Putting service users at the heart of the Supporting People programme
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Service user involvement is central to current government policy (Communities In Control White Paper, 2008) and has always been a major strength of supported housing. Now, the 2009 Supporting People Quality Assessment Framework (QAF) reaffirms the sector’s commitment, requiring evidence for meaningful service user involvement to achieve level C, while level A means that service users will be contributing to future strategy. In a further development, Sitra has been commissioned by Communities and Local Government (CLG) to assess both potential and existing models for cost benefit analysis of service user involvement. The study builds on previous work completed by COMPAS@TPAS.
A literature review
In order to assess whether there is an existing analysis tool, adequate for evaluation of service user involvement, we started by reviewing literature surrounding cost benefit approaches in the social and health policy sector. Health economics provides the clearest system concerning kinds of cost benefit analysis, demonstrating the various methods which can be used. Cost benefit analysis can look at saved costs, use of other resources, outcomes, actual expenditure and finally the impact of different interventions. In terms of supported housing, there have been a few cost benefit tools aimed at supported housing generally, including the benefits realisation model developed by Cap Gemini (2008) and the Space East (July 2007) regional work.
The literature on service user involvement mainly focuses on how to involve residents, and costing the activities directly related to this. For example, the cost of employing a service user involvement officer. In terms of gauging the benefits, the Housing Corporation developed an impact assessment tool for resident involvement (2007). The Audit Commission have also produced a good practice paper (2004). Both of these publications provided a good starting point. However, they are very general needs specific and would need to be widened to focus on supported housing.
In terms of the tie in between service user involvement and funding for supported housing, some tender documents were reviewed. They did not show any specific monetary relationship, although sound approaches to involvement often scored points in the overall bidding process. With the introduction of the Client Involvement objective in the new QAF, this may be an area for commissioners to look again at. A closer link to funding would promote client involvement and, despite what we found in the formal tender documentation, some Supporting People teams are explicitly funding involvement officers.
The literature review also looked at other social policy areas. To put it in a nutshell, it appears that: “….at the end of participation, there is a tendency to look at what users have gained personally from their experience in getting involved – that is fine, but we must also look at the change achieved”.
The primary research
The literature review provided a basis to carry out the primary research. We had already formulated a number of questions:
• Were there any existing models of service user involvement available in housing with support?
• What are the benefits of service user involvement?
• How can these benefits be measured?
• What costs can be attributed to service user involvement?
• What are the dangers/concerns of creating a model of measuring the costs and benefits of service user involvement?
All 802 Sitra members and 150 Supporting People teams were contacted by email to see whether they knew of any models of service user involvement and if they were interested in taking part in the research. In total 54 (34 members and 20 Supporting People teams) responded to our query stating that they wanted to engage. Three focus groups were carried out in February 2009, and those who could not attend were sent a questionnaire.
What is service user involvement?
It is clear that service user involvement can be defined in a variety of ways. The new QAF splits service user involvement into the following levels: client (level C), service (level B) and organisation and community (level A). The responses from the focus groups and the questionnaires also followed this system. For many, service user involvement was so integral to their organisation, it could not easily be separated out, while for others it sat in very specific places. Every respondent noted that client outcomes were the most important element.
What are the benefits of user involvement?
By looking at what organisations define as the benefit of user involvement, it is possible to start thinking about how it can be measured.
Client level benefit:
Increased confidence, self esteem and client outcomes.
Service level benefit:
Improvements in service delivery and processes.
Housing management improvements, for example, reduction in anti social behaviour (ASB) incidents.
Organisation level benefit:
Complying with the requirements of the QAF and Care Standards Improvements in the strategic direction of the organisation
Community level benefit:
Long term benefits of clients impact on the community.
Reduction of ‘revolving doors’.
From the benefits identified, respondents were asked how these could be measured and assessed. Measurements of user involvement were found to be as follows:
• improvements in processes
• employing ex-service users
• improvements in housing management
• satisfaction levels
• influencing commissioning and contracting
• improvements in client outcomes
• budget savings.
All of the above could, in principle, be quantified and reported on. However, client outcomes were seen as problematic, as proving a causal link between involvement and a particular outcome is very difficult. Demonstration of cost savings was seen as key part of client involvement. This is demonstrated through changes in processes which result from it. However, the focus groups reported that there was a need for long time periods to properly look at this impact.
In regards to costings, it was recognised that some activities could have specific amounts attributed, such as staff time, staff costs, and costs of activities. However, a number of organisations commented that service user involvement was part of the ‘ethos’ of the organisation and demonstrating exact costs would be very difficult.
However, demonstrating the value of service user involvement allows services to evidence their value, take stock of what is effective and assess what is possible.
In terms of the differences between services and client groups, the variations noted were not as wide as expected. Essentially, the tools for involvement did not differ among client groups, while all respondents noted that client involvement should be approached in terms of what is appropriate for the individual. This recognises that there are different levels at which people wish to be involved. Any model needs to recognise these differences and account for them.
Next steps
Sitra has now presented the findings of the initial research to the CLG. Work is also under way in looking for best practice examples. A summary of the full report will be available in the late Spring.
If you are interested in the above work please email sitrahelpline@sitra.org
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