SECTION 4 & 5 Section 5: Demonstrating Impact Effective commissioning of services Local Authority commissioners have a responsibility to “optimise outcomes, improve health and wellbeing and reduce inequalities in local populations” and to demonstrate the effectiveness, outcomes and impact of the services which they commission. National policy sets out the measurement of outcomes against key indicators in the NHS Outcome Framework and the Public Health Outcomes Framework 29,36. However, it is important for commissioners to stay focused on the needs of children and young people in the local area, identifying a clear set of outcomes for services which are relevant to the Local Authority’s vision. Equally important is the clarity of the commissioning intentions; the features of the service that commissioner wishes to develop 37. In addition, it is important that School Nursing is not seen in isolation and there is a need to work collaboratively and in partnership with other services to achieve positive outcomes for children and young people 2.
Demonstrating Returns on Investment Moving towards measuring meaningful outcomes in complex, integrated systems “Work with partners and other stakeholders to build a shared view of what ‘good’ looks like, how to achieve this, how it should be measured and how learning should be used”
demonstrating compliance in contract monitoring, they only measure a very small proportion of the scope of the School Nurses role. However, a challenge for School Nursing is developing their approach to evaluating and evidencing impact and outcomes. In response to the criticism of the small and relatively weak evidence base of School Nursing, recommendations have been made to support them to develop their skills in evaluation, ensuring that it is an integral part of their work, using both quantitative and qualitative data, evaluating process and outcomes of interventions to demonstrate impact, evidencing return on investment and disseminating good practice 25,38. To do this School Nurses need to consider how they demonstrate their contribution to locally articulated goals alongside those in national frameworks. There are tools that can support School Nurses to measure impact of interventions such as Public Health Impact pathways. Seeking children, and young people’s and parent/carers wellbeing and experience are a significant contribution to the cycle of service development 1, 2,29. The Integration and Better Care Fund, 2019 recognises the importance of measuring patient experience, not only to guide service improvement, but also because people’s experiences of care may be linked to clinical outcomes and costs 37.
Integration and Better Care Fund, 2019 37 Currently, service specification largely focuses on process measures, capturing outputs such as the number of PSHE sessions delivered in school, the number of children attending a group, the number of referrals received into a service. Whilst
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