Jon Glasby, Health Services Management Centre Do health and social care partnerships deliver better outcomes for service users (and how would we know if they did)? Jon Glasby, Health Services Management Centre

Doubts over value of £3bn Sure Start The first major evaluation of the government's flagship £3bn Sure Start programme… has revealed no overall improvement in the areas targeted by the initiative. Although some Sure Start schemes were successful, an independent study … revealed that Sure Start as a whole failed to boost youngsters' development, language and behaviour. It also showed children of teenage mothers did worse in Sure Start areas than elsewhere.

Doubts over value of £3bn Sure Start cont. The findings… represent only an early snapshot of the programme's effectiveness, and academics involved in the £20m evaluation emphasise that they do not mean the scheme, which varies widely around the country, will not succeed in helping children in deprived areas in the long term

Outline The evaluation challenge (see Helen Dickinson’s session on Wednesday) Key policy challenges Is partnership a concept that has had its day?

1. The policy context (in theory) Partnership Better Services? Better Outcomes? (Do they? How? For whom? In what contexts?)

1. The evaluation challenge What are the outcomes of partnership working? Complex policy initiatives Multiple stakeholders and perspectives Proving you’ve prevented something? Long-term programmes/outcomes What would have happened anyway? Etc etc etc.

1. The evaluation challenge Focusing on evidence of what works v evidence of what doesn’t work? From evidence-based practice to practice-based evidence? A new approach to ‘knowledge-based practice’?

2. The policy context (and the neglect of social care?) Only important when impacting on NHS? Whatever happened to the Green Paper? The Wanless Review Missed opportunities (case management, commissioning, intermediate care, SAP, LINks etc.)

Key policy drivers – same as the NHS? Demography Medical advances Financial difficulties (and changes in health-social care divide) Changing public expectations?

2. Key priorities/questions Does prevention ‘work’ and how do we do it? How should we fund long-term care? How do we work with universal services and the NHS at the same time? What is an outcomes-based approach (and do policy makers really mean what they say)? Will direct payments and individual budgets really bite and, if so, what does this mean?

3. Is partnership a concept that has had its day? A term that is used, misused and abused? Is it worth it? Who is accountable if it goes wrong? Is there a plan B? Will it work when finances get tight? Etc etc.

3. The importance of being clear about outcomes What outcomes are we trying to achieve? How well do we do this now? What needs to happen next? Context ------ Process ------ Outcome

Conclusions Increasing scepticism (and this is healthy) Need to develop more sophisticated approaches to ‘the evidence’ Importance of outcomes Don’t through the baby out with the bathwater