Emma Tomkinson

Why do we use SIBs for service gaps?

SIBs have largely been new prevention or early intervention services. They attempt to prevent or reduce people’s need for expensive existing services down the line. This is also the economic justification for SIBs – spend earlier to save later and help participants avoid worsening outcomes. So SIBs have been new services that try to reduce the need for existing services.

Could SIBs spread to replace existing contracts?

Let’s examine this questions by splitting SIBs into two types (see the diagram above). The first is the type that pay for things that happen, without requiring evidence of improvement. For example per graduation, per job commencement, per child placed with a family.

So could a pay-per-participant-outcome SIB replace an existing contract?

The second type of SIB pays for improvement against what might have happened without the service (a comparison or counterfactual). It seems that when people say ‘Pay for Success’ in the US, this is what they are referring to. The first SIBs in the UK and US, Peterborough and Massachusetts, were set up like this.

Could a pay-per-improvement SIB replace an existing contract?

Again, the answer on theoretical grounds is yes. But payments in this model are made when the SIB improves on a comparison. And where this comparison is ‘no service’ in SIBs so far, now the SIB is going to have to improve on an existing service.

But how do we make sure enough participants are referred to a SIB?

Let’s look at two SIBs where this issue has been responded to. Educating/marketing to government referrers: Essex County Council The Essex County Council SIB relied on referrals from the council, however they weren’t getting enough of the right type. In order to fix this, the delivery organisation went in to educate and encourage council staff about the program and who they should refer to it.