Developing an outcomes framework for children and young people in Hampshire, England

Montague, Chloe, Pears, Robert, Hicks, Nicholas, Smith, Andrew, Cunningham, Eilidh, Bacon, Sallie and Alwan, Nisreen (2018) Developing an outcomes framework for children and young people in Hampshire, England. The Lancet, 392 (Supplement 2), S65. (doi:10.1016/S0140-6736(18)32889-7).

Abstract

Background

In the county of Hampshire, England, numbers of children and young people are increasing, along with a corresponding increase in demand for health and social care services. The move from measuring processes to measuring outcomes is motivated by a need to improve the population's wellbeing at this time of great challenge. Outcomes-based commissioning provides a means by which shared outcomes across the system can be used to drive quality improvement while ensuring the best use of finite resources. The aim of developing an outcomes framework was to improve the health and wellbeing of children and young people in Hampshire through articulating this collective vision and facilitating greater integration between health and care systems.

Methods

The outcomes framework was developed by Hampshire County Council's public health team, working with Captivated outcome-based incentivised care (Cobic), which provides consultancy services on outcome-based care, and Private Public Ltd (PPL), a consultancy for projects promoting health, wellbeing, and economic success in the UK. Development involved: reviewing evidence from key policy documents (eg, Every Child Matters and the Marmot report on the social determinants of health) and existing national and local outcomes frameworks; engaging children and young people (aged 12–19 years), families, services providers, commissioners, and other partners through about 20 separate focus groups, workshops, and interviews; populating the framework with baseline data; and testing and agreeing the finalised framework with a reference group comprising these stakeholders. Ethical approval was not required.

Findings

The framework has six domains: being healthy, staying safe, enjoying and achieving, making a positive contribution, being ready for adulthood, and system sustainability. Within each domain there are “I” statements reflecting service user priorities (eg, “I feel informed to make the right choices about drugs and alcohol”). Beneath the “I” statements are quantitative targets for system-wide improvement, such as hospital admissions for substance abuse. Through the engagement process, it became clear that feeling prepared for adulthood was an important theme for children and young people in Hampshire, leading to development of “I” statements and indicators to support this.

Interpretation

Our ambition is that the framework will become embedded within Hampshire County Council and the National Health Service, supporting both service improvement and integration efforts. This will encourage organisations to work together to address complex issues that are influenced by wider health determinants. A consideration of local drivers and barriers will ensure that any similar framework can be meaningfully adopted elsewhere.

Funding

None.

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Contributors

Author: Nisreen Alwan

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