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Measurable Outcomes

January 1, 2016

Yesterday, I read a post from a parent who had been told by her LA that her personal budget expenditure would be audited to ensure the measurable outcomes of the Care plan had been achieved.

Why do learning disabled people always have to be working towards an outcome? Why do learning disabled people’s lives have to be in a permanent state of being measured? Why do learning disabled people have to succumb to professionals deciding whether they’ve achieved something?

I replied to the post, stating that one of Steven’s self set goals for yesterday was to watch Toy Story 2. At 8.30 last night he achieved that outcome thanks to BBC3 and thoroughly enjoyed himself. The outcome was measured by the number of times he wiped tears of laughter from his eyes.

Anyway, it’s 2016. I thought I ought to set myself some resolutions. Sorry, measurable outcomes. In a gesture of solidarity, I will be seeing my Care Planner, to draw up my own compendium of outcomes.

Firstly, thanks to personalisation and being a recipient of a personal budget, I am now an employer. It’s not something I ever aspired to as an outcome of my life but heigh-ho – you need care support, you have to become a company director. For 2016, I am going to take a leaf out of Vodaphone and Gary Barlow’s book and instead of paying the PAYE monthly, I will make a donation to HMRC. When I’ve got the time. When there’s nothing on the telly.

Secondly, I’m going to follow the NHS’s lead and pretend I’m a charity and go for the 2016 Christmas Number One. I think I’m on to a winner personally. I’ve written the moving first verse already:

“Change is changing.

Exnovation is Exnovating.

Leader love is leading.

A wank is wanking”.

Thirdly, I’m going to write on my underpants a lot more than I did in 2015. Each Thursday morning, I will arise and scribble a few motivational words on my boxers. I’ve started already. Today, my y-fronts carry the message, ” Catch those apples”. The beauty of this outcome is that it is easily measurable. Whenever, my personal budget is due to be audited, I can take my laundry basket to the Civic Centre and let the Direct Payment manager have a rummage through my smalls.

Finally, as all good care plans have an emphasis on independence skills, I will be writing my own care plan. Once again, it is easily measured as all professional care planners will be an extinct species by May.

I might be pushing my luck but I wouldn’t mind a few other outcomes this year:

  • Justice for LB
  • LBBill becomes law
  • Someone, somewhere takes the Mazars report seriously.
  • Southern Health crash their flotilla into The harbour at Cowes.
  • Learning disabled people are recognised as human beings.
  • ATUs become an historical artefact.
  • Leeds United make the play offs.
  • Darts reform.
  • Julian Fellowes writes the screenplay for Camberwick Green, the Movie.
  • Our Norwich holiday turns out as wonderful as Torquay.
  • Steven and I laugh as much as we did in 2015.

Not much to ask for.

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From → Social Care

14 Comments
  1. It’s not the outcomes themselves that I object to – I mean we all want to see that public money is being spent on achieving what it’s supposed to be doing. What I object to is having outcomes foisted on me that are stuff all to do with the actual objective of the funding.

    If a direct payment is meant to enable someone to ‘lead an ordinary life’ then the outputs in terms of access to leisure opportunities are things like ‘going swimming’; ‘cooking a meal for Mum with the support worker’; ‘taking the dog for a walk with a non-family member’; ‘going indoor skydiving’ ‘going Go-Karting’ because the outcomes from all of those are things like ‘having fun’ ‘enjoying himself’ ‘having experiences of competence and success’.

    I’m ok with that and it doesn’t need to be any more complicated than that in my book. My problem is when the LA insist on me showing how xyz activity will ‘promote my son’s independence’ or ‘enable him to learn life skills’ and subsequent to that, insisting on how I will show that independence and life skills crappity crap crap will increase over time.

    Did the LA have to show such these kinds of outcomes when it provided day care services? No….so neither do we, would be part of the case I would make.

    The DP statutory guidance (with thanks to Steve (underpants on over trousers) Broach for giving me the link) says a few things about what DPs are for, which I am going to use to challenge my LA’s assertion that I should be including outcomes other than the ‘having fun’ ones.
    I include these below in case this info is helpful to anyone else:

    121. Parents should be encouraged and supported to use direct payments with a view to enabling their disabled children to access the same kinds of opportunities and activities as their non-disabled peers.

    63. Councils may set reasonable conditions on the direct payment, but need to bear in mind when
    doing so that the aim of a direct payment is to give people more choice and control over the services they are assessed as needing…….Conditions should be proportionate and no more extensive, in terms or number, than is reasonably necessary. Councils should avoid setting up disproportionately intensive monitoring procedures.

    14. Where a child is assessed as needing services under section 17 of the 1989 Act, the local council also has to be satisfied that the direct payment will ‘safeguard and promote’ the welfare of the child for whom the service is needed.

    Let’s make 2016 the year of collective challenge. Use the law to push back folks!!

    • nic permalink

      yes totally agree, use the law. Push back at overly prescriptive LA’s for the good of everyone and keep asking for light touch auditing, the LA should accommodate your request unless there is good reason not to. Evidence your spending as required but insist on the right to a private life,it is a right in law, be that an ordinary or extraordinary life. Refuse to be under constant surveillance and be ready to fight for your wellbeing being on the agenda . Use art /music or mime if anyone insists on evidencing the success of the budget end of year. Cut the crap and the delays for someone else if you know the path and don’t allow others to be signposted to shit creek if you visited that way yourself. Make a lot of noise for independent advocacy as a right and hold services to account for duty of care in 2016.

  2. Oh and let’s not forget that we need to measure these outcomes and provide evidence of whether they’re being achieved or not……my answer is to provide a Likert scale of smiley faces so my son can show the degree to which he enjoyed the activity.

  3. Sally permalink

    I agree. Of course anybody spending money on behalf of a learning disabled person should be required to have a record of how it is being spent,and to justify in what way it assists the LD person.. Of course we all want people with LD to be helped to learn what they are able to and have a sense of achievement blah blah. But the endless, meaningless, recording and justifying required of carers ! The idea, hovering unspoken, that the person with LD should /can be being educated to..be…less LD! And so require less financial support!
    Zoe T (above) put it beautifully. Why is it for parents to have to justify outcomes in detail when the day centres etc ,do not have to ?
    Around here ,of the pretty good day centres and organised activities, there now remain a couple of activities every three months, mostly consisting of sitting in a ball pool being ignored by bored 20 year olds. Hard to get an outcome out of that.
    i want to be able to let my son be and help him have the safest, happiest life he can have, not to be at him all the time trying to work on him.It is an inconvenient fact that learning disabled /autistic people often need help and protection thier entire lives. Why do I get the feeling services would like to somehow stamp this out?

    • From what I have seen in Sheffield, all day centres are now connected to ‘independent’/supported living provision, and often owned by independent living providers like Cambian and Dimensions.

      Therefore, there is a conflict of interest, if an LD/autistic, want to live at home, and decide what activities, they wish to engage in.

      It also means, that the quality/ purpose of these activities, particularly if, as is usual, they are provided mainly for the providers residential ‘clients’, is questionable, as is their purpose. As they are run by venture capital for profit, check who owns them.

      And, even were charitable, it is the same business ethos, just recycled to managers and sustainability.

      Day centres, independent of independent/supported living, are now becoming a thing of the past, on the excuse of cost cutting.

      So that the state can remove all LD/AUTISTIC to the unseen provision of private profit paid 3500-4000 per week of the disable and their families entitlement under the Chronically Sick and Disabled Act 1970.

  4. Lizzie D permalink

    How much are those bored 20 year olds being paid? (Probably not much, but more than any parent carer.) How much is paid to the person who dreamed up this outing as a good idea? The people who do the heavy handed supervising and accounting? Anybody interested in checking whether this is a good use of public money?

    My daughter detests organised outings, and turns very mulish at the idea of “Life Skills”. It is a bit of a problem, and I would love some help with it, but I have despaired of getting any. She WOULD like the idea of a private life, where, like non-disabled people, she gets to do what she DOES like. She isn’t going to be cooking me a meal anytime soon, with or without the help of a carer.. HER version of independence doesn’t have much in common with the approved version. She is happy, and keeping her that way at home costs a lot less than extreme misery in an ATU. Of course, the whole edifice rests on my unpaid labour – and a whole lot of anxiety about having to explain that those “outcomes” make very little sense.

  5. Parents are monitored it seems more closely than service providers, such as care homes and Supported Living packages to whom much larger sums of money are paid each week, but no proper outcomes measurement.
    For example, service users (especially those who cannot speak) are not always looked after well, or provided with personalised activities, or communicated with, or taken out often in the ‘community’, in Care homes. Sub-standard care there seems to be tolerated more, in comparison. Why?
    There should be person-centred outcomes as agreed, and recorded, as in my experience I’ve organised interesting and useful things for my son, but care homes have not attended half of them for no good reason. It has led to great frustration and stress just sitting around in his bedroom with nothing to do.
    If we don’t have outcomes measured, people are in danger of being neglected. Yes, we should choose outcomes, be led by the person, but there has to be some sort of checklist across the board for care providers as well as families.

    • This is why, the dedicated staff, who want to help the vulnerable, are leaving social care, if they can.

      All care in supported living, is prescribed, and the most cost effective.

      That is why USA venture capital, are buying into it, and new units are being built. It is a very lucrative industry.

      Cambian, last year bought up Lifeways, and immediately reduced the hourly rate of workers.

      Supported/independent living, and its community tick boxes, are just factories for profit with wonderful PR and websites.

      As they can be, as services are unseen and unchecked.

      Only overseen on a perfunctory tick box basis by Adult services managers, whose LA commissioned their services. So a huge conflict of interests exists.

      No one, has any rights, consumers are made captive by DOLs under MCA and incapacity assessments, or threat of them.

      If a parent manages, to keep their child from being removed for life, and, does get home support, it will be stressful, as they are spied on, and the Damocles Sword of removal is always hanging .

      If, as in Sheffield, the LA also deduct £77 per week from DLA, no matter how little the support.

      And, if parents need support- cleaning/ respite, they will have to undergo a very invasive carers assessment, which, may result in them being deemed unfit to care, and, even after such an assessment support is rare and discretionary. https://finolamoss.wordpress.com/2014/11/20/carers-act-2014-care-to-ensnare/

  6. Sally permalink

    My friend’s adult son is in supported accommodation. With her, he had a rich interesting life with a lot of excecise, gym visits outings and so on ,all local to their house and to the new accommodation.
    To nobody’s suprise from day one the staff have tried to:
    Ignore his agreed on activities
    Insist he “doesn’t want to do ” much loved routine activities usually by asking him in such a way or at such a time that he says no..or just not asking.
    Claiming the activities are too tiring..maybe a risk to his safety. (No equally interesting alternatives are proposed)
    Really, if at all possible, sit on their backsides and keep him indoors.
    She now shows up every morning and afternoon to outline his plan for the day, check which (resentful) staff members will be doing it and later check what has happened. It takes a lot of time. They don’t like her. But he gets out and about.
    My question is, why is it acceptable to the managers, and the executives for staff at any level to provide such poor service? To not do what they have agreed to do? To ,come to think of it, have not many tasks as such, no obligation to record what they do every day for the disabled person and to justify in what way it is helpful?
    I can’t think of any job at all in which I would be allowed to get away with doing as little as possible for my clients .To sit about indoors . I would expect a manager breathing down my neck asking what the hell I was doing with my time.

    • Shirley Buckley permalink

      This is absolutely spot as to what is happening in the community. With me, I have been side lined. My son is in Cardiff, I am in Solihull, and it is too far for me to travel to visit him. The staff in the home have been forbidden to communicate with me, Martin has been forbidden to tell me which staff are on duty, what he has had to eat, where he is going. He is only allowed home for 3-4 hours every six weeks All this is done under the Mental Capacity Act dols and best interests through the Court of Protection. The costs at the home are £2,4oo a week, and Martin contributes £80 a week from his benefits.

  7. tallguy permalink

    As a Local Government Officer (in Economic Development not social care) I often come across requirements for measurable outcomes and so called “Key Performance Indicators,” and in fact impose them on others. I have lost count of the number of times I have written “will not have a measurable outcome” when rejecting a proposal.

    The key when doing this though is to have a clear picture of what the outcome you want is, and also an understanding that not all outcomes can be measured. However most important is to understand that an activity is not an outcome.

    For example a person asks for funding to run a training course for the unemployed and socially excluded might tell me their outcome is that 100 people will undertake the course. Its easily measurable. But is it an outcome? Not really, its an activity.

    The outcome would be the number of people who get a job who would not have got a job without a course.

    Simple? I spend a shocking amount of my life nearly crying into my keyboard that this is a concept that people won’t understand. Sometimes quite senior people who are not willing to look beyond simply counting activities to measure an impact.

  8. weary mother permalink

    There are serious points being made here around how outcomes, in professions where the role is mainly behaviourally based, and tangible measurable outcomes are hard to find. Social work is one such profession. Social workers can get very twitch when their effectiveness is measure.

    It could be that this is why the copout is to be an inquisitor of families and vulnerable people.

    Years ago I was employed in some early research into case management, now called care management.

    I met a number of SW’s and care assistants working in community and in day services, who were totally happy to apply an annual assessment of pretty punitive questions to vulnerable clients (who dreaded these assessments) focused on what they did wrongly or badly this year. The assessment appeared to be a one way lecture on failure to meet rules set by the worker; on questions that had little to do with improving or far less understanding what quality of service (or life) meant for the service user.

    I asked the SW’s to apply questions to themselves and their role including (approx), ‘What is your role in relation to the people you serve’ ‘, ‘what did you do well (or less well), ‘what do you do to help you understand your service user as an individual. (Behavioural examples, please) What did you do you do to improve what you do for the people you serve’. (examples please ) What does your client/patient etc…..(customer)……think you are paid to do for them’. ‘ How often do you ask him/her’…how do you do this? . ‘What have you done to increase your own understanding and behaviour,…..that could improve the lives of the people you work for’. ‘Is your ‘client’ your peer’. Examples please

    Guess what…..not happy bunnies at all.

    They were some glorious exceptions where people hoped this process (or a similar one) could be applied to their role. But most stated very huffily that their performance is/was measured by their professional lead/manager. I heard the same offended (often outraged) response across the professions. The very idea that users of their (tax paid for) services could be involved in designing the outcomes for their appraisal, was quite horrifyingly insulting.

    Ruffled feathers all around. At this time, some 20 or more years ago, the most offensive ‘C’ word heard in LA/NHS Service,, was not four lettered, it had and still has……. 8 letters,…….CUSTOMER.

    Me thinks not much has changed?

    • As you say, and its now much, much worse, the only performance, that is assessed, is the service user, and, the parents, both of whom, are owed a statutory duty from the professionals, and the support workers, and are paying for the service, either directly through tax, or, indirectly through, what they entitled to claim under the Chronically Sick and Disabled Act.

      These outcomes, are rewarded , no doubt, by promotions and unseen bonuses, and are to assess family carers unfit to care, private corporate supported living provision adequate, and support/ nursing care sufficient. And ensure all are placed, away from family, in effectively institutions of the state’s choice .

      All is assessed for these purposes only, even support staff, are now, assessing parents.

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