In the green paper Independence, Well-Being and Choice and the white paper Our Health, Our Care, Our Say, the government focused on seven positive outcomes for people using health and social care services.

These outcomes are:

  • improved health and emotional well-being;

  • improved quality of life;

  • making a positive contribution;

  • choice and control;

  • freedom from discrimination;

  • economic well-being;

  • personal dignity.

These outcomes are informed by the expressed views of users and carers across the country following a major consultation.

The Care Services Improvement Partnership has developed initiatives which follow the principles set out in these papers and which are changing health and social care services and the lives of people who use them.


CSIP developed 10 high-impact changes for mental health services in June 2006 and they were well received by practitioners, service users and carers alike.

Now, the high-impact changes for health and social care provide a framework for overall service improvement. They include examples of effective partnerships between staff, service users and carers, as well as ways to change practices that make a difference to the lives of people who use services.

The evidence

CSIP has developed these changes from a wide evidence base. The Centre for Social Care Research at SwanseaUniversity conducted academic research thatreviewed literature and also ran web-based searches to identify and classify evidence about the impact of service changes.

Researchers then held focus groups with service users, carers, social care practitioners and managers to discuss the evidence. The work included identifying other service changes not previously captured or written up as evidence.

CSIP also requested evidence from the field by asking providers and commissioners to highlight work that has had a positive impact for service users in at least one of the seven outcome areas.

Some CSIP regional development centres also held focus groups for users and carers or distributed questionnaires to ask them about their experiences of effective services and what has made a difference for them.

High-impact changes

The high-impact changes that emerged from the evidence are relevant for health and social care, across settings from children's and older people's services to specialist services.They are:

  • involvement;

  • dignity and respect;

  • meeting fundamental needs;

  • accessible information and support;

  • partnership working;

  • personalised services;

  • effective commissioning;

  • flexibility/challenge/creativity;

  • inclusion;

  • carers as partners in care.

For more information, view the full publication on or contact Ruth Kent on 01206 287544 or