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Poster Abstracts

Counting Sheep - the journey to outcome based commissioning


Jane Stairmand ,

Eastern Cheshire Clinical Commissioning Group, GB
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Bernadette Bailey

Eastern Cheshire Clinical Commissioning Group, GB
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The Eastern Cheshire Transformation Programme, Caring Together, required a light touch, unrestrictive approach towards monitoring performance that did not stifle innovation by those providing care. So, the programme took its inspiration from sheep. Everyone knows sheep like to follow. Put a bell round the neck of one sheep, a Bellwether, and all the others will follow. We developed an outcome framework which contained a small number of Bellwether Indicators. The development of the framework was led by the lead care professionals in order to identify those outcomes and indicators which would truly identify whether the right care was being provided by the right person at the right time.

The initial phase of the Programme focussed on the co-creation, with the public, patients and system stakeholders, of the Caring Together Ambitions, Vision and Values. The purpose of the framework was to oversee the achievement of the programme ambitions. In order to do this, all the existing national frameworks were aligned to the ambitions. These were then reviewed and those that helped to tell the story we were trying to tell were shortlisted. It was essential that each ambition included system wide indicators (public health, social care, mental health and physical health). The shortlist was presented to the Care Professional Advisory Group who were asked, for each ambition, which one indicator was to most important and thus the Bellwether Indicators were born.

So how was the framework intended to be used? A dashboard was created containing the Bellwether indicators. Initial versions did not contain any data, purely the RAG ratings for each indicator, to ensure they were not viewed in isolation and were telling a story. These culminated into an overall RAG for each ambition. If the ambition RAG worsened, this would trigger a deep dive into the indicators sitting underneath. The aim was to change people’s mind-sets from focussing on the numbers to focussing on change. The dashboard was used by Programme Board as a tool to track the Programmes progress towards delivering its ambitions.

In 2017, Eastern Cheshire prototyped the Care Communities model within two of its General Practice locality areas. The model has now been rolled out into all five locations and with this there is a need to monitor their impact. The Caring Together strategic level outcomes framework has now been translated down to delivery level incorporating sub-outcomes which contribute to the delivery of the strategic outcomes. This has again been developed working with the lead care professionals in each of the localities and a dashboard has been developed which includes delivery Bellwether indicators. A number of indicators within the dashboard use information from the Risk Stratification tool which has now been adopted and is used to inform commissioning decisions within the CCG to target care.

Commissioning for outcomes is being adopted within Eastern Cheshire CCG as standard practice. Outcome frameworks are the focus for monitoring progress of numerous programmes and specifications including RightCare, QIPP, the General Practice Service Specification and the newly developed Care Communities Specification.

How to Cite: Stairmand J, Bailey B. Counting Sheep - the journey to outcome based commissioning. International Journal of Integrated Care. 2019;19(4):363. DOI:
Published on 08 Aug 2019.


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