Qualitative Evaluation of Keep Well Lanarkshire

1. Qualitative Evaluation of Keep Well Lanarkshire Alan Sinclair Keep Well Evaluation Officer NHS Lanarkshire

2. Keep Well in Lanarkshire • One of first five wave one pilot sites • Commenced screening in October 2006 • Covers over 50 practices across Lanarkshire with a target population of around 82,000. • To 30th September 2011, over 34,000 people aged 45-64 years have had a Keep Well Health Check.

3. Targeting Eligible Keep Well attendees are identified in partnership with participating GP practices Engagement 1 Person contacted through an appointment letter sent directly from Keep Well. Engagement 2 Person contacted through a phone call from Keep Well call centre Engagement 3 Person contacted through Keep Well’s Outreach team via phone call or home visit. Delivery Person attends Keep Well health check and is offered further services where appropriate. The Keep Well Lanarkshire patient pathway

4. Patient and staff’s views on referrals Screening attendance literature review Use of a healthy living bus as a screening location. Potential for HCSWs to deliver the health check. Delivery of Keep Well within Gypsy-traveller communities. Use of pharmacies for health checks Staff reflections on the Keep Well pilot. Use of group based weight management. (ongoing) Delivering Keep Well health checks in the treatment room. (ongoing) What has been evaluated so far?A range of areas… • Outreach service • Referral management service

5. Evaluating the Outreach approach to engagement • Outreach service running since mid-2007 • Initially through Community Renewal but consequently brought “in house” (Sept 2008) • Purpose of Outreach efforts is to engage with individuals who fail to attend their scheduled Keep Well screening appointment • Constantly evolving service. • Good track record (up to 90% attendance by those booked an appointment by Outreach).

6. Outreach roles in Keep well Lanarkshire (March 2009) Evaluation Question: What does an outreach worker actually do? Method: Series of observations of the outreach role. Findings: • Outreach duties established. • Delivery issues identified (Data management etc). • Existence of an ‘outreach personality’? Impacts: • Better understanding of outreach role by project management. • Service delivery issues acknowledged and addressed. • Benefits to person specification for future recruitment of staff.

7. Using outreach approaches to involve the hard to reach in a Keep Well health check: what difference does it make? (July 2009) Evaluation Question: How does the outreach approach make a difference to people attending Keep Well? Method: Interviews with patients (n=30) attending Keep Well following engagement by the outreach service. Findings: • Several barriers to health check attendance identified. • Significance of outreach in overcoming these barriers acknowledged. • Some felt outreach was unnecessary or too forward. Impacts: • Barriers identified informed future planning for service. • Value of outreach service recognised by project board. • Engagement strategy refined to avoid waste.

8. How have the qualitative findings from this work influenced practice? • Engagement processes have been improved to limit resource waste. • Improved understanding of who non-attending individuals are has aided future engagement strategies. • Greater clarity regarding the outreach role has helped person specification and HR processes. • Further appreciation of the resources required to ensure health check attendance.

9. Evaluating Keep Well’s Referral Management Service (RMS) • RMS established to provide support in overcoming barriers to referral attendance. • Started in January 2010. • Offered during screening where potential support needs had been identified by Keep Well nurse. • Operated by outreach staff.

10. Evaluating Keep Well’s Referral Management Service (RMS) Key questions for evaluation: 1.Is this kind of support really necessary? 2. Where does Keep Well draw the line? A model for referral management in Keep Well (October 2010) Method: • Interviews with screening and RMS staff. • Review of client case studies and service data.

11. Findings From RMS Evaluation • Staff clarity of service purpose was poor. • Where offered, RMS often lacked appeal for potential clients. • Instances where offer of service had dissuaded patient from attending referral. • Low number of clients referred and most preferred engagement by phone (reminder/follow up calls). • Some positive outcomes from ‘hands on’ support. • HOWEVER, ‘hands on’ support hugely resource hungry and in some cases could have been provided by other services.

12. 1. Is this kind of support really necessary? ‘…some of the people I’m offering it to I’m thinking, do they really need it? You know, they’re quite capable and they’ve accepted it and off they go… the ones that I feel really could benefit from it are the ones that aren’t taking it up for other complicated reasons.’

13. 2. Where does Keep Well draw the line? ‘…it was a great thing to see that happening for that person in particular, you know, getting that opportunity to go out there and do something they really wanted to do. But is that really our role? To take on that level of intense support?... I mean is that part of something we should be doing?’

14. Impact of RMS Evaluation? • Perceived need for RMS not supported by feedback gathered and low referral rates. • Resource hungry ‘hands on’ support not deemed viable in future models. • Alternative model of post screening support suggested. • Role of reminder calls highlighted to onward referral services. • Formal RMS subsequently disbanded.

15. Other areas where Qualitative Evaluation is making an impact Weight management groups • Service user feedback (survey/interview). • Staff experience (focus group). • Early feedback positive. • Group setting deemed to have numerous benefits. Treatment room pilot • Staff feedback regarding pilot period. • Findings helping to shape delivery plans. Both of these are examples of qualitative data actively influencing service development.

16. So what are the benefits of Qualitative Evaluation in programmes like Keep Well? • Deeper insight than figures alone. • Qualitative feedback is recorded formally rather than anecdotally. • Helps record more information regarding process rather than just outcomes. • Pilot programmes are very much trial and error! Prompt feedback of qualitative findings has helped shape Keep Well Lanarkshire’s future implementation choices and limit resource waste.

17. Contact: Alan Sinclair Keep well Evaluation Officer NHS Lanarkshire alansinclair@nhs.net Keep Well evaluation papers available at: http://elearning.healthscotland.com/course/view.php?id=316&a=2 Further information?