Outcomes and Transformation: the building blocks

Published: December, 2013


Michael Kitts and Dr Tim Wilson- Price Waterhouse Cooper

'The key to turning integrated care rhetoric into reality, first, is mindset.  Everyone needs to take an organisationally ‘agnostic’ view about existing arrangements, suspending current rules and mechanisms to establish a single vision for integrated care. All sides need to be working towards the same objectives across the whole care economy – with the patient or community at their heart – to achieve the outcomes they seek, as well as securing savings. 

But agreeing a shared vision for integration will only get you so far. Public sector commissioners need to create the right environment for providers to integrate and improve the quality and efficiency of services in order to manage demand with reducing budgets. This means exploring novel approaches to contracting, such as those being adopted in other countries, as well as increasingly in England, like contracts based on population outcomes.'


The clear and strong voice of service users is being listened to nationally and is a major driver for change – as are financial restraints and the limits of our thinking around human behavior, current social values and how society is organised…  Our government is working on  current issues  eg. why  our NEETs numbers relatively high? What happened in the London riots? What changes do we need to make? Are our children and young people safe? What happened with Baby P? What changes are needed? 

Much thinking has been done and much is changing all the time- below are links I hope you find useful -

 Outcomes Frameworks used to bring about Cultural Transformation  - pages 6-13 provides a straight forward explanation using Safeguarding Transformation as an example.

HOT TIP - use the language of parents, young people and children to articulate outcomes and measures

EXAMPLE   Young Person's Guide to Working Together to Safeguard Children 

This is what Young People said they want health visitors and doctors to do  to help keep them safe:

chat to parents –build up a relationship with them;

• communicate with social workers;

• call round out of the blue;

• look round the house and;

• look in the fridge and cupboards.

• tell people if they are  concerned and;

• do more home visits to see what the home is like.


The methods described in this  72 page document (includes many more hot tips) put alongside practical change programmes eg:

'Theory of Change' by Angela Kail and Christopher Lumley

- Focus on the goal (child, parent, family, community), 

-Show the causal links (how different aspects of your work fit together to reach the final goal)

-Reveal hidden assumptions,

-Base interventions on evidence, 

-Hear the service user voice and ensure those in decision making positions use it to inform service design

-Stakeholder views

-Measure Outcomes and

-Understand how different Outcomes are connected


Better Outcomes New Delivery uses ACE-V

Accountability - clearly defined purpose, clarity about the ways services are offered and interlink, monitor effectiveness through

governance, have clear and fast referral routes

Compliance - have safeguarding policies and procedures, have confidentiality policies and procedures, supervision standards,

staff training and qualifications

Empowerment - commitment to collaborative practice with service users- involving clients in decisions relating to their own treatment, involving clients in decisions relating to service development

Value - commitment to offer high value services - highlight unique features, evidence how the service is good value for money, evidence of how the service provides social value eg through case studies, feedback from formally audited standard review processes or graded accreditations, reference from current or past stakeholders or commissioners.


may enable us all to:

  • Put children, young people and their families at the heart of what happens
  • Act early and intervene at the right time
  • Know about local population needs and plan effectively
  • Create effective partnerships and networks - work collaboratively
  • Care for ourselves as professionals and enable relationship centred care
  • Maintain a golden thread of safeguarding for all children and young people



Outcomes that are mutual to key service providers - Every Child Matters Outcomes are probably the most readily available at the moment but we need to keep up with changes as they develop….. see http://www.every-child-matters.org.uk/home and keep in mind  5 key shared Outcomes - BE HEALTHYSTAY SAFE, ENJOY AND ACHIEVE, MAKE A POSITIVE CONTRIBUTION and ACHIEVE ECONOMIC WELLBEING…  


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