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A wing & prayer? Evidence for integration within social care prevention services Robin Miller Health Services Management Centre: r.s.miller@bham.ac.uk. Disclaimer.

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  1. A wing & prayer? Evidence for integration within social care prevention services Robin MillerHealth Services Management Centre: r.s.miller@bham.ac.uk

  2. Disclaimer This presentation is based on independent research commissioned and funded by the NIHR School for Social Care Research. The views expressed are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health, NIHR or NHS.

  3. Background to research • Changes in demography and types of need combined with difficult financial environment have led to ‘prevention’ becoming a priority • Prevention is commonly seen as an potential outcome of better integrated working • Despite the interest / expectations, evidence of impact of prevention services and role of integration within these is patchy

  4. What did we hope to achieve? • To understand what prevention interventions local authorities invest in and the rational for doing so • To gather ‘practice- based’ evidence from local authorities of the impact of these interventions • To explore the extent and contribution of integration within these interventions

  5. Types of evidence sought

  6. Survey of Directors of Adult Social Services ‘Top 3’ local prevention interventions & leads Interview with lead 1 Interview with lead 3 Interview with lead 2 What interventions do they invest in? What evidence/other factors informed this? What evidence is gathered regarding effectiveness?

  7. I Initial reablement models Focused on a set transition Older people only Local authority home care & OTs Social work referrals only ‘Entry’ point to all adult services All adult user groups Range of therapies & nursing Independent Providers Multi-professional pathways / open access I Emerging reablement models

  8. Measuring reablement outcomes Strategic Outcomes Perf Reports service level (actual /estimated) Exit review User Outcomes Reviewing progress

  9. Limitations of evidence and process • What was measured.. : impacts following interventions, comparison with other options, being realistic about what would have happened anyway • How to measure… : through inadequate IT systems, complexity, insufficient capacity, changing of delivery models, little involvement of older people ‘but it’s in my to do list!’

  10. Key messages • There was no common framework for setting outcomes and collecting evidence. • There was considerable local data, but it was dispersed across local authorities and providers, was difficult to obtain and analyse and impossible to compare • Data most gathered was performance, not outcomes • Impact of different approaches to integration can not be therefore be understood

  11. Next steps • Advisory group were comprised of third sector organisations • Much of the evidence was thought to be held by the third sector providers • Extension project (funded by NIHR SSCR) to gather their evidence and perspectives

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