Antonine works on a outcome focussed approach for each individual service user. This is based on the “Talking points” personal outcomes approach.
Talking Points: Personal Outcomes Approach is an evidence-based, organisational approach that puts people using services and their carers at the heart of their support. At the centre of the approach is a conversation with an individual using services or unpaid carer that seeks to understand the extent to which they are achieving the outcomes important to them in life. These conversations form a core part of relationship building between Antonine, people who use services and their families.
Talking Points: Personal Outcomes Approach is an evidence based organisational approach that puts people using services and unpaid carers at the centre of the support they receive.
Outcomes are defined as what matter to people using services, as well as the end result or impact of activities, and can be used to both determine and evaluate activity.
Personal outcomes are identified through good conversations with people using services during assessment and support planning. It is also critical that the outcomes are reviewed, to ensure the continued relevance of support and services, and to support service planning, commissioning and improvement.
The outcomes important to people using services and their unpaid carers are well understood through research and are summarised in three Talking Points Outcomes Frameworks.
Focussing on outcomes for individuals demands that organisations move away from service led approaches and challenges them to think and act in a person centred way, drawing on the person’s own assets, strengths and capacity.
Implementing personal outcomes approaches such as Talking Points supports organisations to deliver on policy goals, including increased independence, personalisation, enablement, prevention, improved integration and a shift in the balance of care from hospital to the community.
Outcomes important to people using services
Quality of life; Quality of Life Process Change;
• Feeling safe
• Having things to do
• Seeing people
• Staying as well as you can
• Living where you want/as you want
• Dealing with stigma/discrimination
• Listened to
• Having a say
• Treated with respect
• Responded to
• Improved confidence/morale
• Improved skills
• Improved mobility
• Reduced symptoms
The recent report on the future of public services in Scotland identified four objectives for reform (Christie, 2011). In its response, the Scottish Government committed to intensify the focus on improving service outcomes for the people of Scotland and identified four pillars on which this work will be built:
A decisive shift towards prevention.
Greater integration of public services at a local level driven by better partnership, collaboration and effective local delivery.
Greater investment in the people who deliver services through enhanced workforce development and effective leadership; and
A sharp focus on improving performance, through greater transparency, innovation and use of digital technology.
The Christie Commission (2011) highlighted that, with spending not expected to return to 2010 levels for 16 years, major reforms to public services were needed. The commission estimated that as much as 40% of all spending on public services could have been saved by a preventative approach. In its response, the Scottish Government emphasised preventive programmes as a means of improving outcomes, and reducing costs. A focus on prevention is also evident at the UK level, defined in the DH Transparency in outcomes framework as preventing deterioration, delaying dependency and supporting recovery – aimed at both early intervention and supporting recovery, rehabilitation and reablement (DH 2010).
Talking Points can support these forms of prevention. In addition, outcomes focused conversations can themselves improve outcomes through providing an opportunity to be listened to, to reflect, to access information and in identifying how the individual can be part of the solution.
Self directed support
The self-directed support national strategy for Scotland identifies that there are shared messages within personalised, enabling and outcomes focused services as follows:
A change in culture of service provision from task and time approaches to better outcomes and on focused goals
Doing with the service user/patient/carer rather than doing to or for
Maximising people’s long term independence and quality of life
Appropriately minimising ongoing support – and thereby minimising the whole life cost of care
Talking Points shares these objectives with self-directed support. Both approaches emerged from a concern that services had become focused on meeting the priorities of the system, rather than responding to individual needs. Both view individual support planning and review as key to ensuring that the person’s concerns and priorities are central to decision-making. Although they share common objectives however, they also involve different principles and processes.
The solution advocated by self-directed support is to ensure that the individual is afforded ‘choice and control’ through assessment, with particular focus on self-assessment, resulting in allocation of a budget.