Jane Maddison

1
Outcomes-focused services for older people

• Jane Maddison
• Senior Researcher, Acton Shapiro

2
Background why SPRU/ Acton Shapiro?

• SPRU Outcomes of Social Care RD 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/knowledgerevie
ws/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

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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_at_actonshapiro.co.uk
• T 01653 691351 F 01653 698589
• www.actonshapiro.co.uk