Working together for change: using person-centred information for commissioning Dr Fay Haffenden, National JSNA lead National JSNA Dataset project 24 Feb 2010 Author: Sam Bennett, Department of Health

Working together for change

Putting People First “It seeks to be the first public service reform programme which is co-produced, co- developed, co-evaluated and recognises that real change will only be achieved through the participation of users and carers at every stage. It recognises that sustainable and meaningful change depends significantly on our capacity to empower people who use services…”

Co-production “This is not about consultation or participation – except in the broadest sense…it is about broadening and deepening public services so that they are no longer the preserve of professionals or commissioners, but a shared responsibility…” New Economics Foundation, Co-production: A manifesto for growing the core economy

The WTfC project Objective: To listen to what people said about their lives and about services so that we can commission with people to ensure they get more of what’s working in their lives, less of what isn’t working and can achieve their aspirations for the future; Approach: Worked with 4 councils to further develop and test an approach for feeding person-centred information from reviews and support plans into the commissioning process; Outputs: -A fully tested, written-up approach to co-producing commissioning plans;

Why do this? Understanding outcomes for people: …Using the same information in aggregate form provides the opportunity to draw wider conclusions about outcomes for groups of people, or populations” “Outcomes focused reviews provide data about individual outcomes…

Why do this? Strategic needs assessment – JSNA. Socio-demographic data Market intelligence Performance and regulatory information Historical commissioning patterns Input from frontline staff Consultation Customer satisfaction surveys/complaints The commissioning dataset:

JSNA DH guidance states that other data sources “should be supplemented by information gained through active dialogue with local people, service users and their carers” BUT - Ensuring meaningful community engagement in the JSNA process has proved difficult…

Possible limitations JSNA DH guidance states that other data sources “should be supplemented by information gained through active dialogue with local people, service users and their carers” This has proved difficult Data sourceLimitation Socio- demographic data Highlights needs rather than aspirations ConsultationOften occurs after development of the strategy Satisfaction surveys Often use closed questions Market intelligence Imaginative constraints

The raw data for WTfC: person-centred reviews The review of a person’s individual support plan or personal health plan; Includes three key questions: “what’s working?” “what isn’t working?” “What’s important to you for the future?” You can’t use ‘working together for change’ without doing person-centred reviews!

The six stages of WTfC 1. Collect raw data from care plans/person-centred reviews; 2. Organise information: top 3 “working” “not working” and “important for the future” 3. Cluster the information with a diverse group of local people; 4. Analyse – what are the root causes? what would success look like? 5. Action plan – what will we do differently? 6. Share and communicate.

E.g. Step 3: Clustering “I have only one friend” “I only have staff in my life” “I don’t see many people during the day” “I am lonely”

E.g. Step 4: Analysis “I feel lonely” We don’t put enough emphasis on relationships when we commission services; Staff don’t know how to connect people and don’t see it is part of their job; Providers don’t see this as a priority; CQC does not inspect on this so we don’t see it as important; This isn’t part of staff training; Care managers don’t see this as important when looking at placements…etc

E.g. Step 5: Action plan Individual change Strategic change “working”Plan what it would take to spread this practice “not working”Plan what it would take to change this – action at operational and strategic level “important for the future” Inform market development and commissioning

Presenting the data

Outcomes of WTfC implementation People using services and their families are put at the heart of the process so that commissioning is transparent and readily understood; Data generated routinely from person-centred reviews can be used alongside (or as part of) JSNA to inform strategic commissioning; Strengthened thread of robust qualitative data adds ‘colour’ and individual voice; That there is a clear and demonstrable link between ‘what people said’ and ‘what commissioners did’ – the golden thread;