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DEVELOPMENT OF TOOLS TO MEASURE SERVICE USER AND CARER SATISFACTION WITH SINGLE SHARED ASSESSMENT
CHAPTER NINE FINDINGS
9.1 This chapter draws together the main findings from each aspect of the project's work. These findings are elaborated in more detail in individual chapters of this report.
Review of existing practice in relation to assessing user and carer satisfaction
9.2 Key findings from this review were:
a culture of seeking service users' and carers' views about community care is well developed in most areas of Scotland, both by the responsible authorities, by service providers and of course by agencies which represent service users' interests as their primary function. Less work has been undertaken on evaluating user and carer satisfaction with assessment processes
most areas have a mixture of consultative structures and methods, used for different purposes, with some authorities and organisations standing out in having a strong culture of engagement with service users and commitment to finding effective ways of meeting the challenges entailed
seeking the views of older people and of carers is well established; approaches to other groups is less universal, although the development of Partnerships in Practice for people with learning disabilities has stimulated much recent good practice with this group of people
most feedback from service users is obtained for service development purposes, but several respondents also reported how they checked whether individuals' needs were being met satisfactorily. One respondent demonstrated how people had been empowered to make best use of its varied services through a person centred engagement with all aspects of their service experience
much reported research activity was related to recent policy requirements such as the Best Value regime, and in some providers' work, to new National Care Standards
many agencies used their own staff to elicit feedback, but there were instances where independent evaluators were engaged
postal questionnaires generally produced the lowest response rate of all methods used by agencies
the gap between what service professionals see as a priority for the process and what people see as priorities in their lives
people's tendency to be more concerned with services and their availability than with assessment
the stage of implementation of single shared assessment varied significantly across Scotland.
LITERATURE REVIEW
9.3 The literature and research review provided many useful guides and prompts which informed the project. In particular it confirmed that the general approaches we were pursuing were rooted in a sound body of academic work.
LOCAL DEVELOPMENT GROUPS
9.4 Key findings from the Local Development Groups were:
Forum Theatre proved to be a very effective medium for setting the main concepts the groups were discussing in a real life context which was familiar to all participants
the 4 groups produced similar ideas about what mattered most in the course of an assessment (the Guidelines for Assessors)
The groups were able to contribute views about what stops people giving information when they are asked about services; ideas and good practice advice in relation to evaluation questions and approaches for the Toolkit; and suggestions about how people with different communication requirements can be asked about their views
Having diverse groups proved beneficial in terms of bringing a wide range of experiences to bear on the issues and offering group members new learning opportunities
More time was needed to broaden the membership of the groups to reach more marginalised groups
Group members were appreciative of the participation payment and the record of their work in the groups as tangible signs that their contributions had been valued.
PRACTITIONERS' WORKSHOPS
9.5 Key findings from the Practitioners' Workshops were:
Single shared assessment is not yet the universally used term, even among professionals
Staff in Joint Future Partnerships are still preoccupied with implementing the basics of single shared assessment and feel that evaluation at this stage may be somewhat premature
There was significant congruence between the views of service users and carers and practitioners: e.g. practitioners regarded the Guidelines for Assessors as a statement of good practice.
PILOTING THE TOOLKIT
9.6 Key findings from the pilot were:
The co-operation of assessors with people carrying out monitoring is important in enabling the latter to carry out their task effectively. A timescale which takes into account the other pressures on assessors' time is vital. Asking assessors to obtain consent was not an effective way of engaging service users and carers with the pilot, as it was clear that many assessors did not feel able to ask people to participate. There is no evidence that service users and carers were unwilling to participate
if they were asked
More consideration is needed of how to involve assessors so that sampling is not biased towards people who feel well served by them, but the benefits of assessors' involvement are maximised where possible
Assessors' experience of working with individual service users and carers was very helpful in assisting evaluators to decide which toolkit method should be used
More consideration is also needed to maximize service users' understanding of the assessment process so that the purpose of evaluation visits can be more readily established
Insufficient people filled in the postal questionnaire or were interviewed using the postal questionnaire as the interview schedule to enable firm conclusions to be drawn about the 2 methods' effectiveness. However, there are some indications that some adjustments are needed to the interview questions and/or the way they are presented to service users
People who were interviewed generally expressed satisfaction with their assessment
The Guided Discussion questions and approach are effective in enabling people with moderate learning disabilities and people with severe dementia to give good quality information on the main areas of enquiry of the Guided Discussion (which equate with the general questions in the full questionnaire)
This can be achieved by interviewers who feel confident of working with the service user group
There are indications that the carers' questionnaire, whether self completed or used as an interview schedule provided an effective means for carers to give their views on the SSA
There was anecdotal evidence that many users and carers enjoyed an opportunity to talk to the interviewers
The Toolkit background information helps interviewers to understand and prepare for their task
Individualised information from assessors and carers is essential for preparing for discussions where there is a significant degree of communication impairment
Service users can be helped to remember their assessment meetings by skilful interviewers who have obtained relevant information from assessors
Service users' recall of the content of their assessment meetings was more difficult when there was a large time gap between the assessment meetings and the evaluation meeting
The presence of a carer or other supporter contributes enormously to the effectiveness of the monitoring interview
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