Appreciative Inquiry Evaluation - Keyworker pilot in NW London

The Situation

The NHS Long Term Plan says that “all children and young people (C&YP) with a learning disability and/or with autistic spectrum disorder with complex support needs will have a designated keyworker by 2023-24”. The North West London (NWL) Keyworker Service was one of 13 national pilot projects linked to this commitment. It started in February 2021 with Keyworkers covering Hounslow and Hammersmith and Fulham. By July 2022 all eight boroughs in NWL had a Keyworker in post.

In March 2023 the NWL Keyworker Steering Group initiated an independent evaluation. The aim was to inform planning after the pilot project ends on 31st March 2024.

Our Response

We recommended an Appreciative Inquiry approach the the evaluation. The research process included:

• Appreciative interviews with a wide range of stakeholders.

• “Discovery” and “Dream” focus groups and questionnaires.

• A review of case notes and interviews with Keyworkers to prepare 40 mini-cases studies, and 2 in depth case studies, showing exactly what Keyworkers do, and what difference they make.

• Benchmarking interviews with leaders at 4 other national pilot projects to identify best practices that NWL could learn from.

• Assessment of current internal performance management/evaluation processes.

• Review of the feedback gathered by Participating People from C&YP and families with experience of support from a Keyworker.


Our research:

• Established exactly what keyworkers do. It concluded that their independence, DSR role, remit, skills, and caseload enables them to take an overview (including of the family and wider social context) that is difficult for other co-ordinators to emulate.

• Proved keyworkers mostly make a positive difference. Improved outcomes for C&YP and/or families were seen in 36/40 cases, support packages were “rightsized” 28 times, and care and support processes improved “around” the C&YP 18 times.

• Found that the keyworker role rarely overlaps with other professional roles until the professional care, support, and treatment network is functioning well around a C&YP. When overlaps begin to occur, it is evidence that the Keyworker’s job is done.

• Identified that performance monitoring, evaluation, and learning is a key development area and made development recommendations.

• Highlighted a wide range of good practices being used by other pilot projects. NWL could consider incorporating some of these into their future operating models.

• Discussed the advantages/ disadvantages of six different hosting options. Developed six possible future operating models options for the NWL Steering Group to evaluate. Provided an option appraisal tool to help with decision taking.

Alison Knight - Autism (ASD)/Learning Disabilities (LD) Keyworker Programme Lead commented that:

Alder Advice’s work was very targeted towards the objectives of the evaluation. They orientated their research on the range of outcomes sought by the project. Their approach was flexible and adaptable. They always appreciated achievements by a service that was just beginning and still evolving. They were experienced in the arena being evaluated and able to facilitate effectively as well as project manage efficiently. The proposals and concluding recommendations will be pivotal in manoeuvring the future of the service’s function and delivery.”