An essential resource for students, this bestselling textbook includes the latest research findings and contains more tools, frameworks and international examples of best practice to aid practitioners to more effectively evaluate partnerships.
Evaluation is often considered to be a rather specialist and technical term, but we all engage in evaluation activities on a daily basis. At its most basic level evaluation may be considered the ‘process of determining the merit, worth or value of something, or the product of that process’ (Scriven, 1991, p 139). In deciding what car or cornflakes to buy we are making a comparative judgement about the worth or merit of the different cars or cornflakes available based on the information we have access to. Usually we are looking to get best value for the money we spend, or to find the product or service that is most suited to our needs and tastes.
We don’t only make judgements over the worth or merit of products and services that we are personally involved with purchasing, however. Whether it is reports of taxpayers’ money being ‘wasted’ through private-financed hospitals, large-scale procurements of computer systems for various public services, or re-branding services such as the Highways Agency, not a day goes by when there is not some report in the media over the alleged misuse of tax-funded services, organisations or products. The Tax Payers’ Alliance (2014) goes as far as to estimate that £120 billion of taxpayers’ money in the UK is ‘wasted’ annually – at least in terms of their evaluation. In a context of austerity and dramatic reductions to public spending budgets, if correct, this is a significant amount of money. Yet such conclusions are derived on the basis of a series of judgements and assumptions about the way the world is and should be.
In Chapter 1 we outlined the key contours of the discussions and debates around issues of outcomes and evaluation in health and social care, with particular reference to the challenges posed in the context of collaborative working. This chapter examines the evidence to draw lessons around issues such as the challenges in evaluating collaborative working; what the theoretical literature suggests collaboration should achieve; what collaboration has been demonstrated to achieve in practice; and the importance of clarity over drivers and outcomes. The key message of this chapter is that although individuals and groups often assume that collaboration is a common-sense response to a particular challenge or set of issues, the literature suggests that collaboration is driven by a variety of different imperatives. The lack of evidence of the link between collaborative practice and improved user outcomes may be partly due to the fact that individuals and groups are not always as clear as they might be in terms of what they are aiming to achieve through collaborative working. This lack of clarity can pose difficulties both in terms of achieving these aims in a practical sense, and being able to evidence these aspirations. Given this key message, it is perhaps fitting that we start by reflecting on the concept of collaboration, and what it is that is meant by it.
Although collaboration seems like a relatively straightforward idea, it can be used to refer to a whole variety of different sorts of interactions. It generally denotes some sort of working relationship between two or more individuals or organisations, but beyond this there are a whole range of ways that these relationships may vary in terms of what links partners, why they are working together, how strong their bonds are, what form their relationship takes and to what ends.
This chapter explores a series of tensions around the evaluation of health and social care collaboration in more detail, focusing on some specific areas of debate within the literature, including:
How can collaboration be effectively evaluated?
What kinds of evidence about integration might we present to different groups?
Performing governance: what is the additional work of collaboration?
In Chapter 2 we argued that evaluating collaboration can be a difficult process. Gomez-Bonnet and Thomas (2015, p 28) explain that ‘methods to evaluate partnerships have … proliferated, but tend to focus only on particular aspects of partnerships. None alone provide a comprehensive picture of how a partnership is working.’ In this section we explore some of the different approaches that have been used to evaluate collaborative working, and the appropriateness of these to particular purposes and settings. This section provides background in terms of methodology and philosophy of evaluation to consider the frameworks and tools that will be set out in the following chapter. We start by setting out the methodology adopted in the Sure Start programme that we have already spoken about in the previous two chapters (see Box 3.1). As this illustrates, the Sure Start evaluation was composed of different components, each devised to analyse different issues. For each of these components it was decided what was under investigation and which approach would be most suited to uncovering these factors. As this demonstrates, approaches were formative and summative, quantitative and qualitative, and the various components of the national study were used to reinforce and inform other strands.
Drawing on the problems and the issues outlined in previous chapters, this chapter outlines a number of useful theoretical frameworks, tools and concepts to aid readers in understanding these issues in more depth, and to become better equipped to evaluate collaboration in health and social care. Although the complexities and challenges of evaluating collaborative working have been emphasised at a number of points throughout this text, in a number of ways evaluating collaborative working is no more challenging than other complex policy programmes or initiatives tend to be. In this respect, there are many resources available that may be drawn on when attempting to evaluate collaborative working. Those that seem to hold most salience for the context of health and social care have been outlined here, along with an indication of the conditions in which these will likely be most productive.
As we have also sought to reinforce throughout this text, one of the most important things to consider when seeking to evaluate collaborative working is to be clear about what you want to evaluate, what is of less importance, what resources you have available and within which timescales. If you are clear about these aspects from the start of the evaluation process, the likelihood is that you will be better equipped in approaching your project. The chapter finishes by setting out a framework that can help in identifying evaluation challenges and advice about how you might overcome these.
If we are seeking to compare different collaborative working arrangements to one another, and we know that collaboration may take many different forms, it may be helpful to classify collaborative arrangements in some way.
Drawing on the questions, summaries and frameworks set out in this book, there are a series of practical recommendations and potential warnings that arise, for both policy and practice.
Given that collaboration takes so many different forms and is driven by different goals, they cannot be expected to deliver the same outcomes. More research is required to establish what kinds of collaborative arrangements can produce which kinds of outcomes, for which kinds of service users, when, and how?
Central government needs to be clearer about what it reasonably expects collaborative working to deliver, and under which circumstances collaborations are appropriate and, importantly, when they are not.
Political timescales and evaluation timescales are often incompatible. When commissioning evaluations of collaborative working, this needs to be carefully considered.
Service users are not homogeneous groups, and individuals (particularly those with complex or challenging needs) require specific support. More closely involving individuals in determining the nature of their own care may produce positive impacts, in terms of both service effectiveness and efficiency. This can produce different ways of joining up services and empowering individuals to achieve better outcomes, and is worthy of further exploration of its usefulness beyond social care. It can also create new demands for evidence of performance.
Although various structural, legal and technical fixes have aided the formation of health and social care partnerships to a certain extent, what local organisations and front-line services also need is more detail on how they might actually go about producing better collaborative working, and what this would entail.