A new NHS owned company overseeing an £800m integrated older people’s services contract will have to hit outcomes based targets to secure up to 15 per cent of its income, its chief has told HSJ.

  • At least 10 per cent of UnitingCare Partnership’s income is based on outcomes from 2016-17
  • Previously confidential outcomes based arrangements revealed to HSJ
  • Company faces demographic and efficiency challenges to deliver services

Keith Spencer, chief executive of UnitingCare Partnership, said the proportion of income based on achieving specified outcomes agreed with Cambridgeshire and Peterborough Clinical Commissioning Group would taper upwards over the five year deal.

The company, a limited liability partnership, was established by Cambridgeshire and Peterborough, and Cambridge University Hospitals foundation trusts after they won a tender last October for the largest NHS outcomes based contract to date.

It took over services on 1 April. Until now the outcomes based arrangements have been confidential.

Mr Spencer told HSJ: “In years two and three around 10 per cent of the contract will be at risk and in years four and five it’s 15 per cent.”  

However, none of the company’s income this year will be based on hitting outcomes targets. He said 2015-16 would be a “bedding in year” to allow all parties to work through any practical issues with the new arrangements.

The outcomes based framework the provider will be judged against is split into seven domains: patient experience; safe care; quality care; prevention; urgent care; long term care; and end of life care. Within these there are 62 indicators.

UnitingCare has also set out a series of new services it says will improve clinical outcomes, and patient and staff experience. These include:

  • new neighbourhood teams to bring together community health, mental health, acute care and third sector providers, for the first time, into teams “built around general practices in local neighbourhoods”;
  • a new “OneCall” service: a 24/7 single point of coordination, provided by South Central Ambulance Service FT, which GPs or local clinicians can contact to arrange for urgent care for people most at risk of admission; and
  • a 24/7 urgent care, community based rapid response service, called the joint emergency team, will be provided by Cambridgeshire and Peterborough FT.

UnitingCare faces a significant challenge to deliver the services within a tight spending envelope. A number of private providers, including Capita and Circle, withdrew from the tender process because of the steep efficiencies implied by the contract, as reported by HSJ in October 2013.  

Keith Spencer

Income will taper upwards over the five year deal, Keith Spencer said

The efficiency challenge is largely because of Cambridgeshire and Peterborough health economy’s rapidly rising population, and notably for UnitingCare, those over 65-years-old.

The area is part of the “challenged health economies programme” launched by NHS England and its arm’s length body partners in February last year.

A report by PwC, published in September and funded by the programme, concluded that the health economy was not financially sustainable and faced a gap of at least £250m by 2018-19. The rising cost of providing care for more older people was expected to be a significant part of this.

Neither the company nor CCG would tell HSJ how the critical contractual arrangements would work to deal with the demographic pressures.

A statement from the clinical lead for Cambridgeshire and Peterborough CCG’s older people’s programme, Arnold Fertig, said: “Assumptions about population growth have been factored into the contract. There are also mechanisms in place to handle any variations from this forecast.”

Diane Bell, director of insight at consultancy Cobic, which has been advising on a number of the early outcomes based contracts, said it was one of the more ambitious projects in train.

She said: “The fact the outcomes based part of the contract goes up to 15 per cent is really encouraging. The ageing demographic means that productivity gains will be harder to achieve in years four and five than in the early years, so even keeping it at 5-10 per cent would have been challenging. Going up to 15 per cent shows that they are really confident that the quality improvements can be made.”