The Health and Social Care Advisory Service (formerly the NHS Health Advisory Service and HAS 2000) has a long history of service review. Over the years the nature of reviews being carried out by the organisation has shifted, as we have responded and adapted to the changes taking place in health and social care, particularly around inspection and regulation.
Throughout our history, however, we have adhered to some underpinning principles in our work and its methods and these remain constant. We always strive to:
use an evidence based approach to develop a standards framework against which to benchmark and review
engage with stakeholders and make a point of working alongside people
place the service user and carer at the heart of what we do
turn the what into the how – using policy to inform and shape practice and being action orientated.
At times when it might be said there was a lack of policy direction in mental health services, HAS was at the forefront of evidence based standards development. Our reviews at that time were framed by sets of detailed standards and these dictated the form both of the process and the final reports.
At the end of a HAS review the organisation could expect a highly specified report, giving evidence for both performance and potential against a large set of criteria. The report would provide an extensive list of recommendations, which would be presented to stakeholders at the end of the process.
Over time we refined this process, introducing stakeholder events at the beginning and end of a review, adding more value to the project by helping with action planning and, as mental health policy and guidance was introduced and became more coordinated, adjusting our standards to incorporate new ones from government bodies.
CAMHS expertise and experience in HASCAS
In 2003 HASCAS launched a new CAMHS programme. In that time we have conducted around five service reviews per year, commissioned by provider trusts, PCTs and SHAs. Each review takes about three months from beginning to completion. Some have been whole systems reviews, others have focused on Tier 4.
A selection of national work includes:
What a service review looks like now
Evidence base
HASCAS still uses the same evidence based methods, though the standards framework will normally now be derived from national policy.
Engagement
We still place a great deal of importance on engaging with the local service – commissioners, providers, users and carers. Our usual method is to hold an open stakeholder event where we inform people about the process and they offer ways of adapting it to local need and highlight any issues or concerns.
Site visit
We organise an intensive site visit, in which all stakeholders are invited to participate by having an individual or group interview of their choice. Interviews are semi-structured and begin by being open-ended so that people feel free to “tell it how they see it”. All interviews are recorded by hand – verbatim as much as possible. They are entirely confidential.
The review team
HASCAS has a long tradition of using senior practitioners in the field as reviewers and associates. We have a multidisciplinary database of around 150 associates, including service users and carers. A team is put together for each review that best matches the skills required for that piece of work. The review team is vital – associates bring multiple perspectives and diverse skills and expertise to the process.
Documentary analysis
In addition to the views gathered during the visit, a documentary analysis is conducted. This may include an overview of all relevant national policy, as well as a synopsis of local strategy and policy. We normally include some demographic analysis and service mapping, presented in accessible formats that can be readily understood.
Report
The most significant change in our review process is the report. The precise format will be agreed at the outset, but essentially we are keen that the resulting document will be meaningful, helpful, easily accessed and a spur to action. In order to be of most value it might take any of the following forms:
Outline strategy
Commissioning framework
Options appraisal
Scoping document/outline business case
Standards based report with recommendations.
For an informal discussion please contact:
Dr Yvonne Anderson, Director with CAMHS lead 020 7307 2898