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What Works: Who Decides?

What Works: Who Decides?. Professor Siobhan McClelland. What Works: Who Decides. Fitting the Context Speaking the Language Ticking the Boxes Making the Case Defining Success. The Context. The Context. Political: Elections/New Governments/New Ministers/New Organisations

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What Works: Who Decides?

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  1. What Works: Who Decides? Professor Siobhan McClelland

  2. What Works: Who Decides • Fitting the Context • Speaking the Language • Ticking the Boxes • Making the Case • Defining Success

  3. The Context ...........

  4. The Context Political: Elections/New Governments/New Ministers/New Organisations Economic: Stringency/austerity/competing resources/value for money Strategic: “Preventative, primary and community led”

  5. Its a competition ... The Opportunity: To demonstrate that services meet the context: deliver on strategic objectives, are cost effective and tick the boxes of decision makers The Danger: Competing for resources becomes fiercer; hard to change existing patterns of service delivery and resource allocation; easy to get rid of “soft” services; difficulties in securing ongoing revenue funding

  6. This needs ... • Fierce and smart • Robust evidence base • Speaks the language of key decision makers • Captures the policy community

  7. Speaking the Language • National and Local • Elections and Constituencies • Short timeframes • Personalities and beliefs • Priorities • Effective campaigns • Individual testimony Politicians

  8. Speaking the Language • Achieving strategic objectives • Responding to ministers • Avoid embarrassment • Standards and Targets • Accommodating vested interests • Balancing the Books Civil Servants and Managers P45 Targets

  9. The rest of the policy community • Professionals • The Media • Pressure Groups • Third Sector • Private Sector

  10. And service users?

  11. Evidence Based Practice ... And Policy? The Bad News: Rational policy making and resource allocation is a holy grail Lots of decisions about policy and resources are not based on evidence The Good News: It doesn’t have to be like this and it isn’t always like this We shouldn’t give up on developing a robust evidence base to inform decision making

  12. Developing the Evidence Base • Dominance of certain models of evidence notably bio medical model in health and ‘gold standards’ of evidence • These suit pharmaceutical and technological interventions well but are more difficult for ‘softer’ services • Demonstrating cost effectiveness/value for money is critical and developing methods for demonstrating this

  13. National Dementia Strategy Evaluation • Evaluation of nurse advisors and peer support interventions • Very wide range of approaches • Quality of Life Tools: ASCOT and Demqol • Value for Money, Discrete Choice and Willingness to Pay • Wide data set and detailed case studies • In depth interviews with stakeholders, service users and carers

  14. Developing the Evidence Base • Need to develop and demonstrate robust range of methods which can stand against RCTs • Never underestimate the power of the testimony of service users but .. It needs to be more than anecdotal • The Black Arts ...

  15. Success ... • A strong and defensible evidence base • Fits the strategic context • Meets operational imperatives • Convinces decision makers at various levels • Includes evaluation to further increase the evidence base

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