Domiciliary Care Workshop

1. Domiciliary Care Workshop Waterfront Place, Chelmsford 11 October 2007 Gill Herbert, Consultancy & Development Ltd

2. Monitoring and evaluating home care Gill Herbert September 2007

3. What do we really need to know? • What the people we serve want us to achieve (politicians, community, individuals) • What we are trying to achieve • What we currently do • What we currently do not do that may be important • What we need to do differently • Whether the changes we make improve success over time or not HOW MANY MORE PEOPLE ARE WE MANAGING TO SUPPORT IN THEIR OWN HOMES OR AT A LOWER TARIFF OF CARE? Gill Herbert, Consultancy & Development Ltd

4. Thinking about Home Care • Personal and group outcomes are important • Key “link” services and other groups - interfaces are as important as service delivery • Multi-disciplinary and multi-agency working essential • single assessment, joint provision, joint outcomes • Performance management and milestones for changes defined Gill Herbert, Consultancy & Development Ltd

5. The Key Questions for Evaluation • How many people do we serve and where? • How do we improve or support their health, safety, quality of life and well-being? • Does each service effectively meet its defined objectives? • Can the service respond to the requirements of individual budget holders? • How does each user of an benefit from the service (or not)? • How do services link with and support each other and mainstream services? • What happens to people who use the services and their carers over time? Gill Herbert, Consultancy & Development Ltd

6. Management Information or Evaluative Research? • Both required - can inform each other • Different levels needed for different purposes: • National • Regional • Local - county wide • Local – communities or groups (natural or defined?) • Service specific • Individual user specific • Consistent data set for all services could be linked to single assessment framework • Process for constant review, re-evaluation and planning needed Gill Herbert, Consultancy & Development Ltd

7. Methods & Approaches (1) • Macro Level • Using current MI and analysing in new ways - identifying what questions to ask • Mapping of services, resources, skills and supporting facilities • Partnership arrangements at strategic and operational level • Supporting processes and infrastructure • Audit and benchmarking • Developing IT that works across boundaries • Project management to collate and analyse new data Gill Herbert, Consultancy & Development Ltd

8. Methods & Approaches (2) • Locality Level • Baselines - how home care links to and impacts on other services • Collating and comparing / benchmarking between services/approaches • Usage - numbers, hours per week, length of package • ADLs and other measures of enablement • Achieving professional and personal goals and multi-disciplinary working and outcomes • Populations - conditions, age and ethnicity • Pathway tracking for small cohorts • Identifying and monitoring unmet need Gill Herbert, Consultancy & Development Ltd

9. Methods & Approaches (3) • Service & Individual Level • Clearly defined aims and objectives for the service and for individuals • Ensuring users and carers have active and useful input • Outcomes as basis for evaluation • Measurable success criteria which are quantifiable if possible • Qualitative investigation of experience and outcomes • Review processes - for individuals and service • Developing research and self evaluation skills What can be done by practitioners and what needs to be independent? Gill Herbert, Consultancy & Development Ltd

10. Taking an individual / user-perspective view • Qualitative information important • Changes for the individual over time • Quality of life, social inclusion and choice as well as other outcomes and costs • Compare what is expected (pathways, protocols, standards) and what is experienced (perceptions and outcomes) • Compare with other approaches – e.g. befriending or day care • Sustainability of achievements/improvements important • Small cohorts can inform bigger picture Gill Herbert, Consultancy & Development Ltd

11. Making it doable • Use what information is already available • Keep it simple • Acknowledge the variables and influencers - keep the focus on what we really need to know • Win the ownership of the data providers and those that use the information - make it useful to them • Address other needs if possible - inform other interest groups, reduce duplication, produce user information • Learn how to make evaluation an achievement acknowledgment which motivates towards improvement Gill Herbert, Consultancy & Development Ltd

12. Key Decision Points • Initial contact • Overview Assessment • Allocation of “service” or other action • Review or further assessment (in-depth or comprehensive) • Transfer to alternative location • Discharge • Follow up Gill Herbert, Consultancy & Development Ltd

13. Types of information • Personal data • Background and situational data including history • Reports of • diagnosis, need or wishes • action to be taken - treatment, service or other inputs • activity or events • decisions • intentions or goals • outcomes • Other??? Gill Herbert, Consultancy & Development Ltd

14. Making sense of information • Use case studies to explain what is important and why • Use numbers wherever possible to justify investment and change • Constantly review the usefulness of the information and how it relates to the experience of the people dependent on the service Gill Herbert, Consultancy & Development Ltd