Best use of social care or health research
Miller Research and Aneurin Bevan University Health Board – Formative evaluation of the ‘In One Place Programme’
There is a government expectation that public services work more collaboratively; to meet this challenge one Health board (Aneurin Bevan University Health Board), Social Care and Strategic Housing divisions within five local authorities and eight housing associations came together using a pioneering collaborative model, In One Place (IOP).
The initiative aims to streamline the process of obtaining suitable local accommodation for people with complex health and social care needs, therefore providing an alternative to out-of-county residential placements or unnecessarily extended stays in hospital (Delayed transfers of care). People take on a tenancy in a housing association property and receive care and support in their own home.
Miller Research conducted a two-year formative evaluation of IOP, focusing on barriers to collaboration and delivery and highlighting what works, and in what circumstances, via knowledge-exchange workshops amongst partners, presentations and research reports.
The impact evaluation has included longitudinal case studies of individual service users, as well as a cost benefit analysis of this new way of working, using historical data on hospital readmissions and residential placement costs, along with the current costs for IOP schemes.
The research process has been embedded in programme delivery from the outset, demonstrating increased partnership working, improved service user outcomes and reduced public sector expenditure.
Annual costs of an inclusive CHC (Continuing NHS Health Care) package can be £200,000 per person; for service users, residential placements offer a potentially restrictive environment, fostering a culture of dependence (Department of Health (2011) Efficient management of resources: to improve outcomes for people with learning disabilities NHS Evidence). The evaluation demonstrates that service users can live in their own home for up to half the cost of a residential placement.
The research conducted for the evaluation has provided programme partners, other health, social care and housing practitioners and Welsh Government with an evidence-based, independent reflection on key programme achievements, the main barriers to success and challenges for collaboration and examples of best practice and innovation in partnership working and service improvement.
It has highlighted very pertinently the main factors that are undermining greater integration and communication between the health, social services and housing sectors (for example, the lack of an accurate picture of demand for specialist housing amongst service users across the health board and the five Social Services departments; different commissioning practices between health and social care; Ordinary Residence rules discouraging local authorities from supporting the development of IOP schemes in their area; evidence that it can be in the financial best interests of social services if service users remain in – health funded – institutions).
The evaluation culminated in the facilitation of a workshop by Miller Research, bringing together chief executives of housing associations, Directors of Adult Services and Strategic Housing within the relevant local authorities and executive staff within the health board, to consider each of the strategic barriers to the delivery of IOP and to identify and agree measures to overcome the challenges. The outcomes from the workshop informed the recommendations in the final evaluation report of IOP and have established a list of key principles for the programme going forward.
The original objectives from the commission were to conduct an independent evaluation of the IOP Programme; to assess the benefits of public service collaboration in delivery of IOP schemes; to assess the legal and legislative robustness of the IOP partnership model, and to identify the impacts on service users of moving into their own tenancy.
The impact of the research upon the IOP Programme, programme partners and wider stakeholders was significant. The formative nature of the evaluation lead to on-going changes to the structure and delivery of the programme, the processes adopted in progressing individual IOP schemes, and the contribution made by different partners to the success of the programme.
The research has provided external stakeholders with a robust evidence base of the evolution of the IOP Programme and a detailed account of the challenges that faced programme delivery and, essentially, created a blueprint for rolling the scheme out in other health board areas in Wales and elsewhere in the UK.
Partnership-working was intrinsic to both the IOP Programme and the associated evaluation research methodology. Delivery of the programme was driven by a Professional Network of representatives from each of the partner organisations, a group that were involved throughout the evaluation in the form of facilitated workshops, one-to-one interviews and focus groups. Service users (people who had been accommodated in an IOP scheme) were interviewed about their experiences of the transition process and the impact it has had upon their health and wellbeing.
Despite separate and increasingly threatened budgets within health, housing and social care, the research has demonstrated that through flexible working, innovative action and mutual trust, it is possible for cross-sector partners to work together to deliver better outcomes for service users, increased knowledge transfer and savings to public sector expenditure.
In order to achieve these outcomes, it is essential to secure executive buy-in from each partner and to recognise and pro-actively seek to address the barriers that undermine collaboration and engagement.
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