Evidence matters

The Think Local, Act Personal partnership supports a national network of activists, practitioners and leaders who are engaged in building communities, which I chair. We have done lots of thinking about how we demonstrate that the many incredible initiatives in the network do what they claim to do. At today’s seminar in Manchester, for instance, we heard from Debs who talked about Creative Minds helped her swap pills for paints, after a lifetime inside a mental health system where people with power had reinforced her view of herself as someone who would always be ill, never in work and always in need of significant support and medication. She is now an accomplished speaker, professional artist and change maker. Her daughters, who had been her carers, have both now won places at University. She has now had several years without medication or NHS support and no longer needs to claim benefits.

Some impacts of Debs’ interaction with Creative Minds can be counted: the cost of her medication alone, let alone hospital stays, welfare benefits and unsuccessful support packages far outweighed the cost of her Creative Minds support. But could you measure her impact upon the audiences she talks to, the training sessions she delivers, and the benefits to her daughters and the community? Are stories, however powerful, even considered to be evidence? The difference between medicine A and medicine B may be possible to isolate and measure, but what about the difference a single support intervention makes to someone’s life, given how messy and complex all our lives are?

We have been developing ideas in response to these questions, such as those in our report in response to the government’s assessment of the evidence for personal budgets. With a Green Paper on the way, we wanted to develop some more actions for Think Local, Act Personal, its members and the wider system. Here are some we came up with today:

1. Think Local, Act Personal (in liaison with SCIE’s Prevention Library) is using the Six Innovations format to gather one page examples of community-orientated interventions, which we will put into a catalogue to help commissioners and others understand some of the many approaches out there and how to makes choices between them. If you want to submit your initiative or organisation’s work, please contact Think Local, Act Personal.
2. Measuring the impact of complex service systems is almost impossible using traditional methods. But in Engaging and Empowering Communities, we and all the main health and care bodies agreed that, whilst there is endless variety in our sector, all of us are aiming for a small set of shared outcomes for people, which include (in Prof Jane South’s formulation), people being in control and more connected to each other, and greater equity. We will explore the possibility of making measures for those universal outcomes available to any organisation, so that data on them could potentially be collected about large numbers of people.
3. TLAP Chair, Clenton Farquharson made a powerful point: if we accept something as a basic tenet of a decent society, we stop demanding evidence for it. Few people in health and care would ask if there is evidence for the idea of providing support with dignity for instance. So if it were accepted across the system that connectedness, being in control and equity are the universal values they appear to be, would the question of evidence feel less of an excuse not to pursue them?
4. There are one or two places which are doing lots of community-orientated or asset-based approaches, such as Wigan, Thurrock and Leeds. Does this offer the opportunity to observe and evaluate something approaching whole-system change? Some of us are already working with Thurrock and Birmingham University to consider its programme of work. Today we heard more about the whole-system approach being taken by the Greater Manchester city region. Do you know of other areas out there which are taking a whole system approach?

During the engagement process for the government-backed Joint Review of how voluntary, community and social enterprise (VCSE) organisations work in the health and care system, we heard about double standards on evidence. Anything new, or not considered ‘core business’ tended to be challenged to demonstrate hard outcomes such as reduced hospital admissions. There are large swathes of the NHS and council services which cannot demonstrate they are achieving that: just look at the winter beds crisis. Furthermore, a lack of evidence would often be quoted as a reason not to commission the VCSE sector, but producing evidence was no guarantee that scarce resources would be shifted from existing services to even highly effective VCSE alternatives.

Behind the evidence gap lies a values gap: the chasm that can open up between what our service systems value and will pay for, and what people themselves most value. I don’t believe that current commissioning teams and system leaders are capable of bridging that gap. Only people who use services, their families and front line workers, given a real share of the power and responsibility to shape systems and deploy scarce resources, will be able to do that.