NDA paper on Outcomes for Disability Services

The National Disability Authority (NDA), is the independent statutory body that provides information and advice to the Government of Ireland on policy and practice relevant to the lives of persons with disabilities. We have a role to assist the Minister for Justice and Equality in the co-ordination of disability policy.

The Department of Health asked the NDA to assist in producing a draft framework for outcomes measurement for the proposed model of person-centred disability services. The paper builds on and extends previous work the NDA had done in reviewing models of outcome measurement in other jurisdictions. It presents nine high level outcomes for disability services drawing on the literature on outcomes, the UNCRPD, practice in other jurisdictions and consultation with people with disabilities who saw these outcomes as being critical for their quality of life and wellbeing.

Outcomes for Disability Services

The NDA has done a background paper, which brings together literature on outcome measurement, examines experiences from other jurisdictions, looks at outcome domains used in different contexts and presents validated measurement tools. This short paper draws on that wider body of work.

An outcomes focus shifts the emphasis to achieving outcomes and not only to undertaking activities and delivering services. Outcome indicators seek to measure the impact of disability services on the lives of people with disabilities. This is different from measurement of inputs (such as number of staff) or measurement of activities (such as number of personal assistance hours delivered).

In disability services, at a national level it is important to know what outcomes people with disabilities are achieving for the considerable public monies invested. Accountability is needed to people with disabilities, their families and the wider public for what is being achieved. As a commissioner and funder of services, the HSE needs to know what outcomes individual services are achieving, as well as across the disability service programme as a whole. Managers of individual disability services need to know what outcomes are being achieved within their service, and how different units of that service are doing benchmarked against each other and against comparable services.

Outcomes framework

The key elements of an outcomes framework are

  •         High level outcome statements or outcome domains
  •         Sub-domains within those
  •         Indicators to monitor progress on achieving outcomes
  •         How measurement is done
  •         How often
  •         By who – what roles for external measurement, peer measurement and internal measurement
  •         How monitoring of outcomes is built into data systems at unit level, service level, HSE level and Department of Health level
  •         How an outcome-based focus is adopted and embedded into service delivery 

Considerations guiding selection of outcomes

Set in a wider model of quality of life and well-being
The overall goal of disability services is to increase the quality of life and well-being of those who avail of such services. The proposed outcome goals and their related core set of outcomes indicators comprise aspects of quality of life and well-being measurement that align with UNCRPD principles; good practice literature; international practice; quality systems; and the wellbeing outcomes as laid out in the National Economic and Social Council (NESC) Report, Well-Being Matters: a social report from Ireland (2009). A section of the NESC report sets out the application of a wellbeing model to the whole population of people with disabilities in Ireland and this model has been used to inform the development of the current proposed outcome framework. The model considered the following aspects of people’s lives: economic resources; work and participation; relationships and care; community and environment; health; democracy and values. 

More info on the NDA paper on Outcomes for Disability Services can be found here.