Distilled down more than 30 overlapping outcomes frameworks to 11 the board could use​

Client and setting​

A large urban NHS commissioner taking on a strategic commissioning role for a population of around two million​

The challenge​

There was no shortage of outcomes work. Every place, programme and pathway had its own framework. What was missing was a single statement of what the system was trying to achieve. Measures overlapped, repeated each other and sometimes pulled in different directions, and none were tied to the population health evidence. The new commissioning plan had nothing to be held to.​

What we did

• Went through more than 30 existing frameworks and pulled out around 750 outcomes, priorities and indicators by hand, then separated indicators from outcomes to leave about 450 to screen.​

• Had two public health specialists review each candidate outcome independently against agreed criteria: does it describe a change in health or behaviour, and does it meet the inclusion rules.​

• Grouped what survived by life stage and by purpose, prevention, thriving, or support for people with higher needs, which showed where the system had plenty to say and where it said nothing.​

• Checked the list against the earlier population health analysis, which brought up five priorities no existing framework covered, including multiple long-term conditions, children with complex needs and musculoskeletal pain.​

The outcome​

About 450 screened measures became 11 outcomes for the whole system, tied to two population aims: longer healthy life expectancy and narrower inequality. Because every outcome can be traced back to the measures it came from, the commissioner could also show colleagues where their own framework had ended up.​

Timescale and team​

Eight weeks from commission to draft framework. Three partners.​