Evaluation of the Warrington district CAB GP outreach project

This project report discusses the Warrington district CAB GP outreach project. The project was developed to limit the impact that social deprivation problems may have on health.Warrington Primary Care Trus

A small-scale study of disabled parents' experiences of local services in Cheshire

This report is available through Chester Digital Repository.This report discusses the experience of disabled parents in Cheshire in order to represent diabled parents' perspectives on using local services and can inform local providers and advocacy groups on the strenghts and weaknesses of local provision.The report was commissed by the Cheshire Disabilities Federation and funded by the Cheshire Children's Fund

Examination of the Warrington Falls Management and Prevention Service

This report discusses the Warrington Falls Management and Prevention Service. For older people, falls have a number of significant negative physical, social and psychological consequences including self-imposed restricted mobility, fall phobia and fractures. In evaluating the Warrington Falls Management and Prevention Service, the report focuses on changes in functional performance and mobility levels among clients as a result of taking part in an exercise programme, clients' awareness of the multi-factorial risks associated with falls and the extent to which social isolation of the elderly was addressed by the service.Warrington Primary Care Trus

Evaluation of the Paediatric Home-based Palliative Care Service

Copyright © Centre for Public Health Research, University of ChesterPalliative care has been recognised as a medical speciality since 1987 (Hynson & Sawyer, 2001). However, it remains relatively underdeveloped in the paediatric setting, and there has been little research carried out in the area. One reason for this may be the nature and challenge of surveying caretakers about a highly emotive and painful subject (Hynson & Sawyer, 2001). However, as Dangel, Fowler-Kerry, Karwacki, and Bereda (2000) suggest, ongoing programme evaluation is a necessary component to improve the quality of service delivery. Research is required in all aspects of palliative care in order to ensure that this relatively new speciality can move forward from an anecdotal basis to one that has a sound evidence base (Twycross & Dunn, 1994). The most distinctive feature of palliative care is its divergence from most other types of medical care: the aims are different to that of curative care and thus create different priorities. Palliative care focuses on relieving pain or the symptoms of a disease or disorder without effecting a cure (World Health Organisation [WHO], 2005). As such palliative care aims to preserve normality as far as possible; for the great majority of children and young people, this means delivering care in the home (Watterson & Hain, 2003). In this setting, parents play a key role in decision making as they are involved in the day-to-day management of their child's symptoms (Dangel et al., 2000)

The factors that affect local authority use of adult social care and carers survey data

The second in a series of three blogs produced by the MAX project team which summarises the preliminary findings from an online survey conducted with local authority staff associated with the Adult Social Care Survey (ASCS) and Personal Social Services Survey of Adult Carers in England (PSS SACE or Carers’ Survey)

Emerging themes and provisional ideas for how the toolkits developed during the MAX project can help local authorities maximise the use of data in adult social care

The third in a series of three blogs produced by the MAX project team which summarises the preliminary findings from an online survey conducted with local authority staff associated with the Adult Social Care Survey (ASCS) and Personal Social Services Survey of Adult Carers in England (PSS SACE or Carers’ Survey)

Local authority views and use of the adult social care and carers survey

The first in a series of three blogs produced by the MAX project team which summarises the preliminary findings from an online survey conducted with local authority staff associated with the Adult Social Care Survey (ASCS) and Personal Social Services Survey of Adult Carers in England (PSS SACE or Carers’ Survey

Implementing personal health budgets within substance misuse services [final report]

Executive summary 1. The personal health budget initiative is a key aspect of personalisation across health care services in England. Its aim is to improve patient outcomes, by placing patients at the centre of decisions about their care. 2. In 2009 the Department of Health invited PCTs to become pilot sites to join a programme which would explore the opportunities offered by personal health budgets. The Department of Health commissioned an independent evaluation to run alongside the pilot programme to provide information on how personal health budgets are best implemented, where and when they are most appropriate, and what support is required for individuals. 3. Two pilot sites within the pilot programme explored whether personal health budgets had an impact on outcomes and experiences compared to conventional service delivery among individuals with substance misuse problems. Study design and methodology 4. The evaluation adopted a longitudinal approach, and included people with drug and/or alcohol addiction. 5. The study used a controlled trial with a pragmatic design to compare the experiences of people receiving a personal health budget with the experiences of people continuing under the current substance misuse treatment support arrangements. After applying initial selection criteria, in one pilot site people were randomised into the personal health budget group or a control group. In the second pilot site, the personal health budget group was recruited from patients of those health care professionals in the pilot offering budgets, and a control group was recruited from patients of nonparticipating health care professionals. 6. A mixed design was followed where both quantitative and qualitative methodologies were used to explore patient outcomes and experiences, service use and costs, as well as the experiences of those implementing the initiative. In total, an active sample of 166 participants was recruited: 119 in the personal health budget group and 47 in the control group. Within the active study sample, 55 participants had drug and alcohol addictions and 111 participants had an alcohol addiction only. 7. The qualitative analysis involved interviews with personal health budget holders and organisational representatives. Data were analysed using the framework approach, with the data organised by themes according to the topic guides used in the interviews. 8. The difference-in-difference approach was used to explore whether personal health budgets had an impact on an individual’s quality of life and relapse rates. The analysis subtracted an individual’s follow-up outcome scores from their baseline score. Due to the small sample size, the analysis did not include exploring difference-in-difference multivariate models and therefore we were unable to control for confounding baseline differences. The content of support plans 9. Among the personal health budget group, 103 support plans were returned from the two pilot sites. In terms of the size of the budget, 41 budgets were worth between £1,000 and £5,000 per year, while 4 budgets were worth more than £10,000. 2 10. The majority of care/support plans were managed notionally. While one of the pilot sites did have approval to offer direct payments, we did not find evidence this deployment was offered during the pilot programme. 11. Residential detox was the largest single cost category. The more innovative uses of the personal health budget included driving lessons, alternative therapies, leisure activities and educational courses. Enabling people to access community detox rather than residential detox could also be regarded as an innovative use of their budget. The impact of personal health budgets on relapse rates, quality of life and service quality 12. The shortened version of the Alcohol Use Disorders Identification Test (AUDIT-C) was used to detect signs of hazardous and harmful drinking. Difference-in-difference analysis indicated that individuals in the personal health budget group had reduced their excessive drinking at follow-up compared to those in the control group. Similar results were found with the change in drug consumption at followup. 13. Difference-in-difference analysis indicated that there were greater improvements in care-related quality of life (ASCOT) and psychological well-being (GHQ12) for individuals in the personal health budget group compared to those in the control group, although the difference was not statistically significant. 14. Individuals in the personal health budget group were more satisfied with the help paid for by the budget and the care/support planning process than those receiving conventional services. 15. While the quantitative results highlighted the positive impact of receiving a personal health budget, firm conclusions around the impact of personal health budgets compared to conventional service delivery could not be made, due to the small sample size. Views from patients 16. Qualitative in-depth interviews indicated that personal health budgets had a positive impact on service quality, relationships with health professionals and views on what could be achieved compared with conventional service detox delivery. 17. The importance of effective implementation was highlighted, both in terms of providing the necessary information to enable budget holders to make an informed choice and also to minimise any delays in the process of obtaining and using a budget. Individuals reported that delays could potentially lead to anxiety and distress. 18. A list of suggestions of possible uses of personal health budgets would have been useful during the support/care planning stage. 19. Personal budget holders reported a lack of after-care services available with this treatment route which could potentially have a longer-term impact on relapse rates. This desire for post-detox care to prevent relapse was especially prevalent at follow-up, when patients had completed their detoxification and required relapse prevention services. 20. Individuals receiving conventional detox services expressed more negative views of the relationship they had with health professionals and their experiences of services. Views from the system 21. Organisational representatives believed that personal health budgets had a positive impact on outcomes for budget holders: the way they accessed services, and to a certain extent the content or 3 quality of those services. Organisational representatives attributed these impacts to the personal health budgets enabling: increased choice and control for budget holders; increased flexibility; encouraging innovation and creativity; greater ‘person-centred’ care/support planning; and the opportunity to reduce costs by accessing alternative services or providers of services. 22. A number of challenges within the implementation process were mentioned by organisational representatives. These included: the length of time required to conduct the care/support planning process; the time point at which a personal health budget should be introduced; deciding what can and cannot be included, in particular considering whether the budget should be used for relapse prevention; managing attitudes to risk and the cultural change required for patients in the system; the logistics of managing multi-agencies involved in a person’s care; and establishing integration between services and creating a jointly-funded budget. Recommendations for policy and practice 23. A number of recommendations can be made regarding a possible roll-out of personal health budgets within the area of substance misuse from the results of this study: Personal health budgets increased service satisfaction, facilitated a positive relationship with health professionals and improved quality of life supporting a wider roll-out. The budget-holders we interviewed emphasised the value of information and guidance from operational representatives about the size and operation of their budgets, including what services were covered. Direct payments were viewed as playing a critical role in the success of personal health budgets for people with substance misuse problems. However, managing the anxiety and practical challenges around offering this deployment option may need consideration