Implementing a Value-Based Outcomes Framework in a Local Authority Reablement Service: A Mixed-Methods Study of Critical Success Factors

Objectives: To identify the Critical Success Factors (CSFs) for implementing a value-based outcomes framework within a local authority adult social care reablement team, exploring the rationale, barriers, and implementation strategies. Design: A pragmatic, mixed-methods study, combining qualitative data from two semi-structured focus groups with quantitative data from an online staff survey. Setting: Torfaen County Borough Council reablement service, Wales, UK. Participants: 46 adult social care staff (including reablement workers, social workers, and team managers) responded to the survey. Two focus groups were conducted: one with reablement practitioners (n=9) and another with team managers and wider representatives (n=19). Results: Staff demonstrated strong support for person-centred outcomes but low awareness of Value-Based Healthcare (VBHC) principles (only 4% were familiar). Key barriers included resistance to change (34%), limited organisational capacity (34%), and financial constraints (17%). A central tension existed between frontline person-centred care and system-level efficiency pressures. Leadership was identified as the primary enabler (44% of respondents), alongside service user involvement in goal-setting (46%) and a phased implementation approach (15%). Digital systems were not perceived as a primary barrier or solution, with issues centring on the inconsistent use of existing tools rather than their absence. Conclusions: Implementing a value-based framework in social care is feasible but requires a tailored approach distinct from clinical models. Success is contingent on strong leadership to navigate cultural change, co-production with service users to define meaningful outcomes, and a modular implementation strategy to build momentum. Investment should focus on change management and process redesign rather than new digital infrastructure. This study provides a transferable framework for local authorities seeking to embed value-based care principles to demonstrate impact in an era of constrained budgets.