The need for robust evaluation of complex care initiatives is increasingly recognised as an essential element in managing major organisational and system changes in healthcare. The NHS is encouraging more innovation in the models of health and social care delivery to improve the quality of care, outcomes and reduce costs. Initiatives such as the integrated care pioneers, Better Care Fund and recently announced ‘vanguard’ areas as set out in the Five Year Forward View, have all been implemented with recognition of the importance of evaluation and disseminated learning.
In practice, there is no shortage of ideas for how to design and manage better services, but there is a shortage of reliable evidence about which of these ideas makes progress towards the desired outcomes. When it comes to disseminating learning, the generalisability of findings cannot be taken for granted. It is often difficult to understand which initiatives are transferable beyond the local population and context.
Many recurrent themes need to be taken into consideration by commissioners or providers of new care models when undertaking evaluations including:
- The new models of care implemented are subject to change
- The need to consider a range of legitimate outcomes
- It may take a long time to be able to identify a change in outcome
- The need to include a statement of returns on investment
- Scaling studies such that evaluations that are large enough to show significant change
- Mixing evaluation methods to capture quantitative analysis, patient and staff experience, and factors influencing change
The Nuffield Trust’s one day national conference on evaluation explored these issues, bringing together a range of relevant groups to discuss and explore the application of more robust evaluative methods to the complex care setting focusing on three key areas:
- Evaluation – national policy and direction
- Examples of evaluative approaches in practice
- Key methods and tools for robust evaluation
This event builds on several years of conferences on predictive risk, which have included different approaches for evaluating new services.