The Development of a Measurement Strategy to Enhance Service Provision in Sperrin Lakeland

The development of a measurement strategy to enhance service provision in Sperrin Lakeland

Health and Social Care Trust

EXECUTIVE SUMMARY

School of Nursing

University of Ulster

Mr Kevin Moore

Ms Assumpta Ryan

Ms Siobhan McCann

Professor Hugh McKenna

March 2004

Report prepared for Sperrin Lakeland Health and Social Care Trust

Acknowledgements

The research team would like to thank all those people who made this study possible.

Firstly we wish to extend our deepest thanks to all those people who have contributed to this research by giving their valuable time to share their feelings and experiences, especially the client groups and the carers group.

Sincere thanks to the Health and Social Care Professionals and Managers who also gave of their valuable time to share their views and experiences, despite the demands of their work.

The research team would like to thank especially the Centre Managers, Daphne Clarke, Margaret Dolan and Liam McDermott for their time, patience, consideration and invaluable assistance and contribution throughout this study. In addition, we wish to thank Mr Kieran Downey for his assistance.

We wish also to thank Sperrin Lakeland Health and Social Care Trust for funding this study.

Finally we are most grateful to all of the members of the research project steering group for their invaluable assistance, support and guidance throughout the research project.

Steering Group Members

Ms Daphne Clarke

Ms Margaret Dolan

Mr Kieran Downey

Mr Eugene Gillease

Ms Siobhan Mc Cann

Professor Hugh McKenna

Mr Liam McDermott

Mr Kevin Moore

Ms Assumpta Ryan

Mr Vincent Ryan (Chair)
CONTENTS

Page

Acknowledgements 1

1.0 Introduction 4

1.1 Background 4

1.2 Review of Literature 5

Government Reports 5

Outcome Measurement 7

Audit 9

Person Centred Approach 10

Quality, Quality of Life and Equality 11

1.3  The Previous Matrix of Standards within the Learning Disability

Service 11

1.4 Rationale 12

1.5 Aims and Objectives 13

Aim 14

Objectives 14

2.0 Method 14

2.1  Collection and assessment of current performance measurement

Strategies 15

2.1.1 Ethical Consideration 16

2.1.2 Focus Groups 1: reviewing principles and values……….. 16

2.1.3 Findings: staff focus groups…………………………….. 18

2.1.4 Findings: client focus groups…………………………… 22

2.1.5 Findings: parent focus group…………………………… 25

2.2 Development of measurement strategy and pilot……………………. 27

2.3 Revision of standards matrix and audit tool revision………………… 28

2.4 Implementation and evaluation of audit tool in four sites…………… 29

3.0 Review and finalisation of completed audit tool 31

4.0. Conclusion 31

References 33

Appendices 36

List of Tables

Page

Table 1: Outline of Fundamental Principles in Homes are for Living In,

Social Services Inspectorate, 1989 6

Table 2: Composition of focus groups 17

Table 3: Breakdown of participants in the focus groups 18

List of Appendices

Appendix 1. Previous centre matrix 37

Appendix 2. Criteria for evaluating principles. 41

Appendix 3. Focus group topic guide 48

Appendix 4. Part B. Audit Tool Summary Sheets 50

Appendix 4.1. Part B. Audit Tool Summary Sheets for

Profoundly Disabled Audit Tool 58

Appendix 5 Part C. Audit Tool Action Plan 66

1.0 Introduction

1.1  Background

Sperrin Lakeland Health and Social Care Trust, a combined hospital and community Trust, was established in 1996 and serves the counties of Tyrone and Fermanagh, including part of the town of Strabane in County Tyrone. The Trust delivers health and social care to approximately 118,000 people across 1,000 square miles, with less than one third of the population living in the two principal towns of Omagh and Enniskillen (Sperrin Lakeland Trust, 2003).

In 1993, 1996 and 1999 the Omagh Social Education Centre was awarded a Charter Mark for excellence in service provision to individuals with disabilities. In 1999 and 2003 the Drumcoo Centre was also awarded a Charter Mark. To date, the Killadeas Centre has not applied for a Charter Mark Award. The Omagh Social Education Centre and the Killadeas centre both have various outreach centres, which compliment the main centre provision. The Drumcoo centre, based in Ennsikillen, provides a range of services and support for people with physical and sensory disabilities and brain injury to enable them to achieve social and economic independence in the community, supported by principles of empowerment and autonomy (Drumcoo Centre, Annual Report, 2003). The centres’ broad aim is to nurture the clients’ personal, social and vocational development. Each centre has developed an operational philosophy to maximise the potential of the clients through education and training within a caring environment.

Whilst each centre has developed its own philosophy statement, the Mission Statement and Aims of the Trust are also operationalised within centre practices, policies and procedures. The Mission Statement and Aim of the Sperrin Lakeland Health and Social Care Trust are:

“To enrich and enhance the quality of life for the whole community

through the provision of relevant and efficient health and social care.”

(Sperrin Lakeland Trust, 2002)

The provision of care within all of the main centres and the outreach centres focuses around a key objective to respond to the needs of the those within the local disabled community who fall within the Health and Disability Programme, by providing opportunities to enable and empower people to develop their own resources for more creative and effective living (Drumcoo Centre, Mission Statement, 2003). Standards of care within each respective centre are based on six basic fundamental principles and values:

1. Choice
2. Rights
3. Independence
4. Fulfilment
5. Privacy
6. Dignity

Each standard is operationalised within all aspect of care by specifically focusing on key areas. These include the physical environment; care practices, staff training and carers’ needs.

1.2  Review of the Literature

Government reports

The Social Services Inspectorate published in 1992 the document entitled ‘Caring for Quality in Day Services’ (Department of Health, [DOH] Caring for Quality, 1992) and identified significant issues that required to be addressed in the utilisation of standards in day care. The publication was the first in the series to address issues of good practice, management, evaluation and purpose for day services. This report included a review of the literature 1986-1992 on Day Care Services for Adults (Bearley and Mandelstam, HMSO, 1992, cited DOH., Caring for Quality, 1992). The review outlined the reasons for providing day services, which were to:

1.  Develop the user’s potential including:

§  enhancing physical and mental skills

§  providing rehabilitation and treatment

§  providing basic personal services

§  providing social psychological support

§  providing assessment and review

§  tailoring individual packages of care

2.  Enrich the users pattern of living

3.  Offer social activities and opportunities for mixing

4.  Provide relief and respite for parents/carers

5.  Provide constructive forms of occupation

6.  Act as a resource for users, families and the community

7.  Provide advice

(DOH, Caring for Quality, 1992, p9)

The report on Caring for Quality (DOH, 1992) however, concluded that although day services are an established part of social care provision they had developed in a piecemeal fashion; and were not adequately integrated into coherent local planning between agencies; did not reach most of those in need; and had not been fully exploited to the extent of their potential. The emphasis therefore within the report was to assist and enable managers to address these issues within the provision of day care services by identifying key messages and importantly to assist in the developing of general standards
to inform a more detailed evaluation of policy, planning and practice in local provision (DOH, Caring for Quality, 1992, p10).

The Social Services Inspectorate therefore focused on standards, which they considered would and should inform approaches of both providers and purchasers of day care service provision to secure quality. It was these standards that were to be included within the criteria and evidence to be considered in any review and inspection of the service. These standards would flow from a commitment to the fundamental principles (refer Table 1) and essential components in quality of life for individuals and ought to be reflected in day service provision (DOH, Caring for Quality, 1992, p10).

Table 1: Outline of Fundamental Principles in Homes are for Living In, Social Services Inspectorate, 1989

(Homes Are For Living In, SSI, HMSO, 1989, cited Caring For Quality, 1992)

The Caring For Quality Report (1992) recognised that many centres’ contributions to care in the past have been valuable, but clearly articulated that times change and that service development must be sensitive to this. Inherent to this process is thus the requirement of service providers and agencies to be cognisant of the process of change. An assumption was clearly articulated by the SSI that:

“The basic principle that personal social services must be appropriate

to the needs of a multi-racial and multi-cultural society, and that people

have regard for the different expectations of service users and carers of

whatever race, gender, sexual orientation, religious or cultural origins.

It is implicit that terms such as ‘people’, ‘service users’ and carers embrace this integrated approach.”

(DOH: Caring For Quality, 1992, p11)

In England the Government White Paper Valuing People (DOH, 2001) stressed the need for quality to be assessed in terms of outcomes. The objective of the Government was to “ensure that all agencies commission and provide high quality, evidence-based and continuously improving services which promote both good outcomes and best value” (p90).

Outcome Measurement

Nocon and Qureshi (1996) report that ideas about the achievement of an ordinary life, and the importance of assisting people to undertake socially valued roles, have probably been more influential in relation to people with learning disabilities than any other group of service users. For adults, research-based measurement of outcome has most frequently taken place in situations where people have been discharged from long-stay hospitals, and in many ways the principles, which reflect widely accepted objectives for services are the inferred opposites of institutional practice (p105). Nocon and Qureshi (1996) note that the most frequently measured outcomes are competence and behaviour, community presence and participation, engagement in meaningful activity and individual morale or satisfaction. From their experience, an established set of principles with wide support does not automatically give agreement on what constitutes correct practice and believe that this will lead to disagreement and debate. Furthermore it can be difficult to give the voice of the service user the prominence that might be wished, and there are a range of difficulties in ascertaining the views of people with learning disabilities, only some of which maybe tackled by the use and development of appropriate communication techniques.

Whilst much outcome measurement in relation to people with learning disabilities has focused on the effectiveness of services for people discharged from long-stay institutions (Nocon and Qureshi, 1996), more recent outcome measures are strongly influenced by the framework outlined by O’Brien and Lyle (1987), which is drawn from ideas about the right to lead an ordinary life, and is based on the idea of five accomplishments:

1. Community presence – to share with other citizens choices in respect of workplace, leisure, home and education.

1. Choice – to make choices and benefit from experiences, which guide choice among a variety of options in all areas of life.

1. Competence – to develop competence, which will increase independence and social skills.

1. Respect – to gain respect from other members of the community by being supported in achieving valued social roles.

1. Community participation – to form friendships and relationships with members of the local community.

(Nocon and Qureshi, 1996, p106)

It has also been reported in the literature (Nocon and Qureshi, 1996) that whilst such general statements do not in themselves form effective outcome measurement systems, they are perhaps nonetheless useful in deciding how to measure quality of life. Various adaptations and additions have been suggested in the process of trying to develop workable systems for practice. For example, Evans and Gray (1990, cited Nocon and Qureshi, 1996) modified this framework to produce a standards matrix with seven key elements involving, first the addition of continuity and individuality and second, an emphasis within the domain of participation, recognizing the differing depth and importance of different relationships. The authors suggested that each domain could be investigated along three dimensions: place of residence, daytime occupation and use of leisure time. However, it was reported that the standards matrix was insufficiently operationalised to be of practical use.

Emerson and Hatton (1994, cited Nocon and Qureshi 1996) provide a comprehensive review of research studies, which had measured outcomes for service users. Their review covered over 70 publications representing some 45 studies providing qualitative and quantitative data on user related outcomes, most of which compare hospital-based institutional care and community based staffed housing. They further identified a number of general domains of outcome measurement, and Wright et al, (1994, cited Nocon and Qureshi, 1996) have identified similar broad domains which are:

§  Everyday functioning - adaptive and mal adaptive behaviour

§  Engagement or participation in meaningful activity

§  Personal experience of life and life quality, and

§  Social relationships, networks and community participation.

Nocon and Qureshi (1996) offer a detailed extrapolation and discussion of these broad domains. They suggest that these domains continue to influence ideas about the importance of an ordinary life, and in some ways are close to the spirit of legislation in the sense that emphasis is placed on individual opportunities for choice, developing competence, and living in a homely domestic environment (p115). Many aspects of their discussion are central to some of the fundamental principles of this research, particularly pertaining to interpretations and provision of choice, independence and fulfilment within service provision.

Audit