National health and wellbeing outcomes framework

Annex A: Personal outcomes approach

The term 'outcome' is now in common usage in health and social care, reflecting a commitment to ensure systems support people using services and unpaid carers in ways that are person centred and effective.

Outcomes are defined as what matters to people using services, as well as the end result or impact of activities, and can be used to both determined and evaluate activity. Personal outcomes are identified through good conversations with people using services during assessment and support planning. It is also critical that the outcomes are reviewed, to ensure the continued relevance of support and services, and to support service planning, commissioning and improvement.

In line with Christie (2011)^[16], a personal outcomes approach supports sustainability by moving the focus away from service led approaches. This requires supporting people to make the move from viewing the delivery of service as the endpoint, to focusing on the purpose of engagement and activity with individuals. When the starting point is clarifying purpose (outcomes), the next stage is identifying how those outcomes might be achieved. This includes considering the role of the person and other resources in their lives, as well as services, consistent with an enabling culture.

There are a number of personal outcome approaches used across Scotland, however, they all have shared elements including the importance of focusing on both quality of life outcomes, which prevent deterioration and delay dependency, and change outcomes, more commonly associated with recovery and rehabilitation. Equally important are the process outcomes; the relationship between people using support or services, carers and paid staff. These outcomes all chime well with both the principles of the Act and the national health and wellbeing outcomes.

Through engagement at assessment and review, a personal outcomes approach ensures that care and support are appropriate and effective, avoiding service use that does not make the difference required.

Whilst significant work has been undertaken, it is recognised that there still much to be done to fully embed a personal outcomes approach across Scotland. A key message from embedding outcomes is that, consistent with other programmes seeking to effect culture change, this is a long term game, with the concept of the journey invoked frequently (Petch 2012)^[17].

Many organisations have identified that embedding outcomes requires support to frontline practice and strong leadership. The Joint Improvement Team supports the development and implementation of the Talking Points Personal Outcomes approach.^[18]

Personal outcomes matter to individual people who use health and social care or support services; but they can also inform the teams, organisations and partnerships providing these services about their impact. People working at each level of a health and social care system will want to know about their effectiveness, and this can best be judged by understanding how personal outcome are being achieved for individuals.

The table below sets out an example of how individual personal outcomes might feed up and link to outcomes for services, organisations, partnerships - or indeed for Scotland as a whole.

From personal to national outcomes

Source: adapted from Cook and Miller (2012) Talking Points POA practical guide, JIT: Edinburgh Talking Points: Personal Outcomes Approach, JIT June 2012

Many systems for capturing information about the performance of health and social care systems exist already in Scotland. Some of these have been developed in isolation, and work is underway to bring them together to reflect the Integration of health and social care, and wider partnership working. The schematic below aims to show how local and national systems can help to underpin a focus on improving outcomes for individuals - by improving systems and processes with that ultimate goal always in mind.

SOA = Single Outcome Agreement
H&W = Health and Wellbeing