Reshaping Care for Older People – The Lanarkshire Contribution Story Chapter 4

What was the issue you were addressing or working on?

Lanarkshire is using a Contribution Analysis (CA) approach (Mayne, 2012) to enable a conversation about the strength of evidence gathered from many disparate initiatives, all claiming to influence the outcomes agreed for Reshaping Care for Older People. The previous three chapters of the Story have evidenced contributions to the outcomes the programme aimed to achieve. The robustness of evidence has allowed focus to move to medium term outcomes. Hence this report is concerned only with the medium-term outcomes. It provides:

  • An overview of the evidence submitted against the six medium-term outcomes
  • A detailed review of contributions to the medium-term outcome of improvements in older people achieving their goals,
  • A detailed review of contributions to the medium-term outcome of releasing resources for reinvestment

What you did?

Evaluation meetings were held with most of the initiatives over the past six months to continue to build on the evidence presented in the 3rd chapter of the Contribution Story.  As this is the penultimate report, it was felt to be important to present evidence that would be useful to those making decisions about future service provision, particularly the integrated Health & Social Care Partnerships.

As with previous chapters of the Story, considerable evidence underpins the judgements presented for each initiative. The evidence is generally more robust than previously and is described, and two different approaches are taken to alternative mechanisms – firstly the focus is on possible mechanisms that may account for the changes observed, and secondly there is an exploration of possible alternative service providers, to inform judgements of value for money.

The evidence submitted was reviewed by the authors and where possible meetings were held jointly with project representatives. Each outcome was reviewed in turn to ensure all judgements were based on similar considerations, erring on the side of fairness where there was debate about evidence robustness. The output was then sense-checked with the North and South RCOP Programme Managers.


What were the outcomes - benefits or otherwise?

One part of the report has a particular focus on the avoidance of admission to hospital care and includes data for RCOP initiatives, based on rigorous evidence to September 2014.

The report also asks and answers the question of whether there any alternatives to the RCOP initiative to provide the service and whether these are more expensive.  It also contains a relatively basic cost analysis – cost (£s) per recipient for each RCOP initiative – to help inform discussions as the Change Fund comes to an end.

It also considers the implications for other projects or mainstream services that the RCOP initiatives have linked to and where interdependencies have been created, and describes the sharing of learning between North and South Lanarkshire partnerships.

The Full Report is available here

The final Contribution Story will be produced at the end of March 2015.

Further information on Chapter 1 is available here, Chapter 2 here and Chapter 3 here


Contacts - to find out more

Helen Alexander, Helen.alexander@lanarkshire.scot.nhs.uk  01355-593467/8

Marjorie McGinty, Programme Manager, Marjorie.mcginty@lanarkshire.scot.nhs.uk  07766504321