Understanding outcome based
support planning
LUCIANNE SAWYER CBE
COMMUNITY CARE RESEARCH & CONSULTANCY
The impact of Outcomes on
Support Planning
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Getting support planning right
Brokerage
Resources – not just services
Commissioning – investing not funding
The market
Measuring outcomes
Aims of support planning
– how do we get it right?
• Is the ‘means by which information is presented to release
funding’ (DH) but it’s a whole lot more than that as well –
– Sets out how to achieve the desired outcomes
– What the outcomes are and what the barriers (needs) are
– Who will be involved and what do they will do
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Evidence that DH guidance (personalisation toolkit etc) will work well
for the most able and most keen to manage things themselves – but
what about least able?
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Some have little idea about what might be possible
In some cases family or friends may be too protective
Some have no capacity to plan support
Some just don’t want the hassle of doing it all themselves
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IB pilots modelled on In Control – but LD service users likely to have
previous exposure to services
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Those in pilots who got an IB were x 5 more likely to already be on a
Direct Payment
Support planning – getting it right
• Starts once RAS has allocated resource
• Should focus on bringing about best possible levels of
independence, health and well being but must also reflect
each person’s own priorities
• Will providing assistance solve the problem? How can we
be sure that ‘assistance’ doesn’t skew the person’s own
wishes?
• How can we achieve the right balance of power between
service user and the council?
• How can we ensure that even the least able can gain choice
and control?
• In time, will everyone want to do it for themselves??
Support planning – getting it right
An outcomes approach can help:
• All about the impact that interventions have on a person’s quality
of life
• Concerned with bringing about support which is flexible and
responsive
• About the person being in control, whether support is via
mainstream services or unique to them – but within a framework
in which there is shared agreement about the aims
• Ensures the outcomes are the right ones for that person
These should apply to every service user, however they
get funding and whether they control it themselves
or not – so long as outcomes thinking permeates all
our processes, and way of working
Personalisation – key areas of
focus for Councils
• Universal Services
– Applies to everyone, including those who wont
qualify for public funding
– Demands universal access to such services as
transport, leisure, housing, education
• Early Intervention and prevention
• Choice and Control
• Social Capital
– Community, family and friends networks etc.
An outcome-based approach
CONVENTIONAL
OUTCOME-BASED
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Service user identifies desired outcomes (priorities) in
discussion with assessor
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Assessor considers needs and determines time budget
and eligibility. Possibly agrees some tasks with user,
but user can change these as he/she wishes
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Provider agrees service plan with user, including
times/ days of visits, and tasks – focusing on how best
to achieve outcomes. User and provider can agree
changes in visit days, times and tasks
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Allocated time can be used flexibly over a given period
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Monitoring will include verifying visits and recording
tasks
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Success is judged on whether or not outcomes are
achieved
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Assessor considers
needs in consultation
with user
Assessor identifies tasks
to be completed on each
visit
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Assessor specifies time
of arrival and time of
departure
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Monitoring consists of
verifying visits and
checking tasks completed
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Success is related to
efficiency in carrying out
visits and tasks according
to specification
Brokerage - role
Conventional role of brokerage:
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Identify appropriate choice(s)
Act as a mediator
Should be independent of funders and providers
In the social care context will provide planning supports that are
flexible and are controlled by service user (and family)
DH guidance
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INTERNATIONAL CONVENTION – SAN DIEGO 2002
Provide a range of information
Undertake, or assist with, support planning
Guidance on choice of support resources
Negotiation, mediation
Facilitation
Provide or access technical skills/information
Advocacy
GOOD PRACTICE IN SUPPORT PLANNING AND BROKERAGE –
PERSONALISATION TOOLKIT
Brokerage
An overlap but a
succinct role
BROKERAGE
Information
Support
Advocacy
Who provides brokerage?
Brokers must:
• Understand the concept and practice of outcomes working,
focusing on what is most important to the person
• Understand local market
• Have wide knowledge of local and national resources, including
benefits etc.
• Know where to access specialised advice
• Have ability to ‘think out of the box’
• How to make best use of budget i.e. not just buying paid support
• Be able to design, or assist in designing and costing, support
which supports the person in relation to his desired lifestyle,
needs and chosen outcomes
• Have excellent communication skills, including how to help those
with communication difficulties
• Have stories (examples) of how others have used budget
• Understand issues around capacity to consent
Resources
• Support resources – not just services
• Family and friends
• Community resources to which we should all
have access
• Volunteers or voluntary sector organisations
• Range of specific social care services
– In-house provision
– Voluntary or private providers – commissioned or
purchased individually
– Individually sourced Personal Assistants
Commissioners need to be
investors, rather than funders
The Funder
The Investor
Invites submissions, often to a
rigid specification, and selects
from those applying
Seeks to uncover all promising
opportunities and encourages
innovation
Believes fairness means keeping
a distance from proposers
Believes fairness means intense
interaction with applicants
Considers grant or contract
decisions the high point of the
work
Considers the initial investment
only the starting point
Asks: How can I help?
Monitors for compliance
Taken from Institute of Rensselaerville
document
Commissioning for outcomes
What is the return on your investment?
CHANGE
• Fewer prisoners re-offend – change in behaviour
• Reduction in the numbers of depressed older people – change in
well-being (feelings, attitudes, circumstances)
• More older people remaining independent – changes in mobility,
confidence etc.
• Improved mortality rates after heart attacks – change in health
Making the change
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Involve providers as you develop your ideas – get widescale
commitment and provide training
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Really get to know your local providers – what area do they cover,
what is their capacity, who are the middle managers, how open are
they to change?
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Be clear about what you want and expect, but be open to
negotiation – what are the problems they foresee in changing what
they do and how they do it? How can you help them?
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There are advantages to them as well – staff turnover improves
with outcomes working, the potential for learning new skills, and
taking more initiative
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Relationships with service users will also improve as providers are
able to respond more flexibly and as the service user has control
over what is done and what is not done
AIM AT:
TRUST
Good
communication
PIE IN THE SKY ?
Measuring outcomes
• Must start with baseline data
• Service outcomes
– numbers of people able to continue living at home
• Individual outcomes
– physical or emotional (confidence, engagement
etc.)
• Individual outcomes – simple recording or
more complex tools e.g. depression index,
quality of life measure
Results Based Accountability
approach to measuring outcomes
How much
did we do?
How well
did we do it?
Is anyone better off?
Quantity
Quality
‘hard’ and ‘soft’ outcomes
HARD
• Observable functional
improvements
• Reduction in recidivism or
substance abuse
• Young care leavers have
improved academic
qualifications
• Carers are able to
continue at work
SOFT
• Improved quality of life
• Reduction in depression
• Carers have reduced
stress levels
• People feeling more
confident
• Older people feeling
valued
• Well being
Tools for measuring outcomes
• Scales based on Activities of Daily Living (ADLs) –
focus on dependency eg bathing, dressing, continence
etc.
• Instrumental ADLs include core activities of
independent living eg preparing meals, doing
housework, managing finances, remembering to take
medication etc.
• A number of QOL surveys being developed – Office
for Nat. Statistics leading the Quality Management
Framework QMF. Within team PSSRU developing
ASCOT which measures value of some social care
services – seeks to identify specific aspects of
people’s lives addressed by social care interventions –
applicable across all user groups
User Defined Service Evaluation
Tool (UDSET)
• Investigates users’ or carers’ experience of a
service or package of care
• Determines whether the service/care
package delivers the desired outcomes
• Understand how different features of the
service impact on user/carer experience
UDSET outcomes for
Quality of Life
FOR SERVICE USERS
• Feeling safe
• Having things to do
• Seeing people
• Staying as well as you
can be
• Living where you want
and as you want
• Dealing with
stigma/discrimination
(mental health)
FOR CARERS
• Quality of life for the
cared-for person
• Maintaining health and
well-being
• A life of his/her own
• Positive relationship with
the person cared for
• Freedom from financial
hardship
The Outcomes Star
Personal responsibility
accommodation
Living skills
Social network
employability
Health
Substance risk
Outcomes Star – type of scale
Number
Indicator
1
No motivation
2
Focuses for brief periods of time only
3
Does want to change but feels helpless/powerless to do so
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Begins to request some help
5
Wants to change and has some idea in what way
6
A clearer sense of what he or she wants and some idea of
steps needed to get there
7
Active in getting closer to his or her goal, has a sense of how
others see him or her
8
Noticeable change in behaviour, can evaluate options
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More comfortable with new lifestyle
10
Feel he or she is in right situation/place for forseable future
Data for measuring outcomes
DH recommends:
• Should be available at PCT and/or local
authority level
• Regularly available
• Statistically robust
• An appropriate measure of the framework
outcomes
• Avoid perverse incentives etc.
• Promote improvement