The changing face of health and social care

The changing face of health and social care

Health and social care services are changing, and so is the help we provide our clients. Clare explores some of the changing nature of what clients want.

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.

 

Clare is a Principal Consultant in our Edinburgh Office. She works on health and social care projects across the UK and is trained and experienced in economics and public policy. You can check out her profile here.
When common sense is not enough

When common sense is not enough

Clare Hammond and Clara Mascaro on using Cost Benefit Analysis to justify investing in prevention

The saying goes: “It’s better to build a fence at the top of a cliff than to park an ambulance at the bottom.” And this common-sense notion that it is better to prevent than to cure has in the last decade also become an accepted principle in public policy. This has been helped by the influential work of the Early Action Taskforce and other bodies such as NESTA.

But putting common sense into practice is often easier said than done. Designing a preventative intervention involves important decisions such as when to intervene, and whether the intervention should be universal or targeted at a specific group of people. In particular, making a solid financial case for investing in preventative strategies is proving to be the ‘do or die’ of whether these are implemented at all. This is where cost-benefit analyses (CBAs) have a crucial role to play.

…the costs and benefits of prevention are spread over time…

A major difficulty for financing such interventions is that service providers bear the costs now, for a service that may create benefits in the future – often 5, 10 or 20+ years in the future. Well beyond any service budget or political term. Convincing service providers to divert already limited money from those who need it now, to benefits in the future is a tough one. Particularly with all the uncertainty that goes with things not in the here and now.

… the costs are usually borne by one service and the benefits received by another…

The agency bearing the costs is not always the agency reaping the benefits. For example, a local authority may invest in a programme to facilitate youth transitions from school, but the savings from reduced youth unemployment will accrue to DWP as a result of having fewer out-of-work benefit claimants. In a world of siloed budgets and service pressures and demands for results, moving money across organisations, even within the public sector, is complex.

…the solution is trust and coordination between agencies – and a lot of hard evidence…

To support investment in preventative strategies, co-operation is needed. This could be facilitated by pooling and integrating budgets. For example, this is what happens with Health and Social Care Partnerships, which bring together local authorities and NHS Boards across agencies and institutions.

 

However, when such integration is not an option, strong partnership working, coordination and trust is needed to encourage investment. This can be helped by cost-benefit analyses showing who will benefit from an intervention, by how much and when. On this basis, agreements can be made between agencies to share the costs and benefits of a preventative intervention.

…Cost Benefit Analysis is critical to underpin conversations and agreements between agencies that build this coordination and trust…

CBAs can be used to make a case for investment now for future savings. By clearly showing the expected costs, savings, those who pay, those who benefit and when, decisions about prevention become more tangible. We have been working with a number of Local Authorities and service providers to create CBAs that help them to better understand and articulate the costs and benefits of a range of preventative investments.

A few of these include:

·        Helping the Dundee Partnership to estimate the likely savings to a range of agencies from reducing the incidence and duration of long term unemployment. Our work also identified who to invest in, when, and how to successfully prevent long term unemployment

·        The London Borough of Havering where we created a CBA to estimate the savings to the Local Authority from our recommended interventions to reduce unemployment. These savings were as a result of less demand for council services such as social work, care and housing

·        For a charity called The Yard Scotland, we estimated the savings to the Local Authority of their service through reducing the demand for council funded respite care for children and young people with disabilities by preventing issues from escalating.

In a context of tight budgets, a complicated landscape of provision, and a short-term bias, CBAs can provide the supporting weight to tip the scales in favour of early action. We may all agree that ‘it is better to prevent than to cure’ but, in this case, common sense alone won’t make prevention happen.

 

Clare is a Principal Consultant at Rocket Science based in our Edinburgh office.  You can check out her profile here.

Inclusive Impact – capturing ALL voices

Inclusive Impact – capturing ALL voices

How can you involve vulnerable young people and their families in measuring social impact? Clare Hammond talks about our work for The Yard in Scotland, developing their first Social Return on Investment report.

We have been working with The Yard Scotland and their community since June 2016. The Yard provides safe play spaces and respite for young people with disabilities and their families. During our time with The Yard, we conducted a Social Return on Investment and Cost Benefit Analysis to be able to evidence and quantify the impact their service has on families and how much they save other service providers such as the Local Authority.

For Rocket Science, the voice of the service user should be present, loud and clear, and the central driving force for any impact analysis. Social researchers the world around can talk to you about sampling sizes, interview techniques, and running a great focus group to get that voice. However, social impact research gets slightly more complicated when service users are less able to engage with the more traditional research processes.

Engaging extensively with The Yard’s young people and families as part of this research has been very important to both Rocket Science and The Yard Scotland. To do this we have had to use less conventional methods of social research – and we have learnt a few things along the way: We’ve learnt a few things along the way about how to approach impact analysis using less conventional methods:

Co-design with The Yard of all research activities was vital. As consultants, we brought expertise in evaluation disciplines, analytical processes and robustness. However, it’s The Yard that knows its client group inside and out. Bringing together this expertise was vitally important, particularly in designing and delivering the research activities with their young adventurers.

Abandoning the traditional – for the young adventurers we knew we couldn’t use traditional research techniques. Instead we embraced what made The Yard so great – play! We kept it simple– we had two questions we needed answering.

 

Then we developed a range of play activities that young people could engage with…ever conducted an interview on a go-kart? It’s exhilarating.

Understanding the impact of the service on families was much harder than we expected. Parents and families of these young adventurers are so used to constantly being the advocate for their child. They are some of the most selfless people we have engaged with. For our research – getting parents to think about themselves was difficult. We overcame this in two ways:

We needed to make it clear to parents that this was a space for them to talk about themselves as well as their children. Using colourful post-it notes we put all messages relating to their children on one wall, and messages relating to themselves as individuals on another wall. As expected, the wall of messages about their children filled up fast, while their own wall remained largely empty. We then set them the challenge of filling their wall to be as colourful as the wall about their children. Highlighting their selflessness visually, and colourfully proved to be very effective.

Once again, we embraced The Yard’s motto – fun! We needed to convert outcomes such as friendship and relaxation into monetary values. We chose to use Choice Modelling – which, I promise, is as dull as it sounds if done with no humour. So with fun, laughter and a joke or two we had groups of parents and carers giving us their honest views of what was important to them as individuals as well as their family.

Our time with The Yard has been rewarding, enlightening and a lot of fun. There aren’t many researchers that get to say they got to play with paints, bikes and swings for work! The Yard are now armed with robust evidence of their impact to use with the policy makers and funders. With this information, they intend to influence the design of services and expand their services further across Scotland.

Clare is a Principal Consultant at Rocket Science based in our Edinburgh office.  You can check out her profile here.