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Background: Evidence-based practice in social care and health is widely promoted. Making it a reality remains challenging, partly because practitioners generally see practice-based knowledge as more relevant than empirical research. A further challenge regarding the creative, contextual use of research and other evidence including lived experience and practice-based knowledge is that practitioners, especially in frontline care services, are often seen not as innovators, but recipients of rules and guidelines or followers of pre-determined plans. Likewise, older people are not generally recognised as co-creators of knowledge, learning and development but as passive recipients of care, or objects of research. Aims: This study aimed to address the above issues, through a collaborative and appreciative endeavour involving researchers; social care and health practitioners; managers; older people and carers in 6 sites across Wales and Scotland. Methods: We used participatory action research methodology, applying a dialogic storytelling approach, which enabled participants to explore and address 7 already published research-based ‘Challenges’ regarding what matters most to older people with high-support needs. Findings: Participants discovered and addressed five elements required in developing evidence-enriched practice; the creation of supportive and relationship-centred research and practice environments; the valuing of diverse types of evidence; the use of engaging narratives to capture and share evidence; the use of dialogue-based approaches to learning and development; and the recognition and resolution of systemic barriers to development. Discussion and conclusion: Although existing literature covers each element, this project was novel in collectively exploring and addressing all five elements together, and in its use of multiple forms of story, which engaged hearts and minds, positive outcomes were achieved.

Narrative recording in case records and individual plans within social services represents the means by which stories can be constructed with and about the people with whom services work, influencing relationship building and outcomes. Identities and decision-making are forged in records, shaping people’s lives. Yet, limited attention is paid to narrative recording in research and practice. Indeed, recording, which increasingly veers towards ‘box-ticking’, is viewed by practitioners as a bureaucratic burden, limiting time for the ‘real job’ of face-to-face work. Drawing on Ricoeur’s narrative hermeneutics in exploring qualitative data from a carer support organisation, we identify the potential contribution of narrative recording. Carers often seek support when their sense of identity and quality of life is diminished by their unpaid caring role. We explore practitioners’ views about the role of the narrative record in holding memories, feeding into recognition of capable agency, clarifying possibilities for action, restoration of identity and wellbeing. Applying a Ricoeurian lens demonstrates how attaining these benefits require recording practice which supports recognition through relational practice, in pursuit of better outcomes for carers. Carer benefits could be enhanced by carers holding a copy of and being able to reflect on and further contribute to their own plan.

Collaborative, person-centered approaches to care planning are increasingly recognized as instrumental in supporting attainment of personal recovery outcomes. Yet, while much is known about factors which support person-centered planning, successful implementation often remains an elusive goal. This paper reviews international efforts to promote Person-Centered Care Planning (PCCP) in the context of a randomized clinical trial in the United States and in the “Meaningful and Measurable” initiative, a collaborative action research project involving diverse provider organizations in Scotland. The authors review the history of international efforts to implement PCCP and offer preliminary evidence regarding its positive impact on both process outcomes (i.e., the nature of the primary therapeutic relationship and the service-user’s experience) and personal recovery outcomes (e.g., quality of life, community belonging, and valued roles). PCCP will be defined through description of key principles and practices as they relate to both relational aspects (i.e., shifts in stakeholder roles and conversations) and documentation/recording aspects (i.e., how person-centered relationships are captured in written or electronic records). Similarities and differences across the US and Scottish experience of person-centered care planning will be highlighted and a series of recommendations offered to further implementation of this essential recovery-oriented practice.

Evaluating Outcomes in Health and Social Care is the fifth in a series of five books on health and social care partnerships, recently updated to take account of new studies and changing policy developments since first published in 2008. The book is aimed at students, practitioners, managers and policy-makers in health and social work/care. Health and social care partnership is in itself a topic which has presented considerable challenges to policy and practice in different countries for decades. In addition, this book also aims to tackle the complex issues of evaluation and outcomes, which is no mean feat. The authors usefully blend context and history, an overview of evaluation methods, theoretical approaches, practical examples and links to reading and resources in pursuing their quest.

This paper reports on a ten year programme of collaborative action research supporting the development and implementation of a personal outcomes approach in health and social care, culminating in the recent Economic and Social Research Council (ESRC) funded ‘Meaningful and Measurable’ project. The research brought together academic researchers with practice partners from statutory adult health and social care services, children and families, and third sector carer and mental health organisations. Our primary focus has been working together to find ways to make best use of routinely collected outcomes data, recorded for each service user in the form of a proportionate narrative, to inform individual and collective decision making. Our methodology combined local action research projects in diverse settings with a series of audio-recorded dialogic ‘data retreats’ for all partners, and knowledge exchange events with wider stakeholders, including commissioning and regulatory bodies. Alongside this, a series of focused workshops were co-created and delivered in response to emergent practice needs, addressing issues including having outcomes focused conversations, outcomes recording practices and pragmatic approaches to qualitative outcomes data analysis and reporting. This paper focuses on the ‘how’ questions, examining the collaborative mechanisms that proved critical in: ‘lifting the rock’ to expose hidden assumptions and challenges, including conceptual ambiguities and the subtle yet pervasive nature of positivist influences; learning from local and sectoral differences in establishing the value of different forms of knowledge; appreciating the hermeneutic circularity of shared understanding; and triggering those ‘light bulb’ moments. The importance of attending to different and at times conflicting perspectives is underscored.

There is currently much policy emphasis on both partnership working between health and social services in the UK and on the outcomes delivered by services. This article provides an account of two consecutive projects centred on these two themes. The first project, at the University of Glasgow, sought to address the lack of evidence about the outcomes delivered to service users by partnerships. Following from this project, the Joint Improvement Team of the Scottish Government commissioned the researchers to develop a toolkit to involve users and unpaid carers in performance management in community care in Scotland. The remit of this second project expanded during 2007 as it became linked with the development of the emerging National Outcomes Framework for community care in Scotland. This article outlines the outcomes‐based piloting work currently under way in Scotland.

Policy and practice documents are increasingly adopting a focus on outcomes. This article seeks to clarify what is meant by the term ‘outcome’, the outcomes that have been highlighted in key policy documents, and the extent to which they reflect the outcomes prioritised by service users. The discussion will draw on the early stages of a DoH‐funded project exploring the effectiveness of health and social care partnerships from the perspectives of service users.

Working in partnership, both across social care and health and with serviceusers, has been a persistent theme of the health and social care modernisationagenda in the United Kingdom. Despite a relatively underdevelopedevidence base, the development of health and social care partnerships hascontinued to feature in recent policy and legislative initiatives in the UnitedKingdom. At the same time there has been a major shift in focus towardsthe outcomes that support services deliver. A central question remaining iswhether the policy initiatives driving the development of health and socialcare partnerships are delivering improved outcomes, particularly theoutcomes valued by people who use services. This article outlines researchdesigned to explore this issue across 15 health and social care partnershipsin England and Scotland, building from previous research by the SocialPolicy Research Unit based at the University of York. It sought to assess theextent to which health and social care partnerships deliver the outcomesthat people who use services value, and to determine the features of partnershipworking associated with the delivery of these outcomes. A robustoutcomes framework was defined, which provided the basis for interviewswith those receiving support from partnerships. Working with three userresearcherorganisations, interviews were completed with 230 individualsin 2006. On the basis of this, some service users were able to identifyfeatures of partnership that particularly contributed to improved outcomes.These included continuity of staff and sufficient staff and a range ofresources, including the availability of long-term and preventative services.Given the definitional and methodological complexity surrounding partnershipworking, and the challenges of attribution, the study faced somelimitations in its ability to make wider inferences about partnership andoutcomes. A theory of change should be employed in future studies of thistype.

UK policy promotes third sector organisations as providers of NHS funded health and social care. We examine the evidence for this policy through a systematic literature review. Our results highlight several problems of studies comparing non-profits with other provider forms, questioning their usefulness for drawing lessons outside the place of study. Most studies deem contextual factors and the regulatory framework in which providers operate as much more important than ownership form. We conclude that the literature does not support the policy of a larger role for the third sector in healthcare, let alone a switch to a market-based system.

Over the past 10 years, each of the four countries in the UK has attempted to resolve continuing difficulties with duplication of assessment and lack of shared information in community care, by developing approaches to shared assessment. Relevant literature reviews have previously focused on challenges to partnership working between health and social care, and on different approaches to assessment. The literature review described here differs in three key respects. Firstly, the literature was selected on the basis that it addressed shared assessment specifically. Secondly, it included evidence from the four countries within the UK, providing a cross-national basis to the evidence. Thirdly, this study was undertaken to identify whether benefits from shared assessment were evident, in addition to the challenges. While the evidence of benefits at this stage is relatively limited, it is clear that some have emerged, including two relating directly to relevant policy objectives: improved communication, service user and carer involvement; improved partnership and joined up working. As approaches to shared assessment are currently under review in Scotland, England and Wales, and implementation underway in Northern Ireland, and in light of the economic recession and demographic challenges, consideration of key aspects of the evidence may be timely.