RPP 18 2 Workshops

Research Policy and Planning: The journal of the Social Services Research Group – Vol 18 (2) 2000

Workshop Reports

Title: Needs Analysis: how primary care groups may change the game

Presenter: Sue Balloch, Reader in Health and Social Care, University of Brighton

Summary:Although needs analysis has a long history [Booth and Rowntree at turn of last century; Black Report and Health Divide; Poverty Atlases of 1980s and 1990s], the first Community Care Plans of the 1990s showed that local authorities SSDs had not become accustomed to using these data. In a survey of 40 Community Care Plans, Francis McGlone found little evidence of strategic planning based on either national or local data [McGlone, 1994]. Wistow et al. noted [1997] ‘in most authorities, needs mapping in 1993 was still at an early stage of development and was widely regarded as complex, time consuming and costly. Typically, the mapping of needs was restricted to identifying current service utilisation and rarely extended to mapping latent or future needs. Many authorities were still grappling with information systems and technical deficiencies’ [p.58].The transfer of responsibility for community care to local authority social services was to facilitate rational service planning, including assessments of need, both of individuals and in the wider population. Local authorities were urged to plan strategically and Price Waterhouse prepared a series of guides for the Department of Health to show how this was to be done [Price Waterhouse/DoH, 1993; Blackman and Atkinson, 1997]. It was clear from the outset, however, that the analysis of any concept of need would be severely circumscribed in a cash-limited context and that strategic planning would be hampered by lack of joint working between social services departments and health and housing agencies.Pressures to Improve Data Collection and Analysis Recent pressure on public agencies to improve data collection and analysis has been created by the Government modernisation agenda in which best Value, partnership working and user involvement are key elements:

  • it has been financially led in the bidding for Action Zone status and in the subsequent bench marking for Action Zones and Urban Regeneration initiatives; it has been driven by Audit Commission requirements relating to the Performance Assessment Framework and Best Value Initiatives in which mapping health and social care markets is central;
  • it has become important in meeting targets, not just in health and social care, but also in education and training.

Partnership Working

The emphasis in the Government agenda on partnership working has made a substantial difference. This requires the pooling of information between:

  • different public agencies – raising difficulties relating to the lack of coterminosity of boundaries, inconsistency in categories used (eg for age cohorts) and ethical problems related to restricted data; public agencies and voluntary organisations, requiring matching of quantitative and qualitative data;
  • service users’ groups – providing their own views on the processes and outcomes they want and which are appropriate to their needs.

Guidance on the Health Act Section 31 Partnership Arrangements contains two sections [3 and 5] on Mapping the Use of Information and Preparing to Share Information. The latter lists the local information community as likely to include:The Health Authority NHS Trusts Primary Care Groups and emerging Primary Care Trusts Social Services Education Services Voluntary Sector Providers Private Sector Providers Housing Youth Offending Teams Crime and Disorder Local Responsible AuthoritiesPrimary Care Groups and TrustsOf the 481 created in April 1999 many are now heading towards Trust status. Their problem is how to prepare, present and implement joint strategies for tackling health inequalities and improving public health within the overall framework of their HImP. To do this they require detailed information on:

  • the health and social care needs and related educational, employment and other needs of their local population, which can range from around 50,000 for the smallest KG to 250,000 for the largest; available services, their uptake and users’ views of their effectiveness;
  • recruitment and retention patterns of stag and current training opportunities for staff, sources of funding for training and training needs.

The Difficulties

  • need to shift away from a medical to a social model of illness;danger of ignoring user defined outcomes infavour of present government targets;confidentiality of information;lock of expertise in amalgamating complex data systems;absence of certain types of information eg on funding sources for training and education of staff and available courses; certain groups such as travellers, homeless people, substance users and refugees;funding – the work is often delegated to inexperienced staff;
  • unwillingness to use qualitative or ‘grey’ data.

Possible Strategies

  • development of Partnership Boards with specialist information officers, able to integrate data sets, work with complex mapping systems and tap into qualitative sources; work with voluntary and private organisations to establish the needs of people not on databases;use a community development approach; involve service users/patients in the policy and planning of service delivery;
  • use university/research groups to assist.

Endnote

This discussion paper has arisen from work being carried out in the Health and Social Policy Research Centre at the University of Brighton and from collaboration with Karin Janzon, Stella Law and Alison Campbell of ‘Care Equation’

Title: Can you hear me? Best Practice Standards: Social Services for Deaf and Hard of Hearing People

Presenter: Gerda Loosemore-Reppen is Policy and Research Officer at the Royal National Institute for Deaf People

Summary:This workshop will describe the approach taken by an alliance of central and local government and the voluntary sector to move the provision of services forward. The starting point was the SSI Report ‘Service on the Edge’ [1997] which described the findings from an inspection programme and painted an unsatisfactory picture of service. RNID and BDA therefore thought it opportune to convene a Taskforce representing the main stakeholders to develop service standards. The approach that was taken throughout was to view the required service from the service user’s perspective. Discussions with user groups contributed to the formulation of the standards, which therefore include a user checklist. This guides service users to the social services and asks simple questions. The answers to these questions can be given through observation and from user experience or by requesting information from service providers. The standards have incorporated material from an ADSS Training Working party, which examined training needs of all social services staff likely to be in touch with deaf and hard of hearing people. The standards represent a consensus on Best Practice and can be used as an audit tool for departments, independent auditors or service users. They are presented in a simple to use checklist format and contain guidance notes. It is unlikely that many social services departments or independent service providers will exceed the posited quality standards in all areas. Nonetheless they are not couched in purely aspirational terms. Practitioners can appraise their part of the service against the service standards and work through the guidelines and criteria. On this basis they can develop action plans to address shortcomings.The workshop described the approach and introduced some standards in depth. it also showed how the work could be useful for benchmarking and service development. Because of the positive reception of this work by ADSS and government, a companion volume of Best Practice standards for deaf children’s services is being developed. This is being pushed forward by a consortium of RNID, BDA, NDCS, LGA and ADSS.

Title: Flexible Registers: the importance of collecting and maintaining quality information

Presenter: Anne Bowman is Register Services Manager, South West London Community NHS Trust

Summary: Does your area have joint (Agency) Registers for people with learning disabilities? Does your area have a Children Act Register?If ‘no’, how is prevalence determined? How do planners gain the information they require to plan services? What are the returns to the Department of Health based upon? How is information disseminated and targeted to the population of disabled people and their carers? If ‘yes’, how are registers used? What information and services do they provide and to whom?The workshop discussed the development of the following Registers held within the Register Services Department of the South West London Community Trust:

  • Sutton Register for People with Learning Disabilities;Merton Register for People with learning Disabilities;Sutton Register for Children and Young People with Special Needs;Croydon Register for Children with Disabilities;Merton Children Act Register;
  • Wandsworth Register for People with Learning Disabilities – database and questionnaires provided.

These joint Registers seem to be operating successfully in providing information to both professionals working direct with individuals and planners of services. The registers are joint and each has a Steering Group which monitors development of the Register and its management. The Steering Group consists of representatives from the health authority, the community trust, social services, education, the voluntary sector, carers, and a client/young person or advocate.The philosophy of the Registers is as follows:

  • to encourage self advocacy;to use the information source, that is parent/carer and/or young person as the constant influence on data;to give automatic access to personal data to clients/carers – positive encouragement to own information;
  • to ensure confidentiality – clients/carers are able to deny access to their personal information.

The methods of collecting the necessary information were considered in the workshop and examples provided of the sort of information available, both for professionals working ‘at the coal face’ and service planners and commissioners working to target resources appropriately. This strategic information, it was argued, demonstrates the usefulness of Registers generally.Other subjects on which the workshop focused included:

  • how information is collected and held;identification of client;where the information is gathered from questionnaire completion and distribution; automatic access for clients and carers and accuracy check of record; sharing information and confidentiality; service referral; minimising bias;
  • database design and development.

The workshop also discussed how social services use the Registers in their day-to-day operation and to involve carers in consultations about services.

Title: Round-Up of Management Information Projects

Presenter: Simon Lowles for the ADSS Information Management Group

Summary: These two round-ups were designed to illustrate briefly work going on across the UK whose outcomes are aimed at improving the collection and use of information for management purposes.There are five projects at various stages of development and delivery currently ongoing on across the UK, although it was possible to report on only four at the SSRG Conference. The following presents a very brief summary of each project.Wales: Executive Management Information System National Assembly of Wales – Bob Woodward, Deputy Chief Inspector with Simon Lowles (Nuffield Institute for Health)The NAW has been reviewing many strands of its activity~ and within the Local Government domain has a study group on Performance Management, led by Bob Woodward, Deputy Chief Inspector. The Group has commissioned a project, being undertaken by the Nuffield Institute for Health on behalf of the NAW, whose outputs will include:

  • outlining an information specification to meet the needs of the National Assembly and of LASSDs to manage and monitor performance;a survey of the organisational and IT capacity of LASSDs to deliver to this information requirement;
  • a development proposal which enables the building, through a partnership approach, of the capacity and support on all sides to deliver improved information management and management information on an agreed basis over the next 2/3 years.

The Project has been working with the Directors of all LASSDs and with their planning and information managers. A final workshop was held early in May, and the Project report was delivered in early June 2000.Scotland: Social Work Information ReviewScottish Executive et al. The contact person is Mike Brown, City of Edinburgh.These projects have been led by the Social Work Information Review Group (SWIRG), established in 1998 by the Scottish Executive, the Accounts Commission, CoSLA and the ADSW to address longstanding concerns about the poor quality or unavailability of social work performance and management information, both within local authorities and nationally.In 1999 SWIRG issued a consultation paper on ‘local and national requirements for social work’, which is about to be re-published in an amended version following the consultation. When it has been adopted by the Boards of the sponsoring agencies, it will lay the groundwork for information development to deliver the requirements.SWIRG and its sponsors acknowledge that this delivery will involve significant work. They have identified a number of ‘necessary conditions’ for improving social work information:

  • agreement on the key objectives for social work both nationally and locally;agreement on the information required for practice as well as management and planning; agreed data standards; adequate information technology to support social work staff;
  • improved information culture in social work.

A Data Standards Project has now been scoped (element 3 above) to follow up the information required (element 2) and funding for development of all elements is now being considered.England: Defining a Social Care Core Data Set DH Statistics Division – Roger Staton, Head of Personal Social Services InformationTaking as a starting point the social care information currently submitted to the Department of Health on the regular statistical returns, this project aims to define the core information that local authorities need to hold in order to be able to provide the information requested by the centre. The main output from the initial stages of the work will be a high-level data model.The project will also draw on other work that is looking at information from a local perspective, such as the QP MIS project and the Management Information for Social Care project, to produce a composite model of social care information.The longer-term aim is to develop this model further and create a social care data dictionary as part of an overall strategy to improve the quality of social care information and ultimately the quality of services provided.England. Management Information for Social Care DH SSI & ADSS – Steve Hill, Management Consultant, Advance Consulting ltdThis work complements the above project, and has been commissioned by the SSI with the ADSS IMG. The main output is a process guide for senior managers, covering the definition, delivery and use of management information. It will focus on the processes required to ensure delivery of key policies, to identify major trends and implications, and to monitor local hotspots.The guide will introduce information management principles, and present a process with examples on how management teams can:

  • identify data required to deal with local issues and operational risks; devise a balanced set of indicators, targets and key indicators;organise the flow of information, report formats and responsibilities; control activities and outputs by monitoring variation and exceptions;
  • use the resulting information to improve service performance and value.

The Guide is about to be launched, and is available via the ADSS IMG website.England. Quality Projects Management Information Project DH Social Care Group – John Rowlands This project was initiated in response to the initial QP mapping studies which demonstrated the poor state of MI systems in LA SSDs. Its objectives are to recommend improvements which may bring all LASSDs up to a minimum level in their capability to provide quality management information.A systems and IT infrastructure survey has been undertaken, meetings have been held with suppliers, and a major study has been undertaken to investigate and document the business processes carried out within childrens services. A ‘Process Activity Model’ has been developed, as well as a ‘Logical Data Model’.The report makes many recommendations for improvement, and has just been through its last QA phase before publication.

Title: How to Discourage your Reviewer and to Help Them to Reject your Article

Presenter: Mick Bond, SSRG, Yorkshire and Humberside RPP representative

Summary: Extracts from ‘Towards a methodology for evaluating the effectiveness of social care provision – is it as effective as the class 56 and merry go round hoppers'(1) Ahmed J, Bland R, Bland F, Bloggs J, Crossmith C, Hooley J, Khan J, Walton H (2)Abstract The Class 56 and merry go round hoppers(3) is an emblem of effective fixed path transit mineral delivery from solid fuel extraction site to fired heat generation plant used to produce electricity. This treatise(4) uses this emblem of efficiency to consider the question of the effectiveness of social care in the context of the the multiple perspectives of professional stag and service users. The article reviews the development of MGR services on the railway network in the 1960s and the development of users’ perspectives in the mental health field in the 1980s and 1990s. A Focus Group(5) of users and questionnaires to managers elucidated their respective view points on whether user participation in decision-making had led to increased satisfaction and a lower readmission rate to day care services. The article concludes that, like the example of the MGR train service, the satisfaction of both users had increased(6). No recommendations for practice are made as the authors wished to develop an ongoing theorectical perspective…. The article continues(8) and we provide a few more pithy passages:’… The engine drivers (7) to a man agreed that the development of social care had greatly improved as a result and the report will make clear recommendations on this as a result(9) …”… Both managers and workers thought(10).”After a careful review of the evidence, with detailed statistical analysis using PC-based computer packages, it is, notwithstanding the contrary evidence in the previous paragraph, the case that views on this topic were indeed mixed and even using factor analysis some difficulties in the true interpretation of the data still were evident to the research team (11).Comments (1) Make the, title snappy – you want people to read this don’t you?(2) No simple answer here but authors quoted should be: those who have made a significant contribution to the research (ie avoid ‘honary’ authors or taking all the credit yourself); no limit to the number but if a lot of people have been involved perhaps they should be listed elsewhere.(3) Unless you are a rail enthusiast who knows something about the development of coal traffic in the 1960s, this will mean little to you and unfortunately you may not feel you have the time to learn more. Write in as plain English as you can and keep the article relevant to the readers. If you want to know more about class 56 and merry go round hoppers, see me afterwards.(4) Treatise – why not say article – I’ve deliberately written this in as obscure language as I could invent, although some people see a value in writing in jargon, all you do is to limit the audience who can read your work. Technical terms are inevitable – make sure you explain them in the text or in a glossary.(5) Use of capitals should be avoided. For example ‘Focus Groups’ should be ‘focus groups’. Some people seem pretty addicted to them – I always try to use them sparingly for proper names etc.(6) Is this a relevant comparison? Probably better to stick to something else in the social welfare field.(7) An author who fails to make recommendations from his/her work reduces the chance of changing the world! You cannot always do this, but if there are clear recommendations don’t fail to tell the world.(8) Still awake! Good, though I am surprised! Abstracts should be short and to the point; they should make you want to read the rest of the article, not pick up another book, do the ironing or decide it’s time to go to the pub.(9) One point from this I am sure I do not need to make is that you should not use language that shows any racial or sexual stereotypes. Another point you may have picked up from the sentence is that a recommendation is being made on the basis of the statements of very few people, always be careful not to draw conclusions that your data does not warrant. You may also have noticed that they say they will make a strong recommendation, despite the fact that the abstract says none will be made. It can be hard to be totally consistent in writing an article and if you have put a lot of effort into writing something it may be a good idea to show what you have written to someone else, who could see something you have overlooked.(10) Another issue about the use of capitals, if you refer to a comment from the ‘Deputy Manager’ of somewhere then I think it is appropriate to put their title in capitals. Otherwise if referring to a group of stag or organisations such as ‘managers in social services departments’ then I think lower case is better.(11) I counted 55 words in this sentence; the spell checker on my computer sometimes tells me that sentences are too long to process. I suspect this would be the case here. It is usually better to write shorter sentences and to break down a complex statement into its component parts.

Title: Unit Costs as Performance Indicators

Presenter: Ann Netten

Summary: An important element of the PSS Performance Assessment Framework (PAF) is the section of indicators designed to indicate cost and efficiency. Of the 11 indicators, seven are described as unit costs, most of which relate to the cost of caring for people in care homes. The rationale for these is that lowering unit costs ‘all things else being equal’ would be expected to be associated with increases in efficiency. However, efficiency requires the same or better outcomes to be associated with unit costs and there is a dearth of information about outcomes, both within the PAF and elsewhere.The unit cost indicators as they stand are based on information gathered by systems designed for other purposes. There are concerns about targets set on the basis of data that historically have been acknowledged as flawed in terms of both identifying all relevant costs and matching costs to activity. Nevertheless, in the face of PAF and Best Value, authorities need to identify and investigate reasons for variation in the indicators in order to consider the policy and practice implications for reducing costs and meeting targets.Variations in costs arise as the result of errors and differences in measurement, substantive factors and variations in efficiency. Guidance is available from Cipfa, DH and DETR which can assist in reducing measurement error. In addressing substantive and efficiency variations many authorities are joining ‘benchmark clubs’ which allow them to standardise on some factors (such as local labour markets) and compare others (such as actual wages paid). Estimating bottom-up costs allows authorities to identify how their costs and activity levels vary with respect to other authorities and to consider the cost implications of changing factors where their costs are identified as relatively high or low. However, this can only take them so far. While it is possible to compare characteristics such as staffing levels of homes, it is not possible to identify in this way whether higher staffing levels or expenditure on training is justified in terms of the dependency characteristics of residents or quality of care provided.Research has a role to play in investigating variation in costs and where there is potential for efficiency savings. Two related large-scale surveys of admissions of older people to publicly-funded residential and nursing home care and of homes themselves provide us with some insight into these issues. A series of analyses has been undertaken for a variety of purposes which investigated price and cost variation in homes and placement in different types of home. These suggested that there was limited scope to reduce or keep down prices of independent homes but that there may be some savings to be made through placement policies and changes in management and use of local authority provision. In the future development of PAF efficiency indicators there is a real need for research to make the link between costs, routinely measurable quality standards and outcomes.

Title: Information at the Centre – developing a social care core data set

Presenter: Roger Staton, PSS Information strategy, planning and development, Department of Health

Summary: The availability of good information is key to the effective provision, management and monitoring of social care services. The introduction of social services performance measures has turned the spotlight on local authority information and information systems. Local authority social services departments are currently bombarded with requests from central government in a variety of ways. At a local level, senior managers and elected members are becoming increasingly interested in information and its importance for the effective management of services. There are growing demands for performance measures that can be used as indicators of the levels and quality of services within an authority and as comparators between authorities.Not surprisingly, there are increasing demands from authorities for the development of a core data set that would provide a foundation for more reliable and comparable information. The challenge is to provide quality information at the different levels – operational, local and regional management and central government – without imposing undue burdens on data providers. The aim should be for all management information to be derived from operational systems.This implies that, if the content of the basic records is defined correctly, it should be possible to derive the different levels of management information from those records. In order to achieve this, these base records must be:

  • comprehensive, covering all aspects of the care process;complete, in the sense that all relevant information is recorded;consistent in terms of definitions and terminology,
  • resulting in information that is comparable within an authority, between authorities and across years.

Ultimately, to minimise the burden of collecting management information, records should be held electronically.The Core Data Project The Core Data project is one of three projects looking to map social care information from different perspectives. The other two are the Quality Protects Management Information (QPMIS) project and the Management Information for Social Care (MISC) project. The QPMIS project has focused specifically on children’s services and has looked in detail at the processes involved at the local level in the provision of care services for children and the information required to support those processes. The MISC project is again looking at the information issues from a local social services perspective but this time focusing on the information required by senior managers to ‘run the business’. Both projects aim to come up with a statement of the information requirements.The Core Data project is very closely linked to the QPMIS project and has taken as the starting point the information supplied by social services authorities to the Department of Health on the current annual statistical returns together with proposed new returns.The work focused initially on the returns relating to children’s services, providing an overview of the children’s data submitted to the Department to link with the main QI’MIS project. The model developed on the basis of the children’s returns was ‘validated’ with the statistical section handling the returns and subsequently with one local authority – Norfolk. Minor changes were made to the model as a result. Encouragingly, the work on the QPM1S, carried out independently by Parity Consulting, has come up with a model that is almost identical. Since that model was developed from a local perspective, there are one or two additional aspects to it but the core elements are the same.The statistical returns relating to adult services, staffing and finance were subsequently analysed and the model updated. Very little change was necessary to the core model derived from children’s returns.The resulting high level model has three main components:

  • the person, which could be the client, carer, (individual) service provider, relative, GP, etc; the event, such as an assessment, start of home care, entry into residential care, etc;
  • the service/service provider.

During the course of this project, the team has also identified some work done elsewhere around modelling of social care information. Of particular relevance is that of the Australian Institute of Health and Welfare (A1HW). They have produced a model which is very similar to our model, with ‘party’ (which includes both persons and agencies/service providers) and ‘event’ as the key components. (National Community Services Information Model Version 1; National Community Services Data Dictionary, both prepared by the National Information Development Unit, A1HW).Next StepsThe modelling work so far has in many ways only scratched the surface. it has enabled us to produce a high level representation of the data currently collected but, to be of any use, the work needs to be taken to a lower level of detail, with all the data items and attributes identified and defined.The eventual goal should be to produce a list of data items, clearly and precisely defined, which could form the basis for a social care data dictionary, the main purposes of which would be to:

  • provide a framework for the development of social care information;assist in minimising duplication of effort in information development;assist in promoting use of common definitionsacross the service;inform and facilitate data linkage by improving comparability;
  • provide a management tool to assist in the ongoing development and communication of information on social care services.

An important aspect of the work will be to look at the links with health care information and existing health care data models, particularly in relation to the development of information strategies as part of the implementation of the National Service Frameworks for mental health and older people.The work will also need to take into account developments in relation to the Governments modernisation agenda and particularly the e-government initiative.Success Factors

What is clear is that the project will only be successful if it is done with the co-operation of local authorities and system suppliers. It is important that there is a sense of ownership by all parties and not as an imposition/mandate from the centre. The resulting data set must be robust and enduring – it must be able to stand the test of time. The project will also need to tackle the significant issues around definitions, attitudes to the recording of information and the more technical type issues relating to physical implementation.