Health and work support pilot: interim evaluation report

4. Discussion

4.1 Summary of Findings

A pilot is an opportunity to test and learn, and based on the stakeholder consultations, the Health & Work Support pilot is achieving this goal. The pilot was launched over a short space of time and this has resulted in challenges throughout the service. While many of the frustrations of the first few months of implementation still remain, it is important to note that steps have been taken wherever possible to overcome challenges and improve the service.

There are ongoing concerns about the pilot not reaching its targets and while early analysis suggests improvements to the number of individuals accessing support as compared to pre-existing services this will need to be explored in more detail in subsequent phases of the evaluation. It is likely that access routes, service awareness and marketing play a part in the pilot’s struggle to reach its targets, and this means that it is a priority to undertake a careful disaggregation of the different markets and client groups and develop appropriate engagement approaches.

It also seems possible that the existing targets for the pilot are not realistically achievable in light of available staff capacity. There is evidence that clients who are already coming through the system are seeing delays in getting access to a physiotherapist or a counsellor as a result of increases in referral numbers. If the service continues to grow towards its target numbers it is conceivable that clients will be in the service longer that 20 weeks because of the wait time between appointments. This will consequently have a knock on effect on the service’s capacity to continue to engage in marketing work as well as to conduct assessments for new clients.

There is a question about how effective this service will be given that one of its central appeals to referrers and clients appears to be based on its ability to circumvent long waiting lists for mainstream health services. Although wait times in the pilot are considerably less than the general NHS is experiencing, the pilot needs to consider whether it is still worth developing this model on a national scale, or to invest this time, money, and lessons learned into mainstream NHS services.

There appears to be scope to explore the current match between demand (which is lower than expected) and the level of resources that were put into place. Already these resources appear to be stretched to the extent that staff feel that the levels of demand are threatening service quality. This is an area that requires further exploration, including an assessment of realistic workload levels and the scope to manage service delivery more efficiently, drawing on the different experience and structures in the two pilot areas.

4.2 Lessons Learned and Next Steps

A number of key findings were highlighted in the executive summary section of this report, some of which have been individually highlighted below as next steps (4.2.1 to 4.2.4). These have been selected because they are deemed to be priority areas for action.

The remaining key findings are largely contingent on additional analysis during future phases of the evaluation – these have therefore been combined into the final next step (4.2.5).

4.2.1 Although the pilot has implemented a ‘single gateway’ model, further consideration needs to be given to streamlining the “back-office” functions of the pilot.

Implication for the pilot: there should be a review of the contact handling process in order to streamline the service and mitigate the risk of client disengagement.

Implications for future service provision: at the national level the current structure of services may need to be reviewed in the context of wider health and work approaches.

4.2.2 There are issues around data gathering across the service.

Implication for the pilot: There should be a discussion with delivery staff about what constitutes positive outcomes for clients and how these outcomes can be recorded. Additionally, it will be important to ensure that the data recording system is revised to ensure that it is fit for purpose.

Implications for future service provision: any future provision of services will need to prioritise development of robust data recording systems. This should be accompanied by early training and support to ensure that the staff are appropriately trained.

4.2.3 The number of clients presenting with complex needs has been higher than expected thereby creating additional demands on pilot staff.

Implication for the pilot: Consideration should be given to the suitability of the current target given both the higher level of need which clients are presenting with as well as available staff capacity. This will require further information gathering and analysis to ensure that any changes made are evidence based.

Implications for future service provision: Any targets set for any potential future service should take into consideration the above noted difficulties. Moreover engagement with referrers, particularly GP’s, is required to ensure that there is clarity with regards to the kind of clients the service is designed to support.

4.2.4 Need for clarification of Case Manager Role

Implication for the pilot: More engagement is needed with Case Managers and others to clarify what the expectations are of the Case Manager role.

Implications for future service provision: Case Management based services have an unclear evidence base at present and as such any potential future service provision should take this into consideration. Appropriate steps may include conducting a formal literature review as well as using data from the pilot to critically develop an evidence base, where possible.

4.2.5 Need for follow up of additional learning points during following phases of the evaluation

A number of learning points were identified during the implementation review process for which there is currently not sufficient evidence to make robust recommendations. As such these areas require further exploration during future phases of the evaluation, details of which can be found in the table below.