Evidence, insight, or intuition? Investment decisions in the commissioning of prevention services for older people

Miller, Robin; Williams, Iestyn; Allen, Kerry; Glasby, Jon

doi:10.1179/1750168714y.0000000027

Cited by 12 publications

(17 citation statements)

References 13 publications

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“… 27 Despite these findings, the relative importance of information (or its absence) can be over-stated and may be skewed by the prevalence of its pre-selection as a variable for analysis. 26 , 27 , 30 Importantly, even in these studies information is invariably found to vie for primacy with other contextual drivers and influences. 28 , 30 , 38 …”

Section: Resultsmentioning

confidence: 97%

“…An area of relative strength in the published evidence is enquiry into the factors influencing coverage and commissioning decisions in healthcare systems. 27 - 30 The factors influencing these allocative decisions have therefore been more consistently explored than factors affecting technical decision. The greater variety in technical decision-making makes it difficult to draw definitive conclusions regarding the influence of contextual factors.…”

Section: Resultsmentioning

confidence: 99%

“…Such evidence as exists suggests that decision-makers consult a range of information sources incorporating both explicit and tacit knowledge. 30 , 45 These sources include professional journals, legal advisors, the media and the experiential information provided by other decision-makers, as well as advice from specialists. The relative importance attached to each source varies according to decision-maker characteristics such as age, occupation and education levels, as well the nature of the decisions themselves.…”

Section: Resultsmentioning

confidence: 99%

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Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis

Williams

Brown

Healy³

2018

Int J Health Policy Manag

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Background: Decisions affecting cost and quality are taken across health and care but investigation of the mediating role of context in these is in its infancy. This paper presents a synthesis of the evidence on the contextual factors that influence ‘decisions of value’ – defined as those characterised by having a significant and demonstrable impact on both quality and resources – in health and care. The review considers the full range of resource/quality decisions and synthesises knowledge on the contextual drivers of these. Methods: The method involved structured evidence review and narrative synthesis. Literature was identified through searches of electronic databases (HMIC, Medline, Embase, CINAHL, NHS Evidence, Cochrane, Web of Knowledge, ABI Inform/Proquest), journal and bibliography hand-searching and snowball searching using citation analysis. Structured data extraction was performed drawing out descriptive information and content against review aims and questions. Data synthesis followed a thematic approach in accordance with the varied nature of the retrieved literature. Results: Twenty-one literature items reporting 14 research studies and seven literature reviews met the inclusion criteria. The review shows that in health and care contexts, research into decisions of value in health and care is in its infancy and contains wide variation in approach and remit. The evidence is drawn from a range of service and country settings and this reduces generalisability or transferability of findings. An area of relative strength in the published evidence is inquiry into factors influencing coverage and commissioning decisions in health care systems. Allocative decisions have therefore been more consistently researched than technical decisions. We use Pettigrew’s (1985) distinction between inner and outer context to structure analysis of the range of factors reported as being influential. These include: evidence/information, organisational culture and governance regimes, and; economic and political conditions. Conclusion: Decisions of value in health and care are subject to range of intersecting influences that often lead to a departure from narrow notions of rational decision-making. Future research should pay greater attention to the relatively under-explored area of technical, as opposed to allocative, decision-making.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis

Williams

Brown

Healy³

2018

Int J Health Policy Manag

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“…Here, there are clear dividing lines between the approach to revenue generation and allocation in social care – which is complex and highly individualised – and in health care where tax revenues are often allocated on a population basis (Miller et al. ; Williams et al. ).…”

Section: Personalisation and The Nhsmentioning

confidence: 99%

Going It Alone or Playing to the Crowd? A Critique of Individual Budgets and the Personalisation of Health Care in the English National Health Service

Williams

Dickinson

2015

Aust J Public Adm

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The introduction of individual budgets into English health care is a recent example of the pervasive drive towards personalisation in welfare sector organisation and delivery. As a heavily centralised and highly bureaucratic institution, the National Health Service (NHS) is an obvious target for personalisation. On the other hand, as a symbol of solidarity and nationhood it retains a powerful place within the collective psyche, such that radical reform might expect to encounter resistance. This paper analyses the assumptions that are inherent in personalisation and raises concerns over its ability to transform health-care services. At the heart of these concerns is the tension between appeals to tailored service provision and empowerment on the one hand, and promotion of a strong social contract, public trust in institutions, and collective identity on the other. Lessons are drawn for personalisation in other sectors and settings.

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“…Many day centres, particularly those offering low-level support, have closed or been decommissioned [2], despite evidence that some older people would like to attend them. [3] However, about 59,000 older people using local authority provided or commissioned community services attend day centres. [4] Within this context of change and ongoing efforts to integrate health and social care, the future of day centres is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Day centres for older people: attender characteristics, access routes and outcomes of regular attendance. Finding of exploratory mixed methods case study research.

Orellana

Manthorpe

Tinker

2019

Preprint

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BACKGROUND Social prescribing is encouraged to promote well-being, reduce isolation and loneliness. Traditional, generalist day centres for older people could be suggested by social prescribing, but little is known about their clientele or their outcomes. As part of a larger study of the role, outcomes and commissioning of generalist English day centres for older people, the characteristics of attenders at four day centres, their reasons for attendance and outcomes were explored. METHODS This mixed-methods study used qualitative interviews and standardised tools within an embedded multiple-case study design. Semi-structured interviews with older day centre attenders (n=23, 62% of eligible attenders) of four day centres in south-east England, recruited purposively to reflect organisational differences, were analysed. RESULTS Participants reported non-elective withdrawal from socialisation following health or mobility decline, or losses. Apart from living arrangements and marital status, attenders’ profiles differed between centres. Access had been mostly facilitated by others. Day centre attendance enhanced quality of life for this group of socially isolated people with mobility restrictions and at risk of declining independence and wellbeing. The positive impact on attenders' social participation and involvement and on meaningful occupation was significant (p-value <0.001, 99% CI), with an average ASCOT gain score of 0.18. Nine outcome themes were identified, with a further theme of process outcomes. CONCLUSIONS Outcomes of day centre attendance are those targeted by social care and health policy. Centres were communities that ‘enabled’ and offset loss or isolation, thus supporting ageing in place through wellbeing and contributed something unique to their attenders’ lives. By monitoring attenders’ health and wellbeing and providing practical support, information and facilitating access to other services, centres offered added value. Attendance needs to be set in the context of other social engagement and care provision which may not overlap or duplicate centre support. Professionals may wish to explore the benefits of social prescriptions to day centres but should map local centres’ provision, engage with their organisers, and seek information on attenders, who may differ from those in this study. KEYWORDS: Day centres, Older people, Ageing, Frailty index, Social isolation, Social support, Group activity, Social prescription, Outcomes

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Evidence, insight, or intuition? Investment decisions in the commissioning of prevention services for older people

Cited by 12 publications

References 13 publications

Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis

Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis

Going It Alone or Playing to the Crowd? A Critique of Individual Budgets and the Personalisation of Health Care in the English National Health Service

Day centres for older people: attender characteristics, access routes and outcomes of regular attendance. Finding of exploratory mixed methods case study research.

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