In part 1 I described some of the broader or policy changes
which will impact how health and social care sector interacts with and funds
the voluntary and community sector. The following is a brief overview of some
of the ‘mechanisms’ which may have a new role in this ‘new world’.
Assessments
Preparations for the Care Act has stimulated a lot of
activity around assessments – whether these are carer’s assessments or
assessing people’s needs for social care before they are eligible. There are
assessments for personal budgets and joint health and social care assessments
which will be important for integrated care. We have been studying assessments
for ‘low level’ needs; which may be addressed by voluntary or community
services. There is widespread use of checklists such as ‘First Contact’ which
offer a brief assessment to highlight where a range of organisations could
help, including housing and fire safety. There are benefits in assessing
people’s comprehensive needs, across health, social inclusion, housing etc.
This approach may highlight an issue and enable access to other forms of
support, which may not have been considered previously. It could also be an
opportunity for outreach to isolated individuals. A key issue is how various
assessment relate or overlap with each other and also whether core information
from such assessments can be shared, with consent, with other services.
Collating information could build up a picture of needs within neighbourhoods.
Signposting
Some people may find it difficult to know who to turn to for
help. It can seem that there are a confusing number of similar services. If
community and voluntary services can work together this may help to meet older
people’s personal needs in ways that are appropriate to their preferences and
culture. There are a range of approaches here, which may work in different
settings, and they may all benefit from sharing information from needs
assessments. Within ‘signposting’ I would include; social prescribing, care
navigators, single point of access and home from hospital.
Outcomes
Increasingly, funding is dependent on showing outcomes for
individuals who have accessed services. This can be referred to as
‘outcomes-based commissioning’ and it is also an important aspect of personal
budgets. Outcomes should relate to the actual health or social benefit that an
individual experiences, this contrasts with ‘process’ or ‘output’ measures
which might be number of people attending an event. Outcomes may be specified
by the commissioner (funder) and there is also a whole series of national
outcome indicators. Just to be confusing there are separate indicators for
health (NHS Outcomes Framework), public health (Public Health Outcomes
Framework) and social care (Adult Social Care Outcomes Framework).
The idea is that commissioners (NHS Clinical Commissioning
Group or Local Authority) specify the outcomes they expect and the community
and voluntary sector organisation writes a programme bid to explain how they
will deliver services to enable people to achieve these outcomes. The hope is
that this gives freedom for innovation and flexibility for organisations to
design services which will meet the preferences and be culturally appropriate
to their community members. There is also an aspect of sharing risk between
funder and provider; in theory money isn’t wasted on services that aren’t
attended, whereas popular services can receive more funding. Whilst this sounds
good on paper, in reality both commissioners and providers may need time to get
used to this new way of working. Furthermore some people feel that the policy
direction is tending to favour a corporate-style managerialism within the
voluntary sector, which may ignore or stifle the very strength of the sector –
that is; the voluntary and community sector offers a distinct way of
representing the needs of a neighbourhood and outreach to people who, for
various reasons, may not access public or private sector services.
No comments:
Post a Comment