The EQ Guest Speaker: Dr Eleanor Carter

Outcomes-Based Commissioning and improved public services

We were delighted to welcome Dr Eleanor Carter as our second EQ guest speaker. Eleanor is Research Director for the Government Outcomes Lab at the Blavatnik School of Government, University of Oxford. Eleanor’s research investigates challenges in coordinating and stewarding complex public service delivery networks and collaborations. Before moving to Oxford, Eleanor worked as an advisor for the Social Investment and Finance Team in the UK’s Cabinet Office and undertook collaborative research projects with the Department for Work and Pensions. Eleanor’s key research outputs have been translated into policy submissions and Eleanor frequently advises on policy design and evaluation strategies for government departments and voluntary sector organisations.

In her presentation to The EQ, Eleanor spoke about the history of commissioning for outcomes in public services, including the Work Programme of the early 2010s. The programme was a pioneer in outsourcing public services, but its performance failed to meet expectations. Her research into this has led Eleanor to propose a new research framework over three layers: the market level, the organisational network level, and frontline staff and citizens. Importantly, she proposed that for public services to improve social outcomes and meet complex needs, there should be a collaborative network at play rather than just a single provider.  

Eleanor talked about the interplay between the ‘What Works’ agenda of evidence-informed policy and outcomes-based commissioning. A positive of outcomes-based commissioning is that it necessitates the creation of at least some evidence and gains a sense of whether an outcome is being achieved.

 In outcomes based contracting they pay incredible attention when programmes don’t deliver against intended outcomes. If you put a high fidelity intervention in an outcomes based contract and we see that performance isn’t what we expected compared to the trial evidence, questions will be asked – where is the implementation going wrong? Why doesn’t our evidence hold here? It creates interesting conversations around wider adoption of evidence and a more critical take on when evidence hits the road in public service delivery.

Eleanor also examined the pros and cons of the ‘payment by results’ strategy in outcomes-based commissioning. The hope was that payment by results could unleash innovative interventions when delivering outcomes, but this total radical innovation is absent. Eleanor explained how payment by results can encourage perverse practices where organisations can cherry pick or ‘cream-skim’ in order to service the contract. Some voluntary organisations say however that the focus on outcomes made them think critically about their performance and whether their services deliver meaningful outcomes. Eleanor stressed the need to find a durable intervention for the long term and to appropriately price outcomes.

There are different levels of incentive to put rocket fuel under something totally innovative… but we do not yet have systematic evidence on the way in which different commissioning structures work.

In the Q&A session, a discussion arose on how evidence-based policy and outcomes-based commissioning could be implemented within Local Authorities. Eleanor concluded “What counts as a meaningful outcome has typically been a top down approach… A bottom up and collaborative approach working with people to help define what a meaningful outcome would look like could have a more subtle consideration of outcomes.”

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