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A Brief Word About Outcomes


Is it realistic to be talking about improving outcomes at the same time as making massive cuts to services?


Last week Oxfordshire County Council leader Keith Mitchell set out the County's plans to improve outcomes for users of adult social care services against a backdrop of severe cuts to the budget. I should say up front that in my opinion Officers and Members of the Council have made every effort to minimise the adverse effects on vulnerable adults; Oxfordshire is generally thought to be one of the best performing local authorities in the region, and adult services usually do well when inspected. But is it realistic to be talking about improving outcomes at the same time as making massive cuts to services?


Before answering this question it's important to scrutinise this word 'outcome' and decide what it means. In the strict medical sense an outcome is the outcome of a disease. 'Outcome measures' have historically been used in clinical trials to measure the impact of treatments on the 'outcome' of diseases, but more recently techniques have been developed to look at the impact of whole services rather than individual treatments. The same is true in social care; over the past fifteen years there's been a move away from defining a 'good' service in terms of 'best practice', and towards achieving 'measurable outcomes'. Whether this is a good thing or not depends on the 'outcomes' being measured, and how you measure them.


Whose yardstick will be used?


Old clinical 'outcome measures' were typically 'clinician rated', meaning that where doctors and service users disagreed about what progress had been made, it was the clinician's view that counted. Measures of outcomes in social care now often take the form of questionnaires that people fill out for themselves, although service users are still only rarely involved in interpreting the information that's gathered. Researchers, of course, are often under pressure to find good news even where there isn't any. And this goes double for researchers working in local or national government, where their jobs and those of their bosses depend on meeting targets.


And what will it be measuring?


Now take the second case - which questions are important, and more importantly who are they important to? Many years ago I was involved in developing an 'outcome measure' for people who use mental health services. Much to everyone's surprise, most service users were more concerned about being treated with dignity and respect than with getting effective mental health treatments. Perhaps the gap has closed a bit now, but I think there are still probably big differences between the kinds of things local authorities see themselves as being responsible for providing and the kinds of things 'disabled' people think will make their lives better. After all, this was one of the main justifications for shifting budgets from local authorities to individuals in the first place. But if the way that services are assessed isn't changed at the same time as budgets are devolved, politicians will be able to claim progress is being made even where the people using services don't think it is.


The current cuts are happening at the same time as major changes to services that will give some people more power over the type of services they get. No doubt many people will prefer this to the old system where professionals made choices on their behalves. But will the advantages be so great that they compensate for the damage caused by a budget cut of up to 40%? For some people maybe, but probably not for the majority.


1 #1 jhyslop
on December 15 2010 11:24:20
And this is on top of the changes to Housing benefits, which will also have an impact on many disabled people. See this article in Community Care Magazine about how they'll affect supported housing.http://www.commun...-lurch.htm
3 #2 Keith
on December 15 2010 13:15:20
Mr Mitchell suggests that in "the austere times in which we live" personal budgets are going to help with the current cost cutting exercise.

When personal budgets were introduced in Oxfordshire back in the summer of 2008, before the banking crisis, they were seen as offering a means to manage the increasing social care costs of an ageing popluation, as well as offering greater power to people.

That in itself was a pretty big ask. Now personal budgets are also going to help solve the council's funding crisis. Keith Mitchell is beginning to sound like Paul Daniels: "Now that's Magic!".

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