Across the UK health and social care staff are exploring how to work in a more integrated way for the benefit of their clients and patients – who are often those ‘further from work’ and clients of a wide range of services. There is still a need for independent evaluations, but our experience is that clients are seeking help in three other areas.
Supporting service improvement
After almost a decade of budget reductions, services are feeling it. This is not a new story, but the easy efficiency wins have often gone. For services where demand is still increasing (for example those supporting older people), this poses a particular issue: resources are already stretched, and services need to make more sophisticated, creative and cultural changes if they are to continue to meet demand while managing their budgets.
What has proved helpful here is acting as expert advisor, critical friend, and independent facilitator.
Service change like this requires buy in and change from within. So, we facilitate workshops, oversee the progress of workstreams, and provide a steering hand based on our experience of what works (and what doesn’t) in service delivery and managing change. For a recent client, we have been helping delivery staff to think strategically about their service. This is really about helping the service to find the breathing room to explore the evidence about current delivery in a carefully structured way and develop the solutions themselves.
Reviewing service need and delivery
Health and social care needs are becoming more complex. Policy makers are also shifting their focus on the interaction between health, social care and other outcomes such as housing, education and employment.
Service providers are responding to this by undertaking reviews of their range of services to answer the questions, “What are the needs of my target group, and is what I am delivering – and the way I’m delivering it – addressing these needs?”
Our work with one Health and Social Care Partnership in Scotland has been typical of this.
Having explored with them the range of employability services they funded, and how they could enhance their impact by connecting these around specific client routes and journeys, they asked us to review their tailored health services for young people.
These are delivered through different models that have grown organically in response to local needs and available resources. These services were one part of a range of services provided by an array of partners. We identified the needs of young people in the area and recommended a service delivery model that would best meet these needs while fitting in with, taking advantage of, and influencing other services. This can feel a bit like three-dimensional chess at times!
Understanding costs and benefits
As Clara and I wrote some months ago, in an environment where every pound comes under the microscope, common sense is not enough to drive decision making. Commissioners are asking themselves, “How do use my resources in a way that supports service users, while generating savings elsewhere”. Clients want to understand how spending can relieve the financial pressures and free up resources to be reinvested elsewhere.
One example is the help we are providing to a Clinical Commissioning Group in England to understand the likely financial return to commissioners from changes to clinical follow up procedures. We are also evidencing and measuring how non-clinical support for patients can lead to tangible savings to clinical services (and therefore commissioners), while improving the service users experience. Another example has been helping The Yard Scotland to articulate how much its service reduces the demand for Local Authority funded respite care for young people with disabilities.
You will gather from this that client support needs in the area of health and social care are fluid and shifting. They need to maintain progress and make significant changes while ensuring that their clients and patients receive high-quality care and support. Our experience is that there are still improvements to be made against a background of tightening budgets and increasing demands. But it needs evidence, leadership, sustained investment in staff and their development – and great collaboration across the front line.