What works who decides
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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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What works who decides

What Works: Who Decides?

Professor Siobhan McClelland


What works who decides1

What Works: Who Decides

  • Fitting the Context

  • Speaking the Language

  • Ticking the Boxes

  • Making the Case

  • Defining Success


The context

The Context ...........


The context1

The Context

Political: Elections/New Governments/New Ministers/New Organisations

Economic: Stringency/austerity/competing resources/value for money

Strategic: “Preventative, primary and community led”


Its a competition

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


This needs

This needs ...

  • Fierce and smart

  • Robust evidence base

  • Speaks the language of key decision makers

  • Captures the policy community


Speaking the language

Speaking the Language

  • National and Local

  • Elections and Constituencies

  • Short timeframes

  • Personalities and beliefs

  • Priorities

  • Effective campaigns

  • Individual testimony

Politicians


Speaking the language1

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


The rest of the policy community

The rest of the policy community

  • Professionals

  • The Media

  • Pressure Groups

  • Third Sector

  • Private Sector


And service users

And service users?


Evidence based practice and policy

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


Developing the evidence base

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


National dementia strategy evaluation

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


Developing the evidence base1

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 ...


Success

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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