Commissioning for outcomes often fails people experiencing multiple disadvantage because it oversimplifies their realities, prioritises measurable results over meaningful change, and fragments support systems.

Why Outcome-Based Commissioning Misses the Mark

Commissioning for outcomes is designed to ensure public services deliver measurable improvements. But when applied to people experiencing multiple disadvantage, such as those facing homelessness, substance use, mental ill health, or involvement with the justice system, it often falls short. Here’s why I think this is the case:

1. Complex Lives Don’t Fit Linear Outcomes

  • People experiencing multiple disadvantage experience overlapping challenges that evolve unpredictably.
  • Outcome frameworks often assume a linear path to success (e.g., “stable housing” or “employment”), ignoring the cyclical, non-linear nature of complexity and progress.
  • This leads to services that chase metrics rather than support people through their unique journeys.

2. Measurement Bias Skews Support

  • Commissioners tend to favour outcomes that are easy to quantify, like reduced hospital admissions or job placements.
  • This marginalises softer, yet vital, outcomes like improved trust, safety, or self-worth, which are harder to measure but foundational to long-term change.
  • As a result, services may neglect the relational and emotional support that people truly need.

3. Fragmentation Undermines Holistic Care

  • Outcome-based commissioning often isolates services into silos, each responsible for a specific metric.
  • People with facing multiple disadvantage require integrated, person-centred care, not fragmented interventions that don’t communicate or collaborate.
  • This fragmentation can lead to duplicated efforts, gaps in care, and confusion for people using services.

4. Short-Termism Undermines Long-Term Change

  • Commissioners are often under pressure to show quick wins.
  • But meaningful progress for people experiencing multiple disadvantage takes time, sometimes years.
  • Short-term contracts and performance targets discourage providers from investing in deep, sustained relationships.

5. Power Imbalance and Lack of Co-Production

  • Outcome frameworks are often designed by commissioners, not by the people who use services.
  • This top-down approach ignores lived experience and reinforces power imbalances.
  • Co-production, where people with lived experience help shape services is essential but often sidelined in outcome-driven models.

What’s the Alternative?

Instead of rigid outcome-based commissioning, experts advocate for relational, flexible, and trust-based models:

  • Collaborative commissioning that brings together providers, communities, and service users.
  • Funding for learning and adaptation, not just delivery.
  • Focus on values and relationships, not just metrics.

As one supported person put it: “Someone who has never met me is making decisions about what I can and can’t do. Where am I in all this?”

Commissioning for outcomes may work for straightforward services. But for people experiencing multiple disadvantage, it often fails to honour the depth, dignity, and unpredictability of their lives. It’s time to rethink commissioning—not just for results, but for relationships.