Community Services in Richmond

Transforming community services for 187,000 people in Richmond


The challenge > Increasing older population > Service fragmentation > Lack of integrated working > Diverse range of community services being commissioned

The solution > Richmond now has a comprehensive outcomes framework in place for community services

The impact > Spending on care outside hospital costs Richmond CCG approximately £66 million per annum, or 30% of total budget.1 Covering 187,000 people, the community services outcomes framework will provide a means to improve health and care for adults with clinical needs (such as long term conditions, disability, or frailty) and their carers living in Richmond. The outcomes framework, developed in consultation with local people, delivers a comprehensive set of ready made indicators and measures that will be incorporated into a new contract for community services. Under this new contract, health and care services will be commissioned with a view to achieving the high-level outcomes outlined below.

The process > At the core of a COBIC contract is an outcomes framework, developed by drawing on current evidence and best practice, alongside a rigorous process of engagement and consultation with local service users and clinicians. In Richmond this involved, in partnership with The Innovation Unit, consultation with 144 residents and professionals, and included:

  • Ethnographic interviews – to gain in depth insight into peoples lives, the challenges they face, their aspirations and their experience of care
  • ‘Drop-in sessions’ in the community – to build understanding of the services and care that users receive in local settings
  • Co-design workshops – to provide an opportunity for stakeholders, through case study work and by reflecting on their own experiences, to define what good care and support would look like.  Participants explored key themes, refined and prioritised relevant outcomes, and suggested measures and indicators that could best capture progress towards meeting these outcomes

A robust governance process was in place to oversee the development of the outcomes framework in Richmond. An outcomes reference group was established to provide oversight and advice, and facilitate reporting into the programme board.

Next steps > Richmond CCG and the London Borough of Richmond Upon Thames are now progressing the implementation of a COBIC contract with their providers, with the ambition to have a contract in place to cover community and out of hospital services by 2016. In addition, the project scope is now being extended to include development of a similar outcomes framework for community-based mental health care.

  • “With Cobic's help we can now articulate the outcomes that matter to people for community-based care. The Cobic team has produced a well researched outcomes framework that built constructively on previous work, adding extra depth through attentive engagement with local people and clinicians, and bringing in their knowledge and experience of similar work elsewhere. The quality of their written work and presentations to a range of audiences was excellent. The final report clearly sets out the vision of care that our local people want, that can be understood by all”
    Chief Officer of a London Clinical Commissioning Group