Department of Health Outcomes Programme, 1996-2000

Researchers: Hazel Qureshi (lead researcher), Claire Bamford, Jennifer Harris, Elinor Nicholas, Charles Patmore

Funder: Department of Health Policy Research Programme

Duration: January 1996 to December 2000

The long term aim of this five year programme was to develop and test ways in which social care agencies could collect and use information about the outcomes of services on a regular or routine basis.

Review of the Programme

The SPRU outcomes programme, as originally funded, is now complete. This therefore is an opportune point to give a review of the programme as a whole. When the first phase of the programme began in 1996, recognised obstacles to using outcomes information were:

• Confusion about the meaning of "outcome" in social care. Staff were as likely to be confused as service users.
• Cynicism about whether information would be used to benefit users and carers.
• Overload of organisational change, and new paperwork.

The programme was designed to address these obstacles through two phases of work. The first phase was: 

• Research designed to investigate the views of stakeholders on
  • what outcomes were, and
  • how social services should collect information about them

One aim of this first phase was to develop a clear set of ideas which would reflect the ideas of all stakeholders about the actual and desirable outcomes of social care for older and disabled people. Groups consulted were older people, people of working age with physical or sensory impairments, frontline staff and managers. We used a range of deliberative techniques (such as focus groups) to give people opportunities to discuss and think about the ideas. We included very diverse groups of service users including people with dementia, people who were Deaf, and older people of Asian and Eastern European origin. Among staff we included social workers, care managers, home care staff, occupational therapists, and middle and senior managers.

The second aim of the first phase was to identify possible areas of agency activity where an attempt might realistically be made to introduce a greater focus on outcomes. The two main sources from which outcome information might be gathered routinely were:

• Direct feedback from service users and carers about the impacts of services.
• Analysis of data or information recorded as part of routine procedures such as assessment.

Using ideas from the work of Gerry Smale and Gerard Egan, we sought to identify opportunities to introduce outcome ideas through changes or innovations which would:

• Solve problems which were recognised as such by those who would have to implement the changes.
• Not require large investment of resources (unless there was already a recognition of the need for this).
• Fit well with existing practice, or with existing or planned changes which were already moving in the same direction.

The option of imposing "top down" changes was not available to us in our capacity as external researchers, even had we wished to take such an approach. Therefore we had to work with people to establish "ownership" of new ways of working. Together with our local authority partners we selected five projects as potentially adoptable.

The second phase of the programme involved initiation, planning and trial implementation of the five projects designed to take forward outcome ideas into routine practice. Two involved the collection of evaluative information directly from service users, in one case through conventional survey methods and in the other through direct interviews with a sample of users conducted by senior and middle managers. The three remaining projects involved changes to the care management process: a method to support care managers in summarising intended outcomes for older people; documents and guidance for conveying clear provider instructions; and outcome-focused separate assessment and review for carers. Service users and carers participated variously in planning groups, reference groups and as individual advisers. SPRU staff participated in the development process and used fieldnotes, minutes, tapes and other records of meetings, feedback questionnaires, and the results of trial implementation of recording forms, to draw up an account of the process and identify barriers and facilitators to implementation.

Findings

The projects have clearly demonstrated that the inclusion of outcome ideas and concepts is possible in care management with older people and carers, as well as in surveys of disabled service users, and ‘customer visits’. The specific instruments, guidance, procedures developed are illustrative examples of ways in which this can be done. Some of these, or revised versions, are being incorporated into the routine work of participating authorities. The contexts in which the work has been carried out, and the barriers and facilitators acting within them are undoubtedly similar across many authorities. None of the ideas can be implemented without some costs being incurred, for example, time and funding is needed for: staff training and orientation; funding and facilitation of user and carer involvement; improvement of existing record systems; data analysis and reporting; and making sure there are programmed opportunities to consider feedback and decide on action. However the programme has stimulated substantial interest among social care agencies, and we anticipate that its influence will grow as dissemination continues. The work is very much in line with current policy and practice concerns about quality in social care and achieving Best Value and user-centred services.

Publications

Outcomes in Community Care Practice series
As an on-going contribution to the debate, SPRU is publishing a series of reports on outcomes in community care, which will be more rapidly accessible than work published through conventional channels. Work on outcomes continues with the Department of Health Outcomes Programme, 2001-2005

If you require further information about the project, please contact SPRU's Information Office 

Show Abstract...

2001

Using postal questionnaires to collect information on outcomes from users and carers, 2001
Bamford, C. in H. Qureshi (ed.) Outcomes in Social Care Practice, Social Policy Research Unit.

Implementing an outcomes approach in carer assessment and review, 2001
Nicholas, E. in H. Qureshi (ed.) Outcomes in Social Care Practice, Social Policy Research Unit.

The briefing sheet for home care staff - method for focusing services around each individual user, 2001
Patmore, C. in H. Qureshi (ed.) Outcomes in Social Care Practice, Social Policy Research Unit.

Outcomes in Social Care Practice , 2001
Qureshi, H. (ed.), Social Policy Research Unit .

2000

Surveying outcomes of equipment and adaptations, 2000
Bamford, C., Research Works, November 2000, Social Policy Research Unit.

Implementing an outcomes approach to carer assessment and review, 2000
Nicholas, E. , Research Works, Social Policy Research Unit.

Briefing home care staff about older people's individual needs, 2000
Patmore, C., Research Works, Social Policy Research Unit.

Learning from older community care clients, 2000
Patmore, C., Research Works, Social Policy Research Unit.

Outcomes and assessment with older people, 2000
Qureshi, H., Research Works, Social Policy Research Unit.

Introducing an outcome focus into care management and user surveys, 2000
Qureshi, H., Research Works, Social Policy Research Unit.

Academic coverage

Journal of Integrated Care, 13, 6, December 2005. Focusing on outcomes: their role in partnership policy and practice.

"A linked sequence of projects under the DoH-funded Outcomes research programme at the Social Policy Research Unit, York (SPRU) is of particular significance, both for its emphasis on identification of the outcomes salient to service users and carers themselves (Qureshi, 2001), and for the promotion of evaluation based on these outcomes to be incorporated into routine practice (Nicholas et al, 2003) ... "