We need to talk about outcomes

Someone to love, somewhere to live, somewhere to work and something to hope for

— Norman Kirk, Prime Minister of New Zealand (1972-4)

In our relatively short time on this planet, people want different things. Norman Kirk set out what he thought people wanted from life. Others might add having children (or not) or earning as much money as they can (or not) etc., whilst others might focus on the process of living a good life: being happy, feeling valued etc.

Somewhere there is probably a list of the top 5 things people want from life.

These sorts of things, though, are a long way away from what outcomes in public services tend to reflect.

Take a look at the NHS Outcomes Framework or the Adult Social Care Outcomes Framework, for example (you could pick any public services outcomes framework you like and the argument would be the same). There are some good outcomes in these which begin to get at what could make for a good life: “social care-related quality of life“; “service users with as much social contact as they would like“. There are also plenty of stinkers: “number of patient safety incidents” (pdf); “hip fracture: incidence” (pdf).


Growing Tree Sequence
Image via SiklosKert

Despite the talk of outcomes in public services, we seem to have lost sight of the things people want from their lives and so how public services can enable people to achieve them.

Instead, public services focus on areas pretty narrowly defined by what is in their remit – areas that at their best are secondary to what people most often say they want from their life as a whole – love, home, work, hope.

It’s in this gap between what public services seem to think they are there for and what people want from their lives that I suspect we find much of our trouble. If a professional doesn’t see how the interaction they have with a person can help achieve what the person wants in their life, and also isn’t required to think beyond what the service they work for requires them to concentrate on, then that public service is flawed.

I wouldn’t want you to misinterpret me: if we did away with “outcomes”, relied only on inputs and outputs and kept our fingers crossed that these sum to a difference in people’s lives, then we won’t get anywhere either.

But part of me – the hopeful part, you could say – wants to see love, home, work, hope etc. at the very top of what it is public services are there to enable. All the other “outcomes” could  remain, but we’d see them for what they are: as the means to the greater ends that public services should be there for.


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Man of letters & numbers; also occasionally of action. Husband to NTW. Dad of three. Friendly geek.

2 thoughts on “We need to talk about outcomes”

  1. I have been thinking in this area a lot lately. I think part of the problem re. the outcomes organisations measure is about mindset. The predominant mindset (and the one present in the example given by Paul) is a project management one. There is nothing wrong with this: we need an approach that keeps us focused on the ‘straight and narrow’. When it comes to some things, however, such as health services and their accompanying complexities, we need a collaborative working mindset, which will keep things on a straight but hopefully less narrow path — because a wider diversity of partners can help influence and shape the outcomes being sought. As the article above states, we need the rigour of clear outcomes, but they need to be enriched with the perspectives, ideas and needs of diverse and, especially, human partners.

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