Outcomes-focused services for older people

1. Outcomes-focused services for older people Jane Maddison Senior Researcher, Acton Shapiro

2. Background: why SPRU/ Acton Shapiro? • SPRU Outcomes of Social Care R&D Programme: • to identify outcomes valued by social care users & test ways to introduce an outcomes focus into routine practice  • Outcomes into Practice Resource Pack • origins of Outcomes Network • further research • SPRU/Acton Shapiro links: • development of Resource Pack • training and support for organisations implementing an outcomes approach • partners in research for SCIE Knowledge Review

3. Aims and stages of the Knowledge Reviewwww.scie.org.uk/publications/knowledgereviews/kr13.pdf • Aims • To review: • research on the outcomes valued by older people • progress in developing outcomes-focused services for older people Stages • Literature review to collate research evidence on: • outcomes valued by older people • factors helping or hindering an outcomes approach • Practice survey: • postal survey of 70+ known outcomes initiatives in England and Wales • 6 case study sites – to investigate a range of established initiatives

4. Literature review: what are the outcomes valued by older people? • high degree of consistency between studies, reflected in current policy: • improved physical and mental health • improved quality of life, including access to universal services, safety & security • making a positive contribution to the local community • being able to exercise choice and control • freedom from discrimination and harassment • economic well-being • personal dignity and respect, including comfort and cleanliness • SPRU typology: • change outcomes • maintenance and prevention outcomes • service process outcomes

5. Literature review: which factors help or hinder outcomes-focused services for older people? • assessment and review • commissioning, contracting and provision of services • front-line worker knowledge of other services

6. Practice Survey: Postal SurveyKey findings • sent to those responsible for over 70 known outcomes initiatives • LA generally sole or lead agency – NHS/ private/voluntary sector partners • few long-established initiatives (and so difficult for respondents to judge effectiveness) • most initiatives for: • older people living at home • post hospital discharge • outcomes approaches being used in: • assessment, care planning and review • changing existing services and commissioning new ones • outcomes-based service monitoring

7. Practice Survey: Case StudiesWhat sorts of developments were happening? Six sites selected to cover a range of longer-established initiatives: 82 staff and 71 service users took part Examples of developments in outcomes-focused activities: • assessment, care planning and review • commissioning for change outcomes • commissioning for maintenance outcomes Examples of developments in outcomes-focused services: • intermediate care and reablement • day services • residential care • home care

8. Practice Survey: Case StudiesWhat helps or hinders an outcomes approach? • national policies • performance indicators/ inspections • paperwork • local vision/leadership & investment in change management • involvement of older people in service development • attitudes: staff/ service users/ carers • having scarce resources • extent of provider flexibility • access to resources and skills beyond traditional remit of social care

9. Some reflections…. • a fragmented approach to outcomes • focus on ‘change’ outcomes • risk of marginalising maintenance outcomes • language of outcomes – differing interpretations • partnerships needed to meet outcomes valued by older people

10. Acton Shapiro • School Lane, Greengate • Malton, YO17 7EL • jane@actonshapiro.co.uk • T: 01653 691351 F: 01653 698589 • www.actonshapiro.co.uk