Measuring Outcomes in NHS-Commissioned Services: Moving Beyond Activity Data

December 14, 2025

Many NHS-commissioned services still rely heavily on activity data. Numbers of referrals, contacts or hours delivered are easy to report — but they rarely explain whether a service is actually making a difference.

Commissioners increasingly expect providers to evidence outcomes: changes in people’s health, independence, safety or system use. This shift is not theoretical. It affects contract management, performance reviews and future commissioning decisions.

This topic links closely with outcomes and quality of life and continuous improvement.

Why activity data is no longer enough

Activity data answers “what happened”, not “what changed”. For example:

Number of visits does not show improvement in independence
Length of stay does not show quality of recovery
Referrals accepted do not show system impact

Commissioners increasingly challenge providers who cannot articulate impact.

What NHS commissioners mean by outcomes

Outcomes usually focus on:

Health and wellbeing improvement
Functional ability and independence
Safety and risk reduction
System efficiency (e.g. reduced admissions)

Good outcome frameworks align with service purpose and pathway goals.

Balancing clinical, personal and system outcomes

Strong providers capture outcomes at multiple levels:

Individual outcomes for people using services
Service-level outcomes across cohorts
System outcomes for commissioners and ICBs

This triangulation strengthens assurance.

Using proxy indicators sensibly

Not all outcomes are immediately measurable. Proxy indicators may include:

Reduced escalation
Improved engagement
Stabilised risk

Commissioners accept proxies when they are clearly explained.

Embedding outcomes into day-to-day practice

Outcome measurement should not sit separately from delivery. Effective services:

Embed outcomes into assessments
Review progress in supervision
Link outcomes to care planning

This makes measurement sustainable.

What commissioners look for

Commissioners expect:

Clear outcome definitions
Consistent data collection
Evidence of learning and adaptation

Outcome maturity signals service quality.

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