make changes in my life
Further Information:
http://www.personalisedsupport.co.uk/ui/content/content.aspx?ID=465
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Issue Date: April 2013
Review Date: March 2014
How to use the Outcomes Tool:
Regardless of which tool you chose to use, the process of assessing and recording
initial scores should never be rushed and service users should be involved in each
step:








Service users should be given a full briefing on what each element of the tool
means, how it relates to their life and how the scoring is assigned.
Each score should be assigned based upon detailed discussion between the
service user and support staff.
Always work with and engage the service user in discussions, using their
views to inform the final scoring decision. It may also be helpful to record the
reason for the scoring or associated evidence e.g. missed or maintained
consecutive appointments or meetings. This will be especially useful if there is
disagreement about the final score.
It may be helpful for the service user to provide them with a copy of their final
scored tool for their own review and reflection.
Work with the service user to identify a suitable timeframe to review scores
e.g. 3 months, 6 months etc.
The outcomes approach should be a collaborative process, however, if the
service user is unwilling to engage it might be useful to discuss with them the
possible reasons why, alternatively support staff may complete the form noting
that the scoring is only their view of the service user and you may discuss it
with them at a subsequent session.
There will be various areas to discuss within any outcomes tool used, if the
service user is unwilling to discuss certain aspects, then again, the support
staff may wish to include a score according to their own view of the service
user and discuss it with them at a later time. In these instances it will be useful
to note all the reasons and any evidence to corroborate the scores chosen.
Due to the discussions between the service user and support staff in forming a
view of where they score, there may be times when there is disagreement. In
these instances it will be necessary to listen to the service users views and
reasons why they believe they meet the score they have chosen. In this
instance, take into account the current situation (new service users may be
more optimistic etc) and aim to reach a joint conclusion. Where none can be
reached, support staff may include their own scoring with details and evidence
as appropriate.
Remember, all scores are fluid and are a reflection of the service users situation at
the time of the assessment. There may be instances when scores do not change
regardless of support and services in place; this may not always be a negative
outcome for the service user. Each user is different and will need to travel at their
own pace in order to make real change and progress.
Joint Commissioning & Contracts Team
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Issue Date: April 2013
Review Date: March 2014
Outcome Monitoring Submission Form
Please see Outcomes form for further guidance.
Please only complete the coloured cells when inputting into the form.
Outcomes Information sheet
Provider Name – the name of the service provider as recorded on the
contract/agreement between Milton Keynes Council and the service provider.
Service Name – the name of the service the provider is reporting against.
Service Manager – the name of the responsible individual for the overall
management of the service.
Job Title – the job title of the responsible individual for the overall management of
the service.
Service Address – the address where the service operates. For services that are
delivered in the service users own home, please provide the address of the office the
service operates from.
Post Code - the post code for the service address.
Telephone, E-mail – the telephone and e-mail address of the service manager.
Section 1: Service Level Outcomes
Average Score – This is a pre-populated average outcome score, based on the
service user data in section 2. An average score will be produced for both the initial
and the final outcome scores
Section 2: Outcomes data
The worksheets are separated into two different types. These are “Attain” and
“Maintain”. The Attain sheet is aimed at short term services which will have a
duration period of no more than 2 years for example: information and advice
services, lunch clubs and Home improvement services. The “Maintain” sheet is
aimed at longer terms services where scores are likely to change and have mid point
reviews such as those with duration of over 2 years for example: Long term
Accommodation based services.
Services with a High Number of Users– Sampling Approach
Outcome information should be collected for all service users in receipt of a Milton
Keynes Council funded service. For services with a large number of service users
(generally 500 or over), providers only need to submit outcomes data for a sample
10% of their service users who have left the service. In order to obtain this sample,
at the beginning of Quarter 1, please send a list containing the service user ID
numbers for all service users who have left the service in the previous financial year
to: [email protected]
Joint Commissioning & Contracts Team
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Issue Date: April 2013
Review Date: March 2014
The Contracts and Commissioning Team will then select a sample of 10% and will
let you know which service users you need to submit outcomes data for.
Service User Reference: This is the section that is specific to the service user.
Providers will need to assign each service user with a unique “service user
reference” this is so that regardless of the length of stay or use of the service (day –
years), each user can be tracked and traced back to their original scores.
Outcome 1
Service
User
Reference
1
Start
Date
10/4/12
End Date
13/10/12
Initial or
Existing
Score
5
Exit /
Review
score
8
Initial / Existing score & Exit / Review score:
This is where the Provider will enter the initial or existing score and the exit or review
score for each outcome measured.
Start & End Date: The provider will then insert the start date for the user along with
the end date. This indicates the duration of utilisation and the period in which the
service had to make an impact on the user.
As scores are entered, the change value for each outcome will be automatically
populated at the end of the table to show distance travelled. There is also a column
for provider or service user comments to be added if further explanation is required
for a particular outcome.
Case Studies:
The final tab of the Outcomes Workbook is called “Case Studies” This section should
be used by Providers to mention and reference any specific and exceptional service
users who have made significant progress or experienced significant change to their
behaviour, confidence, support requirements or other factors. It is important to
reference each case study to the unique service user reference so that we may trace
users back should there be further questions from the Contracts & Review officers.
It involves using the same Service User reference number as from the previous
sheets, so that users are easily identified should further information be required.
Details of case:
Details of changes
taken place /
Outcome
Baseline
examples of
Service
Service Service referenced (Start
End
improvements /
User
Start
End
in case
Date)
Date
changes / progress
Reference Date
Date
study
scores
Scores etc…
Joint Commissioning & Contracts Team
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Issue Date: April 2013
Review Date: March
Service start and end dates will also be required to show the duration of the service
user and the length of time within which changes or progress can be made. If the
service user is an ongoing / long term then leave the end date blank.
Please provide as much relevant information about the service user as possible in
the “Details of case” section, if this column is not enough to provide sufficient
information, please provide any / all relevant information within an email to the
Contracts Review Officer. The type of information we would be looking for under this
section would / could be support plans, case notes, service user notes or feedback,
examples of changes in behaviour or support requirement, family/friends / other
feedback etc… It would be helpful to receive any/all supporting information and
evidence of the service user’s progress and change. This information will be used
throughout the contract monitoring process and will help form a picture of how well
your service is performing alongside the monitoring data and QAF assessment.
Please Note: Please ask the service user for their permission if submitting personal
data / pieces of work / information before sending it to us.
Monitoring Support
For any queries or support with any aspect of the monitoring framework please
contact the designated Contract and Review Officer as identified on the contract
page of your workbook. Alternatively, please contact the Joint Commissioning and
Contracts Team on 01908 253558 who will put you in contact with the most
appropriate officer.
Outcomes Data Submission
If there are any issues or difficulty in submitting the information by the due date, the
Provider should contact the team as soon as possible in order for us to provide the
relevant information and support for you. If no data has been submitted by the
agreed due date, three attempts will be made by the Joint Commissioning Team to
follow up and chase information over the course of an additional 30 days. 30 days
after the final due date the Provider will be informed that submissions will no longer
be accepted and that lack of this quality information will be logged and this will most
likely impact the Provider / service risk score and future contract monitoring level /
arrangements. All decisions made and actions taken will be in joint consultation with
Commissioners.
Appeals
If providers feel the outcome they receive is not an accurate reflection of their
service, they may make an appeal. All appeals should be in writing to the Head of
Contracts within 14 days of receipt of the validation outcome letter.
Joint Commissioning & Contracts Team
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Review Date: March
Appendix 1 – Table of Framework Domains
The Adult Social
Care Outcomes
Framework
(2013/14)4
Enhancing quality
of life for people
with care and
support needs
The NHS outcomes The Public health
framework
outcomes
5
(2013/14)
framework
(2013/14)6
Preventing people
Improving the wider
from dying
determinants of
prematurely
health
Domain 2
Delaying and
reducing the need
for care and
support
Enhancing quality
of life for people
with long term
conditions
Health
improvement
Domain 3
Ensuring that
people have a
positive experience
of care
Helping people to
recover from
episodes of ill
health following
injury
Health protection
Domain 4
Safeguarding
adults whose
circumstances
make them
vulnerable and
protecting them
from avoidable
harm
Ensuring people
have a positive
experience of care
Healthcare public
health and
preventing
premature mortality
Domain 1
Domain 5
Treating and caring
for people in a safe
environment and
protecting them
from avoidable
harm
4
The Adult Social Care Outcomes Framework 2013/14 – Department of Health
The NHS Outcomes framework 2013/14 – Department of Health
6
The Public Health Outcomes Framework 2013/14 – Department of Health
5
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Issue Date: April 2013
Review Date: March
Appendix 2 – Types of services
Type of Service
Building Based Services
Day Service
Extra Care Sheltered
Housing
Home Support
Long Term
Accommodation Based
Service (over 2 yrs)
Lunch Club
Meals on Wheels
Personal Budgets
Respite/Rehab/Short
Term Intervention
Short Term
Accommodation Based
Service (up to 2yrs)
Description
These are services that do not offer accommodation as
part of the care/support they provide. They typically
include information and advice services, drop-in clinics
etc.
These services include day (or drop – in) centres which
provide activities, learning opportunities, events,
excursions and lunches. Provision may also include
advice, for example, regarding benefits or just the
opportunity to spend time with other people.
Self contained apartments available to rent/lease for
older people. Care workers are on site to provide care
to persons in receipt of a care package or to other
residents in emergencies. Nursing care may also be
provided via onsite staff or through services such as the
District Nursing service. Some communal facilities,
such as a laundry or restaurant may also be available.
These services offer care and/or support to people in
their own homes. They may provide personal care such
as bathing, dressing and assistance with preparing
meals or support to help people stay in their homes.
Service users may vary and the care or support could
just be for a few hours or 24-hour care.
Service users at this service have a tenancy and are
expected to use the service for over 2 years. Such
services would include sheltered housing.
These services provide a meal and opportunity to
socialise and typically last up to 4 hours.
A service that provides hot/cold meals to people in their
own homes.
These are services that offer help to individuals with
personal budgets. This may include taking people
shopping, supporting them to take part in leisure
activities etc.
Short term accommodation based services offering
care and support typically lasting up to 6 weeks per
episode.
These services offer licensed accommodation and
typically provide housing related support for up to 2
years.
If the service provided cannot be identified using the list above then please contact
your Contract and Review Officer.
Joint Commissioning & Contracts Team
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