Politics eats the evidence-base for breakfast

The idea and fetishizing of evidence-based policy is something we’re interested in at Arbitrary Constant. Here we wonder how many countries there are and what this might mean for Personal Health Budgets; here we explore what some of the biases and heuristics of evidence-based policy might be.

A news article about a lorry speed limit change (from 40mph to 50mph on single-track roads), an evidence-based impact assessment and competing interests was therefore bound to pique our interest.

The Daily Telegraph reported at the end of October:

The Government [has] pressed ahead with plans to raise the speed limit for lorries despite being warned of a likely increase in road deaths because it benefits the haulage industry

The information is generated by the government’s own impact assessment, the topline details of which are as follows:

• There are between 60 and 80 fatal accidents involving HGVs on relevant roads, of which an estimated 18 per year take place at between 36mph and 44mph
• Vehicles that travel between 36-44mph will be influenced by the increased speed limit – driving at an average of between 2.5-3.9mph faster
• This increase would result in 2.6-3.5 more deaths per year
• The potential benefit of reduced accidents from less overtaking is not included because there isn’t “sufficient confidence” it would happen
• On the benefits side, hauliers will save time (worth £13.8m), reduce costs (£2.5m) and government will gain more fuel duty revenue (£2.1m).

Far from bringing certainty to the situation, the evidence base has put us in a precarious position, hasn’t it? We can see this in two main ways.

1. An evidence base has been put together and a policy position derived from it. Whether the evidence base is robust I don’t know, but it clearly involves some assumptions, parameters and interpretations that could be used, if someone were so inclined, to question the conclusions drawn.

2. The evidence base says the change in policy will be good for one group (hauliers and government) to the tune of around £18m. At the same time it also says the change in policy won’t be good for another group, i.e. the approx. 3 additional people who would die because of the speed limit increase.

Nevertheless, the relevant Minister has pressed ahead with the increase in the speed limit.

To me, this is a clear demonstration of how it matters to what end, i.e. policy, means, i.e. the evidence base, are put. It reaffirms not only that evidence-based policy isn’t rational, predictable or benefit-maximising, but that it also doesn’t happen in a vacuum.

Policy nearly always means politics, and – to adapt a phrase – politics eats the evidence-base for breakfast.

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Mental health: on our minds?

Parity of esteem in mental health is something we hear a lot about: it essentially means putting mental health on a par with physical health.

Underneath this, though, it feels to me that there isn’t a parity of attention when it comes to mental health – it doesn’t feel to be discussed or debated anywhere near as much as other topics.

This feeling is borne out by two excellent reports published on the topic of Joint Strategic Needs Assessments (JSNAs) and Joint Health & Wellbeing Strategies (JHSWs) by the Children & Young People’s Mental Health Coalition and the Centre for Mental Health respectively.

The Children & Young People’s Mental Health Coalition found two-thirds of JSNAs didn’t have a section specifically on children and young people’s mental health. They also found that risk factors were highlighted which put children and young people at greater likelihood of having mental health problems, but the links between these factors and mental health weren’t made.

The Centre for Mental Health found 91% of JHSWs aimed to tackle at least one mental health issue, or 9% didn’t mention mental health at all. They too found that the majority of JHSWs highlighted health risk factors (such as drinking or smoking) but didn’t make the relevant links between these factors and mental health.

More encouragingly, though, where mental health was a priority in JHSWs that priority tended to be children and young people’s mental health – somewhere between 55-67% of JHSWs made it a priority.

Nevertheless, we have a situation where around one-third of JHSWs make no reference to children and young people’s mental health, and 10% make no reference to mental health in general.

Is mental health on our minds? These figures would suggest it isn’t as much as it should be. We also need parity of attention on mental health.

The impact of advocacy – call for evidence

In my new work role at the National Development Team for Inclusion (NDTi) (and on which more blogging goodness to come soon),  I’m getting right into it with a really interesting piece of work about advocacy and evidence of its impact.

We’re not looking directly at creating new evidence about advocacy: we’re looking to gather and review the evidence that’s already available about the impact of different types of advocacy for people who need support.

What we want to do is:

• Help to understand the impact of advocacy, and the benefits of investing in it against a range of different factors and outcomes
• Describe this in relation to different forms and types of advocacy to help inform decisions about what type of advocacy to invest in for which purpose
• Focus on gathering evidence of economic and financial impact (if such evidence exists), in order to help inform investment decisions in the current financial context.

The purpose of the work is to present the evidence that exists about advocacy in a more comprehensive and robust way than currently exists. It will also help provide evidence for organisations who deliver advocacy services about their existing and potential impact.

Full details of the work we’re doing is available here: the impact of advocacy for people who need support. If you know of evidence that could be useful as part of this review, please do get in touch using the comments below or via Twitter – @rich_w

DPULOs, social media and accessible engagement – discussion paper Expression of Interest

Introduction

Social media – such as Twitter, Facebook and YouTube – has become a vital tool in the way organisations engage with people.

It is thought that social media may not be as accessible / available to disabled people as it is to non-disabled people, reflecting many of the barriers associated with getting different groups of people online.

However, it is unknown:

• How much DPULOs currently use social media to engage disabled people, and how effective their use of it is
• How well Disabled People’s User-Led Organisations understand and/or value the potential for social media to engage disabled people
• What barriers DPULOs face in using social media – particularly, but not exclusively, relating to accessibility
• Whether social media presents a particular opportunity for DPULOs to engage young disabled people in their work.

The Strengthening DPULOs Programme is keen to find out more about these issues.

What we are going to do

We would like to commission a discussion paper – ideally from a DPULO itself – to help begin our exploration of the issues above. This paper would help shape and inform work some Ambassadors of the Strengthening DPULOs Programme will be doing in 2013.

The objectives of the paper would be to:

• Describe the potential and actual benefits of social media for user engagement in general
• Understand the potential and actual benefits of social media for engaging disabled people in particular
• Identify barriers to the use of social media by disabled people and highlight any existing or potential solutions
• Identify barriers to the use of social media by DPULOs and highlight any existing or potential solutions
• Contribute to and analyse the data we have available to estimate DPULOs’ use of social media
• Identify any good practice that might already exist on DPULO use of social media
• Suggest particular projects or work that could further explore the issue of DPULOs, social media and user engagement.

The particular issue of how social media represents an opportunity for DPULOs to engage young disabled people should run throughout all of the above.

The structure of the paper would broadly reflect the objectives above.

How you can get involved

We would like to commission an organisation – ideally a DPULO – to write this discussion paper. The work would be primarily desk-based, although we are open to any suggestions organisations have that would enable the objectives above to be achieved whilst also delivering value for money.

As a broad guide, we anticipate this work would take between 15-20 days to complete.

Expressions of Interest

We would like organisations to submit a brief (no more than 3 sides A4) Expression of Interest to deliver this discussion paper

Your Expression of Interest should cover:

• Your organisation’s understanding of what a DPULO is and what it does
• Your organisation’s knowledge, understanding and expertise regarding social media. This should include details of your organisation’s own use of social media
• Your organisation’s knowledge and understanding of the barriers disabled people and their organisations face online
• Your organisation’s experience in delivering high quality written materials in relatively short timescales (including examples / references)
• Your organisation’s capacity to demonstrate the ability to deliver this work in a short timescale
• Your proposed daily rate for this work.

This Expression of Interest will be considered and marked by the Strengthening DPULOs Programme team, and the successful organisation will be chosen solely on the basis of the information provided. The work will be resourced through a grant to the successful organisation.

Please submit your Expression of Interest to Richard.Watts1@dwp.gsi.gov.uk by 5pm on Friday 14 December.

If you have any questions, please get in touch with Rich above. Similarly, if you know an organisation that may be interested, please pass this information on to them.

November 2012

DPULOs and fundraising – discussion and options paper Expression of Interest

Introduction

For a variety of reasons, many Disabled People’s User-Led Organisations have not engaged in fundraising activities.

As the current funding based for DPULOs faces more and more challenges, an increasing number of DPULOs are looking afresh at the issue of fundraising and whether it represents an opportunity to their organisation and its sustainability.

Whilst the Strengthening DPULOs Programme itself has not views on whether or not DPULOs should or shouldn’t engage in fundraising, we recognise the challenges facing DPULOs in considering the pros and cons of this potential source of income.

We would therefore like to explore this issue in more depth, and create a practical options tool to support DPULOs in their own deliberations on this topic.

What we are going to do

We would like to commission a discussion and options paper – from a DPULO itself – to explore the issue of DPULOs and fundraising.

The objectives of the discussion and options paper would be to:

• Set out the historical perspective of DPULOs and the issue of fundraising
• Summarise current fundraising trends, as well as government initiatives to further encourage different types of giving
• Highlight any relevant good practice of DPULOs currently undertaking fundraising activity
• Identify as far as possible the general pros of why a DPULO should consider engaging in fundraising
• Identify as far as possible the general cons of why a DPULO shouldn’t consider engaging in fundraising
• Create a practical options tool that can support a DPULO in their deliberations on fundraising, comprising:
  • Examples of different forms of fundraising (e.g. Gift Aid, door-to-door, online, legacies, direct mail)
  • The pros and cons of each form of fundraising for DPULOs
  • Signpost to relevant resources to implement any decision the DPULO takes.

The structure of the paper would broadly reflect the objectives above.

How you can get involved

We would like to commission a DPULO to write this discussion and options paper. The work would be primarily desk-based, although we are open to any suggestions organisations have that would enable the objectives above to be achieved whilst also delivering value for money.

As a broad guide, we anticipate this work would take between 15-20 days to complete.

Expressions of Interest

We would like organisations to submit a brief (no more than 2 sides A4) Expression of Interest to deliver this discussion and options paper

Your Expression of Interest should cover:

• The DPULO’s understanding and experience of the historical relationship between DPULOs and charitable giving / fundraising
• The DPULO’s knowledge of current trends in fundraising and giving, and government initiatives to encourage this
• Experience of developing tools / templates for others to use
• Your organisation’s capacity to demonstrate the ability to deliver this work in a short timescale
• Your proposed daily rate for this work.

This Expression of Interest will be considered and marked by the Strengthening DPULOs Programme team, and the successful organisation will be chosen solely on the basis of the information provided. The work will be resourced through a grant to the successful organisation.

Please submit your Expression of Interest to Richard.Watts1@dwp.gsi.gov.uk by 5pm on Friday 14 December.

If you have any questions, please get in touch with Rich above. Similarly, if you know an organisation that may be interested, please pass this information on to them.

November 2012

Thoughts on CQC’s State of Care report 2011/12 / #socialcare

As a self-confessed social care geek, my second favourite publication of the year is CQC’s State of Care report. My favourite is, of course, the NHS Information Centre’s final Personal Social Services Expenditure and Activity report.

Here are some of the findings that stood out for me from this year’s report, roughly themed by some (hopefully useful) headings. Comments in (brackets) are my own observations on the preceding point.

Useful statistics

• There are 53.1m people in England, of which 8.7m were 65+ and 1.2m were 85+
• There are estimated to be 800,000 living with dementia across the UK, and it is forecast that one in three people over 65 will develop dementia. (The current number seemed very low to me, especially since the latter figure suggests nearly 3 million people living with dementia in the future – a huge leap. This is further exacerbated by the statement on p39 that “over the next 30 years the number of people with dementia is expected to double”, which would still only get us to 1.6m people. Can anyone shed any light on these stats?)
• 1.35m people work in the NHS workforce in England. This compares to 1.63m who work in social care
• The majority of the increase in social care jobs came from Direct Payments (i.e. Direct Payments are good for the economy!)
• In September 2011, there were 8,316 GP practices in England, with 35,319 FTE GPs. The number of patients per practice has grown and stands at 6,651 per practice

Social care

• Only one third of men (33%) and one in six women (33%) will never need social care
• 83% of councils set their FACS eligibility as “substantial” in 2011/12 (this is a rise from 78%  in 2010/11 and from 70% in 2009/10)
• 45% of care home places are occupied by self funders. A further quarter are topped-up by people or their families to make up for the gap between what the local council will pay and what the residential care costs
• Around 220,000 of the 1.1m people who receive domiciliary care are self funders (this is likely to be a significant under-representation of people who pay for their own care, since it will only include those who have made contact with their local council)
• The number of people with a Personal Budgets in 2011/12 was 527,000 – a growth of 40% from 2010/11. Of these, 139,000 receive a Direct Payment – a growth of 11% from 2010/11
• Expenditure on Direct Payments has increased 15% in real terms, to £960m
• 25% of people referred themselves to social care
• 22% were referred from secondary health source (e.g. hospital)
• 14% were referred from primary health sources (e.g. GP)
• 14% were referred by family, friends of neighbours
• It was interesting to note from the table on p.29 that social care providers are much less geographically dispersed than health providers

Poor care and user involvement

• There are three considerable factors which underpin poor quality care: cultures where unacceptable care becomes the norm, an attitude to care that is “task-based” and not person-centre, and managing high staff vacancy or turnover rates
• A recurring issue, particularly for people in learning disability or mental health services, is a lack of involvement in their care plans or having the chance to share their views on how their care is delivered
• More work is felt to be required by commissioners and providers to ensure person-centred planning is embedded into all care for people who use services
• In hospital wards that performed well on people’s quality of care there was strong consistency in the involvement of people in decisions about their care. In those hospital wards that performed poorly on quality of care, a common complaint was that people received little or no information about their care and what to expect
• In social care, problems often arose in people’s quality of care where there had been a lack of person-centred planning, with little information about people’s individual preferences

Capturing and demonstrating the value and benefits of your services – Invitation to #dpulo

This information was recently published by Inclusion London. I’m replicating it below, though substituting “DPULOs” for “DDPO” so it’s consistent with the terminology used in previous posts.

Now more than ever DPULOs need to evidence the value and benefits they bring to the services and contracts they deliver.

Earlier this year Inclusion London commissioned the Office of Public Management (OPM) to develop an easy to use, accessible ‘added-value’ tool kit that would help DPULOs demonstrate to funders and commissioners the value and benefits they bring to service delivery.

The first phase of this project is coming to an end – a bespoke added-value tool kit has been developed and tested by 6 London Deaf and disabled peoples’ organisations.

We now have successfully secured funding to roll out the toolkit to a further group of London DPULOs. DPULOs chosen will receive free training and support to use the toolkit and will, by the end of the project, have:

• Produced a case study, using the toolkit, that demonstrates the value and benefits of your services that can be used when applying for funding or contracts
• Understand the different ways you can best demonstrate your value to funders and commissioners
• Be able to use the toolkit across a range of your services and work

Inclusion London would like to invite your organisation to express an interest in taking part in the second phase of this project.

If you are interested please email your details to geraldine.ohalloran@inclusionlondon.co.uk. Closing date for expression of interest: 17 December 2012. Work with DPULOs chosen will begin in January 2013.

Introducing Peer Support Workers into mental health

One of the shifts I think we’ll see in the provision of public services – particularly in social care and health – is the significant introduction of “Peer Support Workers”. I.e. people who have been through or are still in the social care / health systems formally and informally working with those currently going through the system.

There are lots of good reasons for this, including:

• It generally leads to better outcomes for the people being supported
• It generally leads to better outcomes for the people doing the supporting
• It’s an approach that works well in partnership with professionals
• It utilises the under-tapped capabilities of people who use services
• Evidence suggests it can be a more cost effective way of delivering services.

As with much innovation, mental health services are leading the way. Thus, this research work by St George’s, University of London is very much worth keeping an eye on.

The Peer Worker Research Project is set up to explore how Peer Worker roles are being introduced into mental health services nationally, in both NHS Mental Health Trusts and in the voluntary sector. We aim to assess what is already known from the existing evidence about introducing Peer Worker roles to see to what extent it applies in a range of mental health services in England.

We also aim to develop guidance and online resources about what supports Peer Workers to carry out their role effectively. We will do 12 case studies across England of initiatives that involve Peer Workers.

You can follow their progress and the case studies on the dedicated Peer Support Worker website. There is also a very interesting event on 28 April about this work and practice developed so far, details of which are here.

Big beasts versus social enterprises in health

The King’s Fund had a very interesting report out last week: Social Enterprise in Health Care.

Focusing on the health sector, the report explores the reasons why some social enterprises became social enterprises in the first place, and whether what they were hoping to achieve has happened in practice.

I think this is of interest because Disabled People’s User-Led Organisations operate in the same “space” as social enterprises.

Beyond the specifics of the challenges facing establishing social enterprises, there is a wider context. As the report’s author, Rachel Addicott, highlights in her summary post on the report, there is something of a paradox at the heart of the health reforms when it comes to social enterprises.

On the one hand, there is a desire for the NHS to become the largest social enterprise sector in the world.

On the other, there is the “any qualified provider” drive towards greater competition. Thus:

The question is whether these emergent organisations can really compete with the likes of private companies and large voluntary sector providers.

Of course, the issues that face emerging social enterprises are similar to those that face smaller voluntary sector providers, including disabled people’s user-led organisations – a virtually unheard of provider in the health sector.

But even here there is something of a hierarchy. As Addicott notes:

Many social enterprises have emerged from primary care trust (PCT) provider arms – some taking the entire provider service with them, and others breaking away into smaller enterprises that deliver distinct types of care.

As such, even these spin-out social enterprises have a head-start over smaller voluntary sector organisations, since they’ll have the contacts and the familiarity with health commissioning – issues of process – to compete when bidding for contracts – an issue of content.

The King’s Fund rightly, in my view, calls for creating conditions in which social enterprises can grow and flourish, and so contribute to a

future market containing a plurality of differently-sized, locally-based social enterprises growing and competing.

Creating such conditions would also have a beneficial impact on DPULOs, too.

The King’s Fund suggests that such conditions can be crated through both political commitment to a practical support programme and a commissioning strategy to nurture the development of the social enterprise model.

Such practical support was made available under the previous Right to Request programme (on which more here), and covered areas such as HR, finance, governance structures. It also made mentors widely available for other organisations – mentors being organisations already successfully operating as social enterprises and providers in the health sector.

Having something similar to the support programme for the Right to Request for emerging social enterprises in the current health reforms would be of great use. Making this support available for smaller voluntary sector providers as well would be a generous, and beneficial, extension of the support.