Emma Miller, Glasgow School of Social Work Ailsa Cook, University of Edinburgh

 2004-6: Research – Glasgow Uni  Where did we get the evidence  What can the evidence tell us? ---------------------------------------------------------  2006-11: Work with the JIT  Knowledge exchange  Assembling the pieces of a complicated puzzle

 DH funded research programme  Effectiveness of partnership working from perspective of users and carers  230 interviews with:  older people,   mental health service users, people with learning disabilities  15 services in Scotland and England  Research carried out in partnership with user researchers

Mental Health Older People Learning Disability

2 Community Mental Health Teams 1 Home Treatment Team 2 Day Hospitals 3 Intermediate Care Services 2 Older People ’ s Teams 3 Community Learning Disability Teams 1 Supported Living Service 1 Day Opportunities

 User defined partnership evaluation tool (later UDSET)  Outcomes focus  Developed with reference to:  Previous research on outcomes (SPRU from 96)   Focus groups with service users Views of user research partners  30 minute semi-structured interview  Records stories and yes / no answers  Analysed qualitatively, data coded by themes

Quality of life Feeling safe Having things to do Seeing people Staying well Life as want Dealing with Stigma Process Listened to Choice Treated as individual Reliability Change Improved confidence and skills Improved mobility

 What matters to people  Variations but core similarities – care groups  Variations mainly influenced by external factors and patterns of service provision  Examples: social contact and discrimination/stigma  Interaction between different outcomes  What’s going well and not so well in a service/locality  Ideally consider the person in the context of their whole life – not all about services

2 initial workshops held September 2006  Several staff each from 13 partnerships in Scotland attended  Widespread commitment to user involvement  Considered an outcomes focus in performance management Scale expanded with CCOF in 2007    Work with 6 of 7 early implementers Switch from knowledge transfer to exchange UDSET to Talking Points

2 initial workshops held September 2006  Several staff each from 13 partnerships in Scotland attended  Widespread commitment to user involvement  Considered an outcomes focus in performance management Scale expanded with CCOF in 2007    Work with 6 of 7 early implementers Switch from knowledge transfer to exchange UDSET to Talking Points

Talking Points: Personal Outcomes Approach

      Aims to improve outcomes for individuals using services, carers (and staff) Based on three outcomes frameworks  Service users, carers, people living in a care home Staff work with individuals to identify outcomes and develop outcomes focussed care and support plans Review progress in relation to outcomes Conversational approach Draw on range of evidence to record information on outcomes (qual and quant)

1 User’s view 2 NEGOTIATE 3 AGREE OUTCOMES Carer’s view Assessor’s view 4 RECORD OUTCOMES Agency’s view ‘EXCHANGE MODEL’ OF ASSESSMENT

Evidence for improvement

 Information on individual outcomes can be analysed at individual and aggregate level to inform:     Service improvement – what is working well, for whom and why?

Planning – what are the key issues facing client groups / communities? How do services need to change to address these? Performance management – are we delivering good outcomes for service users and carers in this service / partnership?

Commissioning and contract management – which providers, which supports, to whom?

Dimensions of change implementing an outcomes approach

CULTURE Performance Improvement SYSTEMS PRACTICE

Use of Talking Points

 31/32 partnerships in Scotland engaged with personal outcomes / Talking Points  Approx 60 provider organisations linked into TP programme   More activity related to personal outcomes Specific pilot in Care Homes  Links to Wales and England  Small pilots  Whole systems change  Activity across social care, health, housing, community and long term care

Assembling the jigsaw…

 Consensus over philosophy and principles  ‘Buy in’ from inspection and regulation, policy, practice and service users and carers  Body of evidence in relation to implementation      Requires shift in culture and practice Importance of staff training and ongoing supervision Leadership and strategic engagement vital Improvement before performance Whole system approach

Assembling the jigsaw…

 Growing body of evidence in relation to impact      Service users and carers feel more listened to and empowered Growing numbers of individuals whose lives have been transformed Staff doing their job the way they want Organisations working and thinking differently Supports personalisation, re-ablement, community capacity building, positive risk taking, person centred care

Missing pieces / development areas

 Commissioning  Use of information on outcomes  Acute care

Talking Points website: http://www.jitscotland.org.uk/action areas/talking-points-user-and-carer involvement/ Community of Practice: http://www.idea.gov.uk/idk/forum/networ king-gateway.do

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