36 Exploring the difference made by Support at home 5.2 recommendations of life is given a prominent place on the agenda within the wider health and social care sector. The findings from this research have led us For example, as the clinical commissioning to develop a number of recommendations to groups start to choose the local indicators make to the organisation, drawn from the that will be matched to their Quality Premium impacts and challenges found in the study. The Targets, the Red Cross is well positioned to recommendations are a result of both the research try to influence them to consider quality of life findings and subsequent discussions with staff related indicators. focused on drawing out the implications for the organisation.23 2. respond to the changing profile of our service users The following seven recommendations emerge The findings suggest that, as social services tighten from this study: their eligibility criteria, Support at home staff and volunteers are seeing greater numbers of people 1. champion our strengths with complex needs – especially mental health The findings from this study confirm that our needs. The Red Cross would benefit from making greatest impact is observed in improved wellbeing a strategic decision about how we best support and related quality of life, which directly supports our service users and, indeed, whether this the NHS outcome “Enhancing quality of life observed shift is acceptable and desirable to us. for people with long term conditions” (Dept of Health, 2012). Furthermore, these positive If it is Red Cross policy to respond increasingly changes are more marked for those who rate to this new group of service users with increased their capacity in these areas as ‘poor’ before needs, then there are key activities that could they receive the intervention. In other words, occur to support this proactively. These include 24 the greatest change can be seen in those with the sharing learning from existing services , greatest need. providing necessary training for staff and volunteers, and ensuring referral criteria reflect Our evidence also suggests the service supports this shift towards those with increased needs. both safe hospital discharge and carers, where present. These are the strongest qualities of If it is not desirable that this group form part of Support at home, and they need championing Support at home’s core support group, then the over areas where the evidence is weaker. Red Cross will actively have to turn down these higher-level referrals, possibly with humanitarian Implications for the organisation to consider: and contractual implications. > Use the evidence available to promote what we’re good at. Look at what the data is telling Implications for the organisation to consider: us (from this study and other sources) about > Acknowledge the implications of supporting the outcomes we achieve. In addition, we people with more complex needs and the should continue to gather further evidence, internal and external consequences of this. where needed, to support our work. Support Internally, the Red Cross would benefit at home is not a “one size fits all”. There is a from exploring its role in this new “care variety of services that sit under the umbrella framework”, where limited resources are of Support at home, with different strengths increasingly deployed to address greater and selling points. Consistent evidence numbers of individuals with more complex gathered on these and other services will needs. By doing so, it would be necessary to highlight the specific strengths of each. reflect upon the implications to existing service delivery models – most notably whether this > Ensure quality of life is high on everyone’s reduces the time afforded to service users with agenda. The importance of the quality of life lower-level needs. There are also resource of our population needs to come to the fore implications for taking on this additional level of our discourse on Support at home. The of need – in terms of staff/volunteer training, research suggests that the Red Cross is very time and patient outcomes. Externally, our well placed to advocate and ensure that quality commissioners should be kept fully aware of the implications of this changing landscape, as well as any potential risks and other general 24 Some services have specific experience in supporting people with more 23 Discussions of the findings were held across the country with staff from complex needs and are well placed to share their learning, e.g. the the services that participated in the research. Tenancy Support Programme in Wales.