Do health and social care partnerships deliver better outcomes for service users and how would we kn

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Do health and social care partnerships deliver
better outcomes for service users (and how would
we know if they did)?

• Jon Glasby, Health Services Management Centre

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Doubts over value of 3bn Sure Start

• The first major evaluation of the government's
  flagship 3bn Sure Start programme has revealed
  no overall improvement in the areas targeted by
  the initiative. Although some Sure Start schemes
  were successful, an independent study revealed
  that Sure Start as a whole failed to boost
  youngsters' development, language and behaviour.
  It also showed children of teenage mothers did
  worse in Sure Start areas than elsewhere.

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Doubts over value of 3bn Sure Start cont.

• The findings represent only an early snapshot of
  the programme's effectiveness, and academics
  involved in the 20m evaluation emphasise that
  they do not mean the scheme, which varies widely
  around the country, will not succeed in helping
  children in deprived areas in the long term

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Outline

• The evaluation challenge (see Helen Dickinsons
  session on Wednesday)
• Key policy challenges
• Is partnership a concept that has had its day?

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1. The policy context (in theory)

• Partnership
• Better Services?
• Better Outcomes?
• (Do they? How? For whom? In what contexts?)

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1. The evaluation challenge

• What are the outcomes of partnership working?
• Complex policy initiatives
• Multiple stakeholders and perspectives
• Proving youve prevented something?
• Long-term programmes/outcomes
• What would have happened anyway?
• Etc etc etc.

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1. The evaluation challenge

• Focusing on evidence of what works v evidence of
  what doesnt work?
• From evidence-based practice to practice-based
  evidence?
• A new approach to knowledge-based practice?

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2. The policy context (and the neglect of social
care?)

• Only important when impacting on NHS?
• Whatever happened to the Green Paper?
• The Wanless Review
• Missed opportunities (case management,
  commissioning, intermediate care, SAP, LINks
  etc.)

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Key policy drivers same as the NHS?

• Demography
• Medical advances
• Financial difficulties (and changes in
  health-social care divide)
• Changing public expectations?

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2. Key priorities/questions

• Does prevention work and how do we do it?
• How should we fund long-term care?
• How do we work with universal services and the
  NHS at the same time?
• What is an outcomes-based approach (and do policy
  makers really mean what they say)?
• Will direct payments and individual budgets
  really bite and, if so, what does this mean?

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3. Is partnership a concept thathas had its day?

• A term that is used, misused and abused?
• Is it worth it?
• Who is accountable if it goes wrong?
• Is there a plan B?
• Will it work when finances get tight?
• Etc etc.

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3. The importance of being clear about outcomes

• What outcomes are we trying to achieve?
• How well do we do this now?
• What needs to happen next?
• Context ------ Process ------ Outcome

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Conclusions

• Increasing scepticism (and this is healthy)
• Need to develop more sophisticated approaches to
  the evidence
• Importance of outcomes
• Dont through the baby out with the bathwater