Outcomes are widely discussed in care, support and SEND education. In recent years, the phrase has arguably become a buzzword, following the 2023 Procurement Act which (via referral to the National Procurement Policy Statement) effectively requires services to be procured with the expectation of achieving positive outcomes.
Of course, the phrase ‘positive outcomes’ has broad implications, which may complicate things for those commissioning and delivering support services.
Whom should the outcomes benefit? – and if there is tension between outcomes for the individual, the support provider, and the economy, who takes priority?
How should delivery against outcomes be measured, and over what timeframes should the measurement take place?
Crucially, how are different outcomes defined, in what language, and how does terminology affect consistency and quality of support delivery from one local authority to the next?
To tackle this issue, we spoke to two experts in the field:
- Adam Burley of Burley Inclusive, an education provider, and the founder of Gradually Fading Support, a pioneering framework for attainment in SEND provision
- …and Hannah Tough, CEO of Inclusion North, a Community Interest Company (CIC) working across the North East, Yorkshire and Humber to make inclusion a reality for people with a learning disability, autistic people and family carers by influencing systems, building leadership and ensuring lived experience shapes policy and practice.
Between us, we identified seven core principles for outcomes in care and support, which should be understood and implemented by support providers, funders and regulators nationwide.
You can read more about each principle below, but in summary, they are as follows…
- There must be a single set of universal themes for outcomes, with the freedom to fully personalise peoples’ personal goals around those themes
- Clearly defined terminology for support outcomes must be adopted by all stakeholders
- The time period of a support goal must always be considered so that outcomes can be practically achieved
- The economic benefit of support outcomes must be considered to ensure they work for individuals, businesses and society
- It must be mandated for stakeholders to prove that outcomes are achieved, and not with the use of arbitrary scoring systems
- The personal choice of the supported individual must be evidenced whenever a support goal is set, or an outcome is reported upon
- Central government must provide the framework for support outcomes to ensure high quality support provision with consistent reporting.
From working in adult social care, we believe these principles are eminently practical for daily use in care and support.
Support provision is already heavily documented, with the widespread use of digital social care records (DSCR) used to collect, organise and share data. This means that much of the infrastructure needed to report on the implementation of these principles is largely already in place.
Furthermore, these principles are crucial to ensuring the long-term economic viability of Britain’s adult social care sector, and to enabling the greatest independence, quality and enjoyment of life for people who receive support.
1. There must be a single set of universal themes for outcomes
Different stakeholders prefer different types of outcomes, depending on their personal or professional priorities.
Organisations, including support providers, governments and regulators, prefer data metrics, cost-savings, and anything else that makes for simpler reporting.
Individuals, by contrast, mostly don’t care about data, but do care if they can go to the shops independently or have their breakfast at the right time. Furthermore, individuals’ goals are highly varied. In order for support to be personalised, therefore, any framework needs to be able to accommodate infinite flexibility into its design.
The answer is to adopt:
- a common set of themes
- …around which peoples’ personal goals and outcomes can be organised.
This can be relatively simple, argues Adam of Burley Inclusive, because outcomes can be organised into themes which are universally considered to be positive.
“Being healthy, having a job, socializing, fitness, all of these things… they’re the same for everybody in that we want people to be as healthy and as much of a member of society as they want to be, and as happy as they can be.”
Hannah Tough, of Inclusion North, adds that there are various existing frameworks which could be adopted as the core themes for support outcomes.
“For example, you could take the keys to citizenship, which each key as a theme. Then within each theme, outcomes specific to the person, which can be measured for the sake of having some data.”
Hannah, having previously worked as a care data services manager, is naturally in favour of the effective use of data, but cautions that a fixation on performance metrics may lead to support provision and expected outcomes becoming misaligned with individual peoples’ needs.
“I’m concerned about the idea of outcomes always being progressive. In my career we’ve worked with people who aren’t going to get well again, they’re on a life-limiting or palliative pathway. There will be outcomes that we try to achieve for these people; sometimes it’s something as simple as making sure they can maintain some enjoyment. But from a commissioner’s perspective they may seem like smaller achievements.”
The answer to this problem lies in the ability to build personalisation on top of those themes. For example, two people may both want to work towards an outcome of a more active social life:
- Jim, an elderly person who has dementia, uses a wheelchair and lives in a nursing home
- Sally, a young adult with Down’s syndrome who lives with her parents, is physically well, but needs to build greater confidence to go out independently.
For these two people, the pathway to that same outcome would be very different. Jim may simply need the nursing home staff to take him into the lounge more often; Sally may benefit from lessons in how to use public transport and cross roads.
In Adam’s words…
“We should not seek to individualise the outcome; we should individualise the journey towards that outcome through person-centred practice.”
2. Clearly defined terminology for support outcomes must be adopted by all stakeholders
For outcomes to be truly useful, they need to be discussed in a common language.
This is crucial in a fragmented care and support ecosystem like Britain’s, where thousands of different funders and support providers operate independently of each other – yet often collaborate to support the same people. Hannah comments…
“To be truly effective, outcomes should be so broad that they can span dementia services, children’s services, etc. This requires a universal terminology so that anyone across the sector can pick up the same case, report, etc., and know exactly what it means.”
Indeed, even the definition of a ‘good’ outcome is not set in stone. Adam explains…
“People can generally agree than an outcome should be a good thing. But if you went round a room and asked different people what it should mean, they’d all give you a slightly different interpretation.”
…and furthermore, slight differences in language can materially change whether an outcome is achieved.
Adam gives the example of the word ‘prompting’, a widely-used concept in LD support where people often need to be encouraged to take desirable actions in pursuit of their goals.
“If an outcome includes prompting, how is the ‘prompt’ defined? It tends to vary greatly between different organisations. Is it a reminder? At Burley Inclusive and Gradually Fading Support, it’s very well defined as: ‘a way of guiding cognition without supplying an answer or a solution’”.
Of course, if a ‘prompt’ ventures into a supplying an answer or solution, it raises the question of whether it’s the outcome preferred by the supported individual, or the one preferred by their support worker
If the theme for the outcome, in this example, related to greater independence, this different interpretation of ‘prompt’ could scupper the outcome entirely.
3. The time period of a support goal must always be considered
A common frustration for Adam and Hannah alike is the failure to consider appropriate timescales when setting a goal or determining whether an outcome has been achieved.
This is a problem in many fields, not only in care and support. Business and governments set financial or performance targets, whilst professionals work to deadlines, nearly always marked by the ends of days, weeks, months, quarters or years.
These timescales very rarely map neatly onto the time needed for a person to learn a skill or achieve any other desired outcome.
“It’s good to have a time period in mind; just keep it smart”, says Adam.
“Let’s say it was a travel outcome – and so the person needs support to travel. But you’ve arbitrarily set a deadline of a given day, and the person does not achieve the outcome by that date.
Well, you have wasted money there, because if you’d extended the deadline, you would have saved that money…
It’s not just the annual assessment or end of year report; it’s actually the weekly window. Add up all those little slices, and you get far more useful data that empowers the individual, empowers their capacity to make safe decisions, and empowers commissioners to spend things wisely. Setting a time deadline for the sake of setting one can cause more damage and ultimately be more expensive.”
Hannah adds that it’s also important to treat outcomes not as static moments in time, but part of ongoing progress, “‘What’s next?’ is really important.” She also recommends that expectations should be flexible, as to what extent the outcome may be achieved.
“It’s really unhealthy to think every outcome is going to naturally go the right way. There is that unspoken expectation that you from feel funders and commissioners. Actually, things happen outside of our control; someone’s health could decline, and that means that that outcomes have to be parked or changed. I think that there needs to be a lot more dialogue.”
That, in turn, implies the need for significant breadth in the types of outcomes that are expected, so that they work well for supported people and other stakeholders.
4. The economic benefit of outcomes must be considered
One can debate how useful this conversation of outcomes is when the adult social care sector is under severe financial pressure.
In summer of 2025 – in one of thousands such stories – The Guardian wrote:
“100,000 adults have been denied government-funded social care because of a decade’s worth of spending cuts. That injustice is compounded when caring responsibilities fall to friends and family, many of whom leave the workforce or reduce working hours to care for loved ones.”
Some commissioners may resent having to fund the achievement of outcomes when their councils can’t even afford to carry out basic adult social care.
In fact, the situation we currently have is that initiatives which may yield an economic benefit are often sidelined in pursuit of short-term cost-savings – ultimately costing funders more money.
Helping people learn to live independently can, says Hannah…
“…save the system vast sums in different areas, and there’s a lot of research that can prove that. But it doesn’t matter to a commissioner who’s got a problem on their desk that day… We know it works, but it’s hard to sell that to people sometimes.”
By contrast, if funders, supported people, and providers were to collaborate around a common understanding of outcomes, with economic benefit as part of the design, it would make for a more financially healthy adult social care ecosystem.
We discussed the hypothetical example of a working-age adult who wants to do a cycling proficiency test, and this comes at a short-term incremental cost to the local authority. If, says Adam, the person could then…
“…cycle independently, and can get to places independently in the future, that’d be really good saving… We’ve got a system that focuses on the future as well as the present”.
Support outcomes should, therefore, often consider the economic benefit to the funder, or to wider society. Failing to do so not only risks wasting care budget, but potentially also incurs a far greater financial loss in failing to help people greater independence.
“It is too simplistic to say that the more independent somebody can be, the less money we have to spend… But I think in my own mind, we can sort of pretty confidently say that independence helps with reducing cost.”
Of course, not every support outcome will have much economic impact; most people who learn to paint, for example, won’t make money from the hobby and it may not have any effect on the cost of their support.
But if the economic impact is at least considered, for every outcome, it could avoid self-defeating cost-cutting and harness more cost-saving opportunities.
5. It must be mandated for stakeholders to prove that outcomes are achieved
Concerning, neither Adam nor Hannah have seen any positive change, following the Procurement Act 2023, in how funders procure support services.
In fact, Adam feels it may have had the opposite effect.
“From our perspective in SEND education, if anything, outcomes are getting dialled down to make success easier to show. The outcomes aren’t future-focused, or aren’t challenging to the individual or the organisation.”
Of course, there will be many support providers who are working towards peoples’ desired outcomes honourably and constructively. But in such a diverse and sprawling sector, there would seem to be a need for a mandated reporting framework – akin to the CQCs reporting standards, perhaps – so that it becomes much harder to game the system.
This also seems important given that outcomes have historically been scored using a wide variety of abstract measures, some more helpful than others.
A system developed by The Care and Outcomes Research Centre (COReC), part of Kent University, known as “ASCOT”, scores all outcomes from 0 to 1; this system has been adopted internationally.
But Adam and Hannah both express frustration with scoring systems, and any other abstraction which dilutes the reality of the individual’s support or attainment. Hannah argues that the only ‘score’ useful for any outcome is to describe it as:
- Outcome not met
- On the journey
- Outcome met
She explains…
“I don’t agree with measuring it. You can give people ‘I’ statements; try to explain what a 6 means and what a 1 means. In reality, it’s meaningless; it’s overanalysing it.”
Adam adds a helpful distinction between the type of data that is and isn’t helpful.
“Can they cross the road: yes or no? Their opinion doesn’t keep safer. It means nothing in terms of better commissioning, better outcomes, safer provision.
Yet by the same token, the data on such attainment does give weight to peoples’ opinions and voices.”
This seems crucial for funders and local authorities working towards healthier adult social care provision and better control of funds. Being able to say that 96% of people in your county can cross the road safely – up from, say 94% last year – is a lot more useful than saying that the average road-crossing ability in the county is a “9.6”. The former implies an obvious cost-saving for the funder.
Rather than applying abstract metrics to attainment, simpler and more useful metrics should be applied at individual-level in order that better data can be gleaned at population-level.
That can in turn be used to optimize budgets and strategies – so really, mandated, consistent reporting on the attainment of outcomes should be welcomed by all stakeholders.
6. The personal choice of the supported individual must be evidenced
Whereas more standardisation around outcomes would be welcome, it is crucial that this does not lead to people being ‘standardised’ or their personal preferences being ignored.
Hannah cautions…
“The phrase ‘person-centred’ gets really overused; the person has to be saying what they want to do… “There should be evidence that it’s genuinely come for the person it’s designed for. A lot of professionals can sit in a room and make decisions about someone’s life. But something that needs quality-monitoring is that the person-centred outcomes are actually real and about that person. I hear so many stories where people haven’t been involved in their own plans around their life and it’s quite sad.”
Adam reiterates that universal terminology, here, is crucial to defending individuals’ interests, so that…
“If I describe an outcome, every other field knows what that is: through health, through commissioning, social care, everybody can understand it. Because if a person’s wants are written down in a way that can be interpreted in multiple different ways, and nobody else necessarily understands what that means, then they’ve not really selected whatever goal they’re working towards.”
Really, this should be obvious. But reporting frameworks are, in and of themselves, a risk-factor in personal independence, since there will often be the temptation to put the paperwork before the work itself. This is why it’s crucial for the individual’s personal choice to be one of the seven mandated principles for support outcomes.
7. Central government must provide the framework for support outcomes
All this discussion, of course, raises the issue of how a better understanding of use and outcomes can be implemented in adult social care.
A core part of the answer, all agreed, is for central government to provide the framework for support outcomes, which must be adhered to by all support providers. Hannah says this would help to resolve conflicted interests…
“Commissioners want one thing and real people need something very different. And that is at the crux of where the issues with outcomes lie: trying to make outcomes person-centred when commissioners have KPIs to meet.”
…and it would also help all stakeholders work towards long-term economic outcomes which can benefit local communities and the country as a whole.
There are already some positive signs from ICBs, says Hannah, albeit somewhat lacking due to fragmentation and structural uncertainty.
“I’ve noticed a shift in my conversation with ICBs; they want to move away from being so metrics-focused and to have more dialogue.
But that is coming up against all of the changes to ICBs, all the cuts, and this recognition that they’ll need to be more stripped back.
So those two things do feel very conflicting. But there does seem to this general feeling that metrics aren’t enough; they recognise they need more granularity, but there isn’t any consistency across the country about what that looks like.”
Of course, top-down legislating will only ever be part of a solution; Hannah also says that an education piece with commissioners is needed, on how outcomes work in different environments. Such educational work is a crucial part of the mission of Hannah’s team at Inclusion North.
Nonetheless, this is clearly a space where greater leadership is needed from Whitehall. Beyond simply passing laws, we need further action from policymakers so that the positive aspirations of legislation can be practically implemented by the support sector and produce positive outcomes, for people, support providers, funders, and the country as a whole.
About the contributors
Adam Burley is the founder of Burley Inclusive and Gradually Fading Support (GFS). For post-16 SEND education in North Somerset, Somerset, Bristol, and South Gloucestershire, or to use the GFS attainment framework in your support provider organisation or local authority, get in touch here.
Hannah Tough is CEO of Inclusion North. To improve LDA support provision in the North East, Yorkshire or Humber, get in touch here.
