Focusing on Outcomes

Author: Tim Keilty

Tim offers a clear and practical approach for 'focusing on outcomes' - the new orthodoxy in the English social care system.

We are New Prospects and we’ve been supporting people with a learning disability for over 20 years. We support people to live the lives they choose whether they need support 24 hours a day or just a few hours a week. We’ve learned a lot over the last 20 years from the people we support and their families and we’ll keep on learning and changing to make sure we stay focussed on giving people what they want. We are small, local and well connected. Being small doesn’t mean we don’t think big!

Outcomes, Outcomes, Outcomes - Why?

It seems like we’ve gone a bit outcomes mad. For years the social care system has trundled on, surrounded by a plethora of measurements, frameworks, criteria, and the odd outcomes framework thrown in. Now apparently it’s ‘all about outcomes’. Good, but good support was always about that.

Support Providers in the North East have been asked to develop ways of measuring outcomes as part of their ‘Framework Contract’ with local Authorities. All good stuff, but the danger is that you end up having a different outcomes framework for North Tyneside, Newcastle, Northumberland as well as CQC, if you’ve signed up to Making it Real you’ll have some more, If you support a team of Quality Checkers, like we do, you’ll also have the REACH standards.

In order for things to stay the same they have to look like they are changing.

I read a lush book years ago called The Leopard by Guiseppe Tomassi di Lampedusa, I’m sure the above quote or something like it appears there. It was tempting to spend months and months creating a new list of ‘I’ statements, interviewing people asking them, “What makes a makes a good life?” We could have created a new list of outcomes, cross referenced our outcomes with all of the other lists out there, we could even have ‘co-produced’ it. Then we could have plonked it all on top of all of the stuff that we’ve already got – like a big sparkly blanket. It would have sparkled for a little bit until the next sedimentary layer covered it up. And perhaps nothing would have changed.

If you’ve got something to bring to the table – for God’s sake bring it!

So rather than waste all of that time, we just decided to use the best ‘Outcomes Frameworks’ out there - John O’Brien’s 5 Accomplishments and Simon Duffy’s Keys to Citizenship – they are a perfect fit – the point of our work is to support people to live their life full, a life full of valued experiences where they can experience the rough and smooth of Citizenship. We were confident we could ‘squash’ any of the other ‘outcomes’ expected of us into these tried and tested ‘measurements’ of a ‘Good Life’.

We worked on this together, with people we support, their families and staff but we did bring the 5 Accomplishments and the Keys to Citizenship to the table, and told people we didn’t think they could be bettered!

The Outcomes are:

Having Friends and Relationships
Making Choices – Being in Control
Sharing my Gifts and Talents
Sharing Ordinary Places
Being Respected for Who I am
Being Healthy – Staying Safe

Here’s an example of how they look:

Ain’t Nobody’s Business But My Own – Taj Mahal

I’m uncomfortable with measuring and reviewing because I’ve seen it too often turn in to a measurement or a review of people. We are really clear. The only thing we’ve got any right to measure and review is our support, and the best people to tell us about that are people we support and their allies.

We think it’s our task to support people to develop (or maintain) a foundation from which they can live THEIR good life. A good life is the person’s own business and is lived with family, friends, community.

The Hope

We hope this outcomes work will:

Make it easier for the people we support and their families to hold us to account – we’ve been clear and honest about what we are trying to achieve together.
Enable support workers to be bolder and have a greater sense of purpose, they know clearly what we hope to achieve.
Run through all of our work – planning, everyday support, reviews, training, monitoring, reporting back to our customers – a clear, concise and shared language.
Make us better at supporting people!
Help us take control over how we report back to customers.

How should it work?

The idea is that it’s a continuous process which is embedded in our everyday work – not something added on top, it is just what we do.

Here are the major steps:

We can only support people with their good life if we know what it is – so we’ve been offering people the chance to do the ‘Big Plan’ – at the very least we need to sit down and have a craic about how life is now, how it could be better – with the outcomes loosely in mind.
Supporting people with those outcomes as a guide, learning about how to support people better.
Reviews of support, “how well are we helping Jimmy make choices and be more in control?”
Staff supervisions reminding us of our purpose.
The Quality Checkers team using the outcomes to check our support.
Training based around those outcomes, we are using Open Future Learning and matching modules to outcomes.

So we hope it will have some big impacts on the way we support people, our relationships with people we support and their families, and the organisation as a whole.

Open Source Outcomeware!

This might not work for everyone, you may have your own really successful thing in place, you might be involved in some of the other Outcomes frameworks. However, if you are an organisation starting out on this road - New Prospects have invested in this work, and it is tax payer’s money that has been invested – we want to share this as widely as possible so other people can benefit from that investment. Feel free to use, nick the pictures, if you get in touch we’ll send you all of our stuff!

Get in touch with Tim by email: Tim.Keilty@new-prospects.org

The publisher is the Centre for Welfare Reform.