Creating the conditions for co-production within an outcomes approach to
commissioning in Camden
By Lucie Stevens, New Economics Foundation
nef (the new economics foundation ) has worked with the London Borough of
Camden to develop an Outcomes Based Commissioning Model (OBCM). The OBCM
captures the additional value that can be gained by adopting an outcomes-based
approach to commissioning. The model achieves this by relating service-level
activities and outputs directly to the service-level outcomes that a Local Authority
aims to achieve through the provision of services, and then links these outcomes to
the wider policy objectives for the whole of the area. It values the wider economic,
environmental and social impacts of providers and captures savings over the life of a
contract helping to maximise benefits from all public spending. It can be easily
incorporated into commissioning and procurement processes across service
contracts and creates a coherent framework which can be applied to strategic
planning across services from in-house to competitively tendered provision.
In common with every local authority, Camden has identified and committed to
important outcomes for their whole populations, documented in its Sustainable
Community Strategy and Local Area Agreements. These outcomes are broader than
the direct outcomes sought by individual service teams, such as those responsible
for implementing Putting People First. However, the whole population focus of these
outcomes offers the opportunity to connect particular services into the wider
community, and to support community capacity building approaches to become part
of the mainstream.
Figure 5: Outcomes Based Commissioning Model
Commissioner &
Service User Priorities
Sustainable
Community Strategy,
Local Area Agreement
1.
2.
3.
4.
5.
Activity
Output
Service Outcomes
Wider
Community
Value:
- Social
- Economic
- Environmental
Outcomes
- Social
- Economic
- Environmental
National Outcomes
Framework
- Qualitative
- Quantitative
- Monetizable
Where value accrues:
-
the individual
the service
whole area
Wider Public
sector
Figure 5 illustrates the outcomes based commissioning model. Reading from left to
right across the framework it describes:

How activities and outputs (columns 1 & 2) delivered as part of the service
contribute to the desired service-level outcomes (column 3) established by
service-users, other stakeholders and commissioners.

How these service level outcomes relate to the areas wider community
outcomes (column 4) as reflected in the Sustainable Communities Strategy
and Local Area Agreement (social, economic and environmental outcomes).

How the council will monitor the additional value and benefits created
through the delivery of this service (column 5). Value can be measured in
qualitative, quantitative or financial terms. It is also recognised that value
will not just accrue to the service, but also to individuals and communities,
across the council, its partners and to the wider public sector.
Being able to describe services in this format explicitly:



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Links the commissioning process and service level activities to the wider
strategic goals for the area.
Takes an outcomes-based approach to commissioning services which
consistently focuses attention on achieving sustainability for all services i.e.
social, economic and environmental outcomes.
Incorporates an outcome-based performance framework for monitoring and
tracking outcomes.
Increases opportunities for innovation by moving to describing outcomes as
opposed to prescribing activities.
Embedding co-production in the outcomes based approach
Within the commissioning process for its Mental Health Day Services contract,
commissioners in Camden did not set out in great detail the activities which had to
be delivered by potential services providers. Instead, they made clear the total
financial value of the contract and explicitly set out its intention to procure services
that are co-designed and co-produced. This allowed potential providers to work
with local people and local resources to shape activities that were important to them
and would result in the outcomes set out. It was vital that co-production was
explicitly described in the service specification, so that this became part of the
subject matter of the service being contracted. This allowed commissioners to judge
tenders on the basis of their capacity to co-produce, incorporating this as part of the
value for money that they represent.
Defining co-production within the service specification is important for providers and
commissioners. The following text was used by Camden Borough Council in the
Mental Health Day Care Service:
‘We would encourage providers to adopt the model of ‘co-production’
whereby services are planned and delivered in mutually beneficial ways
that acknowledge and reward local ‘lay’ experience while continuing to
value professional expertise. Service users should be regarded as an
asset and encouraged to work alongside professionals as partners in the
delivery of services.
Co-production requires professionals and service managers to move out
of traditional roles as ‘experts’ and ‘providers’ into partnership models
that work with ‘clients’ and ‘communities’. This enables them to find a
solution together to the complexity of their problem and sometimes
requires that the ‘problem’ be redefined. Real and lasting changes are
possible with approaches that build or strengthen social networks and in
turn motivate people to learn about and exercise their powers and their
responsibilities as citizens. Networks of friends and families should also
be considered positive co-contributors to success in this approach.’
Prompts were also included in Camden’s service specification to provide guidance
about the type of activity that would encourage co-production and community
capacity building within services. In Camden these included:
Increase community participation
 To facilitate access to and involve existing community resources and
networks as a core element of the services
 To increase the capacity of community resources and reduce stigma
and discrimination in order to enable service users access to
mainstream services and facilities
 To build new social networks
Improve social inclusion
 to encourage and facilitate opportunities to extend positive social
networks
 to enable users to build positive social networks outside service settings
Maximise involvement of users and carers
 to maximise the use of the experience of those with a personal
experience of services
 to encourage and involve user and carer involvement in designing and
delivering services, including those who may not be using existing
services because they find them inaccessible or unacceptable
 to encourage people who are not accessing current services and
increase the extent to which services are led and run by people with an
experience of services themselves
In order that commissioners were able to track and evaluate the extent to which coproduction is proposed within tenders they included targeted questions against
which to assess potential providers capacity to co-produce services. The responses
to these questions were included and judged within the scoring process (within the
‘quality’ aspect of the tender). The questions included;

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

How does your service identify and mobilise service user’s strengths? Please
illustrate your answer with reference to previous contracts.
How does your service support people in finding ways to help/ support
others, including fellow service users, family, neighbours and the local
community. Please illustrate your answer with reference to previous
contracts.
What role do you envisage for service users’, carers, family, peer group,
neighbours and the wider community in the provision of your service. How
would this contribution be measured or rewarded?
What work will your service play in engaging other statutory and nonstatutory agencies in enhancing service users’ well-being? Please illustrate
your answer from previous experience.
The winning tender was a consortium of Camden based third sector organisations,
MIND in Camden, Holy Cross Centre Trust (HCCT) and Camden Volunteer Bureau, a
mainstream volunteering organisation. The consortium advocated a co-production
approach to running the service, which uses time banking1 and peer support
approaches to create a mutually supportive network of people in and around the
providers.
By treating service users and the wider Kings Cross community as potential assets,
rather than as passive recipients, the consortium delivering Camden’s day care
services has been able to leverage previously invisible or neglected resources – the
capacities and knowledge of service users and the wider community itself, who
provide support to each other, anything from advice to gardening and lifts. It has
enabled the consortium to focus on the broader social, environmental and economic
aspects of the services, as well as to focus on preventative work that encourages
independence and inclusion in mainstream community activity amongst those
dealing with mental health issues2.
The OBCM is an approach which identifies ways in which more sustainable, joined-up
procurement can help the Council to meet multiple social, environmental and
economic goals via its procurement processes. Applying the OBCM also results in:
Stimulating Innovation: By focusing on desired outcomes, the OBCM opens the space
for innovation, allowing providers and people using services to bring their own
unique added-value to designing and delivering the service. The process supports
providers to work in partnership with commissioners and service-users, building on
their assets as well as meeting their needs, using a ‘co-production’ approach.
1
For more on timebanking see http://www.timebanking.org/ and http://www.justaddspice.org
Harrington, R. and Ryan-Collins, J. (2009) Users as producers: innovation and co-production in
Camden. In Parker, S. (Ed) ‘More than Good Ideas’. London: IDeA.
2
Value for Money: By focusing Council spend on the longer term economic,
environmental and social outcomes it is seeking commissioners will maximize the
impact of every pound spent. This will enable them to find more effective ways of
delivering services including building in preventative approaches, saving money and
improving outcomes for local citizens. The valuing component of the model will
explicitly capture the savings achieved through delivering the service over the life of
the contract and highlight where savings are generated for other services. In so
doing, the OBCM will enable commissioners to better demonstrate the longer term
Value for Money their services are achieving.
Achieving better outcomes: Clearly identifying the outcomes sought and how they
will be measured and monitored throughout the contract period will result in a body
of evidence that supports continuous improvement and helps drive innovation in
other services. The involvement of service-users in the design and delivery of the
service and in the monitoring process will enable better and broader understanding
of the value of the changes supported by services.
Camden is now using the outcome model with a home care service for people with
dementia worth £3 million over three years and will be using it across all of their
Supporting People and related social services. The total contractual value of services
employing the outcome model between 2008 and 2010 is approximately £30
million3.
3
Reference Camden’s Outcomes document for ADASS 2008