3.10 The challenges of an outcomes-based approach
This section has described the steady shift towards outcomes-based approaches in social care, health and other services in Scotland. But what challenges are associated with these changes? The next activity is an opportunity to reflect on what you've been learning about in this section and to think about what may lie ahead.
Activity 3.10: Challenges ahead?
Take some time to review your learning and, if you have been recording your reflections, the notes you have made in your learning log .
Make a list of the challenges in focusing on outcomes and write some notes about how you think these challenges might be addressed.
There are a number of challenges you may have identified. Some of these may be about practitioners changing ways of working, and others about questions and conflicts that may arise when deciding about outcomes. For example, our critical readers for this course identified questions about:
- conflicts that may arise if children or adults are at risk of harm
- differences of opinions about outcomes that might arise between, say, carers and service users; parents and children; service providers and service users
- how outcomes can be agreed when people may not be able to speak for themselves, e.g. they are very young, or lack capacity because of dementia or a head injury.
There are no easy answers to these questions, but, as this section has suggested, practitioners will need to be knowledgeable about their role and their legal powers and duties, skilful in enabling resolution of different opinions and clear about the values that underlie personalisation. This has implications for practitioner training and support and is likely to require continuing change in organisational cultures as they adapt to changing law and policy.
Another important question raised by our critical readers was about resources – is it unrealistic to encourage citizens to decide on their own outcomes in times of cutbacks to public services? Will this not just 'break the bank' and make it harder to support those people in greatest need? Simon Duffy argues that one of the attractions of personalisation to policy-makers has been its very ability to deliver better outcomes for less. He suggests that:
Primarily this efficiency occurs both because people can better determine what really matters to them and also because they can then use all their available resources – not just services – to meet their needs. Put simply, it’s more efficient to treat people like citizens, than as service users
Duffy argues, however, that much of this apparent efficiency is 'untapped' because of pressures to limit eligibility and to 'move' citizens through over-burdened systems more rapidly in order to keep costs down. Following this logic, whilst an outcomes-based approach may appear to be a costly threat to efficiency and resources, it may be that the opposite is true – that an outcomes-based approach may ultimately be not only better for citizens but also less demanding of the public purse than a needs-based approach. This once again reinforces the importance of evaluating the impact of outcomes-based approaches in health, social care and other services.