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7 SDF'S FUTURE ROLE IN USER INVOLVEMENT

Introduction

7.1 An evaluation of SDF's engagement with users was identified as one of the key issues for closer scrutiny in the review. It is the subject of particular consideration because of the views expressed by stakeholders that this is a 'unique selling point' of SDF and because of the importance of the role in the new policy and structural environment.

7.2 This section considers the implications of review evidence gathered for SDF's future role in this area.

7.3 SDF's user involvement work sits primarily under its first strategic aim "to support an improvement in the quality of all responses to drug use in Scotland", whilst also informing the other strategic aims. The objectives under the first strategic aim are:

• To support the empowerment of communities to respond to drug problems
• To ensure that service providers and policymakers are fully aware of the interests and concerns of those affected by drug use
• To assist the development of high quality services
• To promote service development/service changes to meet unrealised human and social potential of people with drug problems
• To undertake research and audits which assist in improving the response to drug use.

SDF's UI model

7.4 SDF's UI model is outlined in an article written by the Director and West of Scotland Manager of SDF, published in 2008 ¹⁰. It describes the development of a model "that focused extensively on peer/social research". The key overall aim of the SDFUI model is to aid an improvement in the quality of specialist drug services.

"The work involves undertaking peer surveys, presenting findings to relevant authorities and then seeking service changes.

Focus groups are also held to gain more in-depth feedback from service users, often following individual interviews."

7.5 The benefits of the model cited include greater honesty from survey respondents, since both the interviewers and interviewees are current or former drug users; and the opportunity for the group of users conducting the surveys to quickly develop a representative overview, rather than an individual perspective, of issues facing problem drug users. SDF reports that this model has provided a focus and direction for its UI work which assists in the maintenance of active groups.

7.6 One of the weaknesses in the model acknowledged in the article is that "there is no certainty that planners and/or providers will respond positively to the survey findings".

7.7 Other strands of work undertaken by SDFUI volunteers include seminar presentations, focus group work, user representation on working groups and input to service planning process at local level.

7.8 SDF has a User Involvement Volunteer Handbook which provides guidelines for volunteers on:

• SDF purpose and value
• SDFUI model
• Joining the UI Group: eligibility criteria
• Group activities
• Roles and responsibilities
• Policies

7.9 The policies cited are Volunteer Policy (which in practice is covered by the Volunteer Handbook since it is only in its UI groups that SDF uses volunteers); Disclosure Scotland Policy; Complaints Policy and Insurance Policy. The review team has received copies of the following:

• Policy on Protecting Vulnerable People
• Policy on the Recruitment of Ex Offenders
• Policy on Secure Handling, Use, Storage & Retention of Disclosure Information

7.10 It was confirmed with the Director and Head of Business, Finance and Administration that SDF has not carried out a formal performance review of its UI work.

7.11 Evidence from stakeholders (paragraphs 5.37 and 5.43) suggests that in 2 locations (Glasgow and Perth & Kinross), SDF's user involvement work has developed in somewhat different ways in different locations, in line with the specification of local commissioners.

Research findings

The central role of people with drug problems in the recovery strategy

7.12 'The Road to Recovery' describes recovery as 'an aspirational, person-centred process', which incorporates the principle that 'recovery is most effective when service users' needs and aspirations are placed at the centre of their care and treatment'. ¹¹

7.13 It was emphasised by stakeholders with experience of the recovery approach in the mental health field that this requires a fundamental shift in thinking, whereby the emphasis goes beyond the individual in the context of treatment or a service, to encompass the individual in their social setting:

"Recovery takes place in communities, and in families. Therefore you need to look more widely, at transport, employment, access to kids, public attitudes etc." ( VCS [other] stakeholder)

7.14 The focus is not solely on the individual but also includes the collective empowerment of people with mental health problems to influence strategic planning, commissioning and the way in which services are organised and provided; and their involvement in challenging public preconceptions about mental illness. There is a strong emphasis on gathering evidence on what elements have been shown to help or hinder the recovery of individuals and on peer support.

Benchmarks

SAMH

7.15 SAMH has a clear policy that people who use its services are at the heart of everything it does. Its formal User Involvement Strategy is currently under review, as is the organisation's corporate strategy for 2007-10, following the recent appointment of a new Chief Executive. The corporate vision, values and mission reflect a rights-based approach.

7.16 The majority of SAMH staff are involved in service provision. In addition to UI in each of its local services, some regional UI work is undertaken. A national user group meets quarterly, with a morning workshop facilitated by staff from SAMH's Centre for Research, Influence and Change in order to draw up an agenda and plan the formal afternoon meeting with the Chair of the Board of Management and Executive Management Team.

7.17 In the role of a sector intermediary body, the Centre - which comprises a Director plus 4 staff - does a limited but increasing amount of capacity-building work with other service providers to support the development of UI. Staff speak at conferences and seminars about the challenges and successes of UI work.

7.18 There is a constant attempt to be creative and imaginative in finding means of giving service users direct impact onto how campaigning, influencing and policy work is undertaken. A current example in respect of policy work is an online questionnaire to inform SAMH's response to the consultation on smoking in psychiatric hospitals.

7.19 SAMH is developing peer evaluation as a useful adjunct to direct service user involvement. It is also in the process of developing a model of participatory action research, under the banner of work on social networks 'A World to Belong To'.

Dundee Substance Forum

7.20 There is a service user Task Group model as part of the Substance Forum in Dundee. The work is overseen by the substance forum management group and CAIR Scotland plays a lead role in the task group and hosts the co-ordinator for the work. This is an additional level to the requirement for services to integrate UI into their operations. It provides a route for a group of users linking into the Forum and to the ADATs in the area.

7.21 Recognising the concern that users of a particular service may not feel able to be frank in their feedback where it is organised at service level, this model aims to enable user input that is independent from individual services, but also emanates from users who have personal experience of the local Substance Misuse Pathway components. Task groups of users are set up to carry out specific tasks, which include conducting questionnaires. This means they are fluid and change, so keep getting fresh service users involved - avoiding the creation of a small group of users who continually represent the voice of the user across the board.

7.22 Where a UI task group is to conduct a survey, it is involved in design of the questionnaire.

Factors that promote and hinder User Involvement in services

7.23 In England it has been a statutory requirement since 2003 that all providers of state funded health and social care services involve service users. In light of this, academic research was commissioned by the Department of Health to look at evidence to support UI as a means to improve service quality. ¹² It looked at involvement of service users in planning, commissioning and delivery at Drug Action Team level using a number of methods, including a survey of service commissioners, providers and users.

7.24 The research team noted wide ranging views amongst respondents about the rationale for UI and its objectives, and varying opinions about the effectiveness of various methods. Nonetheless there was a comprehensive acknowledgement that UI"was here to stay" and in the main it was viewed as "having potential to enhance service development and increase efficiency and cost effectiveness".

7.25 The authors stress that they found "multiple interconnected cultural, organisation and individual variables" influencing UI. They conclude that it was not possible to identify a single best practice model.

Source: S Patterson, M Crawford, T Weaver et al "User involvement in efforts to improve the quality of drug misuse services: factors that promote and hinder successful working": Executive Summary, Department of Health, March 2007

Stakeholder views on SDF's future role

7.26 The overall view across the 25 stakeholder responses on SDF's future role in UI and enabling users to have a say in planning and delivery is positive. This is in line with the positive rating for SDF's work on UI to date and the frequency with which SDF's pioneering work on UI was cited by stakeholders as a strength.

Model and approaches

7.27 Within this however, a majority (13) expressed a concern about the currency and flexibility of SDF's UI model and/or the need for SDF to review and clarify how and why it undertakes UI work. The new strategy was felt by some stakeholders to cast UI in a different light:

"There are implications for UI work. The recovery network will be led by ex-users. 'Road to Recovery' will bring in a dimension of UI led initiatives generally. There are implications for SDF in that." ( ADAT stakeholder)

Embedding UI in services

7.28 Several stakeholders feel that there is a need to move forward with user engagement and that it needs to be core to all drug services. Some interviewees suggested that SDF should have a role in supporting services in developing their UI, whilst others had reservations about SDF's past performance in supporting this approach to UI. An academic stakeholder commented:

"The only way they can continue to exist is to make it clear who they are providing a service to: they need to decide that they will help service providers to set up service user involvement. It needs to be a service provider response to user involvement and the longer someone else does it, the less service providers will. They need a proper service spec saying that they are there to support providers.

Everything that they say should place service users at the heart of it. It is about giving service users a voice."

7.29 Another suggestion was that the new Alcohol and Drug Partnerships should be given a statutory duty to report on the level and quality of their user involvement; and SDF should consider concentrating on areas where UI was not yet embedded.

"…the world has moved on and that SDF's traditional model is not universally applicable. But UI is very patchy across the ADATs. In some areas, people have taken it on board, very willing to involve users and users are an accepted part of the set up. But I think there is a valuable role for SDF in areas where UI is poor or patchy." ( NHS stakeholder)

Scope and coverage

7.30 Eleven respondents had worries about SDF's capacity to comprehensively cover all sections of the drug using population across all of Scotland, including carers, people not in treatment, women, young people etc. In some cases this doubt was a reflection of SDF's perceived focus on some sections of the population rather than others.

7.31 The new delivery framework was a particular concern i.e. whether SDF could, or should, attempt to operate across 32 local partnerships. One stakeholder commented that it need not be SDF in every case representing the sector and that this role could be undertaken by a voluntary sector provider. The suggestion in paragraph 7.29 of a targeted role for SDF to promote UI in areas where it is weak might offer a way to resolve this challenge.

User views on SDF role

7.32 Volunteers expressed an interest in deeper involvement in the research process. To date, most analysis has been done by SDF staff. As volunteers get more experienced and are offered more opportunities for development, they could do more of that. They felt it might be good practice to aim for that as standard. They would also be interested in doing more running of groups and training others to do the research. They felt that ideally they would be self-sufficient, but with the structure of SDF providing support and respectability.

Conclusions

7.33

• SDF is recognised as a pioneer in UI work in the drugs sector and its experience in this area is regarded as a strength. The value of the peer evaluation model is recognised. At the same time, there is demand for more flexibility of approach.
• 'The Road to Recovery' strategy and recovery model set a new context for UI. There may be valuable lessons which can be applied from the role of users within the mental health recovery approach. Alcohol and Drug Partnerships will strengthen local accountability and are likely to require evidence of the involvement of service users from service providers, as well as input from users and carers at local level into planning and commissioning.
• User involvement at service level is a critical component in driving improvement in services and monitoring National Quality Standards. This presents an opportunity for SDF to build on its experience and expertise by supporting service providers to embed user feedback within service provision e.g. through training, facilitation and the development of toolkits.
• Academic research evidence suggests no single best practice model and the need for flexibility in approaches. Stakeholder feedback underlines the need to review the traditional SDFUI model and consider adopting a range of approaches.
• Some concern was expressed that 'peer research' is a misnomer and could undermine credibility in some quarters.
• It is recommended ( see Recommendation R3 , above, p.47) as a conclusion of the VFM assessment that SDF would benefit from a full review of its UI work. That recommendation is reinforced by stakeholder views on SDF's work with users and carers going forward.

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