Insight from our Rocket Scientists – Working with Young People

Insight from our Rocket Scientists – Working with Young People

This week we ask some of our Rocket Scientists What is important for services that support young people?

Over the last year, we have evaluated a range of programmes supporting young people. Our clients include the Wise Group, Venture Trust, Scottish Waterways Trust, Princes Trust, and Centrepoint. This work has given us the opportunity to refresh our insights into what works when helping young people to improve their education, employability and financial resilience.

Using this insight we have asked our Rocket Scientists to share lessons they have learned about what works for young people.

Dina Papamichael, Assistant Consultant

For me, it is crucial to understand the intersecting issues which young people can face. For young people, issues around health and employment are so closely linked with self-confidence, social inclusion, substance misuse, homelessness and mental health. The most successful interventions enable a young person to overcome multiple challenges on the road to the programme’s primary objective. A programme which helps young people gain a qualification while developing a social network can have the impact of boosting self-confidence, developing work-related skills and increasing the level of stability in a young person’s life, while health services that focus on the social drivers of the sexual and mental health of its young people can obtain better and more enduring health outcomes.

Richard Scothorne, Director

The transition to work is a very tough one for many young people. Some have never really succeeded at anything at school and have often lacked the stable support of parents or other carers.  The most effective programmes we have worked with have provided different kinds of support – in other words, support that young people can chose from in terms of the quality of the relationship and their different needs from time to time.  These sources include trainers, mentors and personal coaches – someone who can provide the young person with a fixed point in a shifting world – and who will listen to them and stay with them through their journey.  In addition, working on shared tasks in small, well-managed groups – often in quite demanding conditions – can provide invaluable peer support, show people they are still appreciated even when they may be struggling, and help to build a young person’s confidence in dealing with others.

Natalie Dewison, Senior Consultant

Traditionally, the effectiveness of employability services has been assessed by looking at the number of people moving on to ‘positive destinations’ (education, employment, training or volunteering). For employability projects supporting young people facing multiple barriers to work, particularly those that only run over the course of a few weeks, this approach fails to capture the full impact of support provision.

We have found that often the most valuable outcomes are increasingly recognisable over time. Improvements in a young person’s confidence and outlook for example, which make them more resilient to knock backs and motivated by new long-term goals and ambitions. These things have the potential to greatly improve future job prospects. We are currently supporting three organisations delivering employability projects to evidence the sustainability of these outcomes. This means developing methods of longer term data collection that are simple, effective and enjoyable for the young people involved.

 

Max Lohnert, Assistant Consultant

Vulnerable young people often come from unstable backgrounds and face a range of intersecting barriers to entering employment. Considering this, our experience shows that there is no “quick fix” and that vulnerable young people benefit most from sustained engagement with employability programmes. For example, young people often benefit immensely from the trusted relationships with trainers and mentors and from the peer network they establish – and such relationships take time to build. However, since funding arrangements often require organisations to prioritise the number of young people being helped over the length of time they can engage with a single person, organisations have found other means to engage young people for longer periods of time: ranging from trainers or mentors staying in touch with a young person informally after the official completion of the programme, to building linkages and strong referral networks with other organisations along the employability pipeline.

Clare Hammond, Associate Director

The job market is becoming more complex and more competitive. Teaching young people to navigate this complexity is so important. This includes helping them look beyond the well-known and more obvious opportunities. How many jobs did you know existed when you were in high school? Doctor, teacher, engineer, nurse and banker? Probably. How about business analyst, GP practice managers, food safety consultant, project manager? Probably not.

The role that employers can play in helping young people understand the lay of the land is well evidenced. However, engagement between schools and employers often focuses around larger private sector employers. These large businesses make up a small part of employment in the UK. Most people will work for small or medium sized private firms, or the public sector. Where schools partner with small and medium sized businesses and the public sector young people are able to have a fuller understanding of the labour market.

Eleanor Sanders White, Consultant

There are many assumptions out there about young people which can interfere with our ability to reach and support them. Sometimes, the only thing in common in a group of young people is their age – we need to be careful about treating them as a homogenous group. A lack of confidence or fear of failure can often be misinterpreted as apathy. While some young people want to engage online, others need to develop a trusting relationship to engage. Many young people are technologically savvy, but some won’t have the digital skills required to engage online. While some young people will need a tailored and very supportive experience, others will interpret this as patronising. The way through this? Some of the most successful examples we have seen go straight to the source and ask the young people, others have shown a huge flexibility in how they engage with the young person to tailor for the individual walking through the door.

 

For more information on our work with young people get in touch with Clare Hammond, one of our Associate Directors [email protected] or 0131 226 4949

How does a health and social care organisation become a big player in employment? The power of stepping back from a diagnosis.

How does a health and social care organisation become a big player in employment? The power of stepping back from a diagnosis.

Clare Hammond looks at why health, social care and employment are so important to each other

18 months ago, we were working with a Scottish Health and Social Care Partnership (HSCP) and were struck by what we found. This HSCP was spending the equivalent of 50% of the value of the new national programme for those further from work, on helping their service users into employment. How does a HSCP end up being such a big player in employment?

More and more, services are stepping back from a diagnosis, or presenting issue, and looking at the whole person. A perfect illustration of buzz words such as ‘person centred’ and ‘holistic’. In health and social care, this is driven by a growing understanding that medical conditions are often driven by, and in turn drive, other issues such as trauma, poverty, social inclusion, and worklessness.

These intersections are what has driven the growth in health and social care integration, information and support services, complementary therapies, and social prescribing, and where prevention has found a practical expression.

Subsequently, services have needed to work across their typical service boundaries. These partnerships find two main forms (1) strategic and structural partnerships, and (2) practical and operational partnerships at the coal face.

Much of the focus on health and social care integration in both England and Scotland has focused on structural integration. However, we have found numerous examples of long standing, pragmatic and effective operational partnerships as front-line staff recognise the need to engage with other services to get the best outcome for their clients.

So, while strategic partnerships often feel that they a have responsibility to support partnership working across every level, there is a lot that strategic partners can learn from front line delivery staff for whom partnership working has long been part of their everyday approach to support provision.

Coming back to the HSCP mentioned at the beginning of this blog, how did they end up here? This HSCP had 16 employability related projects covering a variety of health and social care services. Despite operating independently over a period of more than 5 years, front-line staff working across all projects had identified the important role that employment (or the prospect of employment) could play in managing an individual’s health and wellbeing and maintaining their progression. As such, working towards employment became part of a recovery journey in mental health, addictions and criminal justice, and a way of improving health and care outcomes for those with disabilities, or young people raised in care.

From an employability perspective, these service users were effectively pre-stage 1 in the Strategic Skills Pipeline. By encouraging participants to lift their aspirations of future employment and begin setting goals. these HSCP services effectively prepare them for mainstream employment services.

This approach is echoed by new national employability programmes (Work and Health Programme and Fair Start Scotland) being developed across the UK which have a particular focus on supporting those with multiple barriers to employment. The only way these programmes are going to be successful is if they link in with projects like those being delivered through the HSCP and encourage people to think about employment as part of their recovery journey. Doing so should improve the level of engagement when they enter the first stage of the employability pipeline and the outcomes achieved.

To reach this point, health and social care services can learn from this HSCP, step back from the diagnosis and consider how they can help service users make the next steps on their longer term pathway to employment.

Clare Hammond is an Associate Director at Rocket Science specialising in health and social care including evaluation, strategy and organisational development, cost modelling and cost benefit analysis. You can check out her profile here.

This blog is part of a wider series on Health and Social Care Integration. Other blogs in this series can be found here

Health and Social Care – What’s the point?

Health and Social Care – What’s the point?

Health and Social Care Integration – What’s the point? Clare Hammond explores the early evidence on the impact of health and social integration

Health and Social Care integration has been in the spotlight in both England and Scotland with promises of large financial savings coming from both countries. But can integration really be the silver bullet for these financially stretched services?

The Scottish Government estimated a potential annual savings of between £138 million to £157 million from the integration of Health and Social Care. This represents less than 2% of the more than £8 billion of spend integrated bodies are responsible for. When compared with the expected increase in demand of between 18 and 29% between 2010 and 2030 it is hard to see integration as the saviour of financial woes.

A core element of integration in England is the Better Care Fund which was estimated to save £511 million in its first year, a little under 10% of the pooled budget of £5.3 billion. Interestingly, the NHS Sustainability and Transformation Fund for 2016/17 had £1.8 billion of its £2.1 billion rediverted from integration to fund NHS deficits, indicating the scale of the financial situation.

So, it seems unrealistic to expect health and social care to plug the growing gap between demand and public budgets. But how is integration going in achieving the savings that are expected?

The primary assumption for integration related savings is that a more preventative and social care focused approach can steer people away from the more expensive emergency hospital-based care.

The National Audit Office (NAO) concluded that integration in England has “yet to show that integration leads to better outcomes for patients”. NHS England had hoped to reduce hospital activity growth from 2.9% to 1.3% (by 2020/2021), however both the number of admissions and delayed discharge days increased in 2015/16 at a total extra cost of £457 million. Audit Scotland are due to report on the progress in Scotland in November of this year.

Of course, you can’t know what would have occurred without a counterfactual. The NAO themselves acknowledge that there is a lack of comparable data across different care settings to place evaluation findings into context.  So, what does the evidence have to say about integration’s ability to reduce hospital admissions?

A University of Oxford study published in 2017 concluded that, while the policy discourse around Health and Social Care has pushed the approach as a solution for reducing emergency admissions, the evidence available tells a very different story. According to them, there is a mixed view on the success of a number of integrated care programmes that have been evaluated so far. Of 13 reviews conducted, only three had a significant impact on the number of hospitalisations that occurred. This review included studies on Case Management systems (a common component of health and social care integrated models) found that this approach did not have an impact on hospital admissions.

 

The Kings Fund has reported on a range of examples of integration at the coal face – where integration of services occurs rather than the integration of the institutions that sit behind them. One example described is in east Kent where professionals are working together across five community hubs coordinating the care individuals identified as high risk of hospitalisation. These community hubs include teams of “GPs, community nurses, social care workers, mental health professionals, pharmacists, health and social care co-ordinators and others”. They conclude that early findings suggest “that these changes have led to year-on-year reductions in emergency admissions to hospitals”.

So why is the evidence available so mixed? Well, perhaps it is as the Barker Commission concluded in 2014 of integration in England. “Moving to a single budget with a single commissioner is not a sufficient condition to tackle the myriad problems of integration that face health and social care. But we believe it is a necessary one.” Or as Scottish Government said “[s]tructural integration brings few benefits unless accompanied by many other changes”.

There may also be a problem with the focus on structural change rather than on the behavioural and relationships changes that are needed to drive real transformation.  Research by the King’s Fund identified that there was “a strong recognition that the relational and behavioural aspects of transformation deserve as much, if not more, attention than technical and structural aspects.” So integration bodies may be looking in the wrong place and not paying enough attention to how staff behave and work together on the ground

Is it too soon to tell? While Health and Social Care Integration has been discussed for more than a decade, large scale action is still relatively new. In addition, integration is occurring in already financially strained and very complex environments. It is hard to isolate the various strands in this complexity to understand what has worked, what hasn’t, and why.

Indeed, a frequently quoted example of ‘best practice’ is Greater Manchester who are operating multi-disciplinary neighbourhood teams, intensive support targeted at those considered high risk, and driving the use of community and primary health care settings to reduce hospital use. But when you explore what makes Manchester work so well it appears to boil down to two factors:

  • Their long established public-sector partnership that crosses typical service boundaries.
  • Their ability to access additional funding for integration activities from the Sustainability and Transformation Plans Fund that reduces the choice between either funding rising financial pressures or integration initiatives.

 

Clare Hammond is an Associate Director at Rocket Science specialising in health and social care including evaluation, strategy and organisational development, cost modelling and cost benefit analysis.You can check out her profile here.

This blog is part of a wider series on Health and Social Care Integration. Other blogs in this series can be found here

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The integration barometer – the state of play of health and social care integration

The integration barometer – the state of play of health and social care integration

The integration barometer – Clare Hammond looks at the state of play of health and social care integration

The integration of health and social care. Currently held as the holy grail of getting public services right. Both England and Scotland have been attempting to integrate these services in various ways for a while now. So, where are we? What have we achieved? This blog looks at what each country is doing and what where they have got to.

So, what’s happening in Scotland?

In Scotland, the Public Bodies (Joint Working) (Scotland) Act 2014 requires NHS and Local Authorities to integrate social care and a proportion of NHS activities. This move is driven by the Scottish Government’s 2020 Vision where everyone in Scotland can ‘live longer, healthier lives at home, or in a homely setting”.

The integrated activity equates to around £8 billion of the nearly £15 billion spent on health and social care across Scotland and covers adult social care services, adult primary care and community health services and a portion of hospital services. The integration of services such as criminal justice social work and children’s services are at the discretion of each area.

The legislation dictates that this integration must cover governance, planning, and resourcing recognition of Joint Bodies as legally separate entities. Since then, 31 Joint Bodies have developed across all 32 Local Authority areas in Scotland (with a slightly different model operating in the Highlands.

A 2016 report by Audit Scotland provided an update on the progress of integration. It acknowledged that new approaches to making health and social care integration really work are springing up across Scotland. However, they also conclude that this integration isn’t occurring fast enough to keep up with the growing service demand resulting from an ageing population and the increasing complexity of need. Audit Scotland are due to report again on the progress of Health and Social Care integration in November 2018.

Institutionally speaking, these organisations are in their infancy. This shift is considered the largest change in services since the creation of the NHS. The integration of two very different organisations, service structures, budget priorities and cultures is going to take a while. And it is probably going to be longer than 4 years for the benefits of integrated governance and decision making to bear substantial and financial fruits. Even one of the most advanced examples of health and social care integration, in Canterbury New Zealand, has failed to achieve a financial saving to their District Health Board despite achieving a large impact against a range of the typical indicators of success (average bed days per admission etc).

And, what about England?

In England, the picture is somewhat more complicated than Scotland. Here, Health and Social Care integration requires coordinated efforts from NHS England, the Department of Health (DoH), the Ministry of Housing, Communities and Local Government (MHCLG), and Local Authorities across England.

Numerous commitments to integration have been made by these organisations over the years. In 1999, the Health Act allowed Local Authorities and the NHS to pool budgets and merge services where appropriate. Very little action occurred in response to the 1999 Act, much of which is put down to Clinical Commissioning Groups and the Health and Social Care Act 2012 complicating integration.

 

English health and social care bodies have made more recent recommitments to integration. In 2013, the Department of Health committed to making health and social care integration ‘the norm’ by 2018. In 2014, NHS England made a commitment to integrate health and social care by 2020.

Various integration approaches have been used. There was the rise (and current slow death) of Health and Wellbeing Boards around 5 years ago. The latest are Sustainability and Transformation Partnerships (STPs) between the NHS and Local Authorities. There are currently 44 of these across England. A national performance system for STPs has been established with a dashboard of measures that STPs will be measured against annually. July 2017 saw the release of the ‘baseline’ performance of STPs.

Some of these STPs have ‘upgraded’ to Integrated Care Systems (ICS) which indicate an even closer integration between health and social care than the STPs. In 2017 there were seven ICS with a limited range of accountabilities around operational and financial performance. In 2018, ICS are expected to gain greater flexibility in financial management.

How integration occurs in England is less specified than in Scotland with local areas able to choose what integration looks like for them with no requirement for that integration to be the creation of a joint institution. For example, integration could include joint commissioning, or joint patient assessments.

Also unlike Scotland, English integration recognised that to reduce the pressures on hospitals means that social care will need to pick up the slack. At a cost. The 2010 Spending Review transferred £2.7 billion from NHS to Local Authorities for the following four years.

Despite the commitments, development of STPs, ICS and a number of integration initiatives, the National Audit Office (NAO) released a fairly scathing report in February 2017. Most of their recommendations were for NHS England, DoH and MHCLG and related to providing national standards, guidance and oversight on progress. However, there were two conclusions that are particularly pertinent in terms of encouraging integration in the future.

As in Scotland, there was recognition that a number of examples of good integration are occurring across England. However, these were yet to be tested at scale, not where they proven to have a sustainable impact on service budgets and outcomes. As with Scotland, comprehensive proof that integration can reduce budgets and improve patient outcomes is yet to be provided.

NAO concluded that attempts at integration are still ‘siloed’, with each ‘side’ having their own mechanisms to encourage integration. The Better Care Fund is seen by most as helping Local Authorities, while the Sustainability and Transformation Planning Process is viewed as an NHS initiative, despite both initiatives’ focus on integration. This siloed view of programmes as either NHS or Local Authority, combined with concern that much of the funding available for integration is being diverted to plug funding gaps in an already struggling NHS, leads the NAO to conclude that much needs to be done for services to see themselves as part of the same team.

 

Clare Hammond is an Associate Director at Rocket Science specialising in health and social care including evaluation, strategy and organisational development, cost modelling and cost benefit analysis.You can check out her profile here.

This blog is part of a wider series on Health and Social Care Integration. Other blogs in this series can be found here

 

Prevention in Action – Invest early in housing advice according to our latest SROI on Legal Aid

Prevention in Action – Invest early in housing advice according to our latest SROI on Legal Aid

Prevention in Action – Invest early in housing advice according to our latest SROI on Legal Aid – Clare Hammond looks at the latest findings

Prevention is heralded as the long-term solution for tackling poverty and disadvantage.

Since featuring as one of the four pillars of public sector reform set out by the Christie Commission in 2011, prevention has been a firm fixture on the Scottish Government’s agenda. However, for many policy makers and service providers, it is a much spoken about ideal that still feels out of reach.

When it is done effectively prevention work can slash the costs of later support provision and reduce the demand for a wide range of pressurised services. Most importantly however, it can lessen the impacts of poverty and improve the health and wellbeing of individuals, families and their communities.

As we have previously discussed, making a decisive shift towards prevention is not without its challenges. These challenges cut across sectors and tend to centre around two areas:

  • Where funding is directed from: insufficient budget flexibility; the potential mismatch between who funds interventions and who gains from the benefits; opportunity costs associated with re-prioritising resources
  •  Evidencing return on investment: risk and uncertainty about future impacts of upfront investment; the timescales for a return on this investment

As a company, we have sought to help our clients, and others, to understand practical and realistic ways to implement prevention in an imperfect world where funding is restricted, and support provision is fragmented across different organisations and policy areas.

Don’t get us wrong, we are working with organisations across the UK to improve the coordinated efforts across policy and budget silos. However, we think that there are also a number of easy wins to implement preventative approaches that aren’t reliant on a fundamental shift in service delivery models.

The Law Society of Scotland have recently published the findings of a study they commissioned our team at Rocket Science to undertake. This study sought to identify and quantify the preventative benefits of legal aid in Scotland, focusing on housing, criminal and family law cases. We used a Social Return on Investment model for this research which measures the social, economic and financial impacts of an activity on all the relevant parties including service users, service providers and other stakeholders.

The analysis of housing cases revealed a particularly interesting finding. Many cases involved providing housing advice, often to those facing eviction as a result of debt or rent arrears. We estimated that for every £1 spent on early provision of legal advice on housing cases, there was a return of £11. This included savings to homelessness services and reductions in temporary accommodation costs, as a result of avoiding eviction and addressing growing housing arrears. It also considered the benefit to individual tenants such as improved mental and physical health and confidence in their ability to maintain their accommodation in the future.

This research provides a clear steer for local authorities, housing associations and the NHS to invest further upstream, ensuring that legal advice around housing debt is available at the earliest opportunity to avoid the higher and longer lasting costs of eviction.

Recognising the benefit of investing upstream to prevent homelessness, the Royal Borough of Kingston upon Thames is piloting a new project focused on early interventions. This project supports its service users with a wider range of issues, such as mental health, which are found to be trigger future housing problems. We are currently working with Kingston and two of their surrounding boroughs to evaluate the effectiveness of this pilot. This work will include a cost benefit analysis of their impact.

We will continue to evidence the value of investing in preventative approaches and research the most effective ways to implement new approaches. We hope that this encourages investment, so that prevention begins to feel less like a long-term ideal and more of a current opportunity.

 

Clare Hammond is an Associate Director at Rocket Science specialising in cost benefit analysis and social return on investment across a range of sectors including employability, health and social care, housing and poverty reduction. You can check out her profile here.