Quality, standards and outcomes: personalised and cost effective delivery – a contradiction in terms?

1. Quality, standards and outcomes: personalised and cost effective delivery– a contradiction in terms? Emma Miller University of Stirling

2. Defining outcomes • Involve the person in identifying the goals they want to work towards • Outcomes can be measured both for the individual and for the service as a whole Understand outcomes as the impact or end result of service(s) on a person’s life:

3. The assessment, care/support planning and review loop By focusing on outcomes in assessment, the person is involved in identifying desired goals – move away from tick box and one size fits all Partnership is key – users, carers, services, other community resources – to delivering outcomes Intended outcomes recorded, including areas of disagreement Quality of interaction is key – quality of recording also important Review provides opportunity to assess whether outcomes achieved, and whether outcomes need revised due to changed circumstances

4. Exchange Model of Assessment EXCHANGE INFORMATION - Identify desired outcomes

5. Defining personalisation • A simple definition is that: ‘It enables the individual alone, or in groups, to find the right solutions for them and to participate in the delivery of a service. From being a recipient of services, citizens can become actively involved in selecting and shaping the services they receive.’ Changing Lives Service Development Group July 07

6. What is the UDSET? (user defined service evaluation toolkit) • Started as a toolkit – developed by the JIT –based on DH research on outcomes (background) • Started by focusing on review and evaluation – users and carers (UDSET Dec’07) • Evolved as an approach – driven by Community Care Outcomes Framework – based around the two outcomes frameworks (UDSET update Nov’08) • Enable information on outcomes to be systematically gathered - assessment and review (sample tools) • Support for use of this information to improve outcomes at individual, service and organisational levels (data management) (Materials available on website): http://www.jitscotland.org.uk/action-areas/user-and-carer-involvement

7. UDSET and national minimum information standards (NMIS) • NMIS and UDSET developed in tandem: assessment, support planning and review for users and carers • Shared emphasis on outcomes – active engagement • Both part of community care outcomes framework • DH research influenced community care measures - reflected in data standards in NMIS • Complementary – UDSET focus on person’s priorities and NMIS ensure core info is gathered – both concerned with quality (see JIT website for November update report – links between UDSET/NMIS /CCOF/SOA)

8. Findings – outcomes/personalisation • Focus on outcomes in assessment, care planning and review process leads to more person centred care • ‘This is a shift away from processing people to engaging them’ • ‘Assists in developing creative options and meaningful intervention’ • ‘Outcomes get to the source of what the person feels is important and what needs to be done’ • ‘The tool encourages strong relationships between users, carers and professionals, which is empowering for all’ • ‘We now review carers and check whether outcomes have been achieved’

9. What about cost-effectiveness? By involving the person in identifying outcomes – • more likely to engage and be motivated = conducive to re-enablement • written plan provides clarity of purpose – avoids wrong assumptions and wrong services • supports staff to know when to disengage as well as engage • investing in review equally important • good quality interaction is itself an input and can deliver good outcomes – being listened to = Investing time in quality interactions to save time and resources

10. Cost-effectiveness Move away from tick box – needs and services – to outcomes About the role that everybody can play not just about what services can do – ‘natural supports’ and wider community resources Permission for staff to think creatively Allows a more honest conversation about the means to an end (outcome) – identify the outcome and work backwards Recruitment and retention – evidence of staff satisfaction – sense of purpose – engagement

11. Cost-effectiveness – use of data • Gather data via routine processes • Apply to local performance management • Counterbalance national targets – skews • Apply to contract management, SLAs etc • Potential to feed into regulation and inspection – avoid duplication – but retain external scrutiny as safeguard Development work continuing in these areas

12. Digital stories • UDSET – DS projects working together – shared emphasis on user and carer stories • DS retain emphasis on user and carer stories amidst complexity of service change • DS - key role in supporting UDSET challenges with implementing UDSET: role of staff stories = peer communication = what outcomes mean in practice, working with carers, concerns about resources, working across health and social care boundaries, communication difficulties http://www.jitscotland.org.uk/actionareas/themes/involvement.html