Payment by Results in the UK: Progress to date and future directions for evaluation

Abstract

In the UK, Payment by Results (PbR) is a central element in public service reform. This policy intention is being translated into practice through programmes of varying designs and scale, operating in multiple areas of policy. There are few completed evaluations of these programmes – although results are starting to emerge – and empirical evidence is lacking. This, combined with the strength of feeling, political imperative and conceptual confusion surrounding PbR, has meant that debate has often been heated and focused on whether or not ‘PbR works’. Within this context, this article examines the role of evaluation in approaching PbR. It argues that evaluation’s focus should be on explanation (looking within programmes; surfacing and testing their theories) and refinement (using findings to improve programmes; using theories to look across programmes) to advance the debate on PbR from ‘for or against?’ to ‘when, how, for whom and under what circumstances?’ The article advocates a Realist approach to this undertaking, setting out an illustrative framework of PbR’s mechanisms and hypothesized outcomes for exploration and development.