A study of outcomes measures in forensic mental health

Outcomes measures, which is the measurement of effectiveness of interventions and services has been propelled onto the health service agenda since the introduction of the internal market in the 1990s. It arose as a result of the escalating cost of inpatient care, the need to identify what interventions work and in what situations, and the desire for effective information by service users enabled by the consumerist agenda introduced by Working for Patients white paper. The research reported in this thesis is an assessment of the readiness of the forensic mental health service to measure outcomes of interventions. The research examines the type, prevalence and scope of use of outcomes measures, and further seeks a consensus of views of key stakeholders on the priority areas for future development. It discusses the theoretical basis for defining health and advocates the argument that the present focus on measuring effectiveness of care is misdirected without the input of users, particularly patients in their care, drawing together the views of the many stakeholders who have an interest in the provision of care in the service. The research further draws on the theory of structuration to demonstrate the degree to which a duality of action, which is necessary for the development, and use of outcomes measures is in place within the service. Consequently, it highlights some of the hurdles that need to be surmounted before effective measurement of health gain can be developed in the field of study. It concludes by advancing the view that outcomes research can enable practitioners to better understand the relationship between the illness of the patient and the efficacy of treatment. This understanding it is argued would contribute to improving dialogue between the health care practitioner and the patient, and further providing the information necessary for moving away from untested assumptions, which are numerous in the field about the superiority of one treatment approach over another.

Climate change performance measurement, control and accountability in English local areas

Purpose – This paper aims to consider how climate change performance is measured and accounted for within the performance framework for local authority areas in England adopted in 2008. It critically evaluates the design of two mitigation and one adaptation indicators that are most relevant to climate change. Further, the potential for these performance indicators to contribute to climate change mitigation and adaptation is discussed. Design/methodology/approach – The authors begin by examining the importance of the performance framework and the related Local Area Agreements (LAAs), which were negotiated for all local areas in England between central government and Local Strategic Partnerships (LSPs). This development is located within the broader literature relating to new public management. The potential for this framework to assist in delivering the UK's climate change policy objectives is researched in a two-stage process. First, government publications and all 150 LAAs were analysed to identify the level of priority given to the climate change indicators. Second, interviews were conducted in spring 2009 with civil servants and local authority officials from the English West Midlands who were engaged in negotiating the climate change content of the LAAs. Findings – Nationally, the authors find that 97 per cent of LAAs included at least one climate change indicator as a priority. The indicators themselves, however, are perceived to be problematic – in terms of appropriateness, accuracy and timeliness. In addition, concerns were identified about the level of local control over the drivers of climate change performance and, therefore, a question is raised as to how LSPs can be held accountable for this. On a more positive note, for those concerned about climate change, the authors do find evidence that the inclusion of these indicators within the performance framework has helped to move climate change up the agenda for local authorities and their partners. However, actions by the UK's new coalition government to abolish the national performance framework and substantially reduce public expenditure potentially threaten this advance. Originality/value – This paper offers an insight into a new development for measuring climate change performance at a local level, which is relatively under-researched. It also contributes to knowledge of accountability within a local government setting and provides a reference point for further research into the potential role of local actions to address the issue of climate change.