Measuring quality in social care services: theory and practice

Measuring and assessing service quality in the social care sector presents distinct challenges. The 'experience' good properties of social care, for instance, and the large influence played by subjective judgements about the quality of personal relationships between carer and user and of process-related service characteristics make it difficult to develop indicators of service quality, including those of service impact on final outcomes. Using some of the key features of the 'Production of Welfare' approach, the paper discusses recent developments in the UK of the theoretical and practical frameworks used for assessing quality in social care and for understanding the final impact of services on the wellbeing of their recipients. Key current and future challenges to the development of such frameworks include difficulties in disentangling the impact of social care services on final outcomes from the often dominating effects of other, non-service related factors, and the generalization of consumer-directed care models and of the 'personalization' of care services. These challenges are discussed in the context of the different possible applications of quality indicators, including their role as supporting the service commissioning process and their use for assessing the performance of service providers

Younger Adults' Understanding of Questions for a Service User Experience Survey. Funded/commissioned by: The Health and Social Care Information Centre

For some time now councils with social services responsibilities (CSSRs) have been required to conduct surveys of user’s experience of social services. These have taken place nationally in three-yearly cycles. In 2002/03 the survey was for older people, in 2003/04 it was for younger adults with physical and sensory impairments, and in 2004/05 it was for children. 2005/06 marked the beginning of the second wave of the cycle. The mandate for conducting surveys of user’s experiences and satisfaction with services was first given in the white paper Modern Local Government: in Touch with the People (Department for the Environment, Trade and the Regions, 1998). In 2002 the Office of National Statistics (ONS) and SPRU developed a set of questionnaires for this purpose (Qureshi and Rowlands, 2004). Subsequent national surveys have drawn on this work to identify a set of compulsory questions for each round. User experience surveys (UESs) are regarded as an important part of the overall performance framework for social care and, providing councils with information about how they might improve services locally. Local authorities are required to submit their results to government bodies so that the relative performance of the CSSRs can be judged. This report is composed of five sections. The aims and objectives of the report are outlined in the second section and the method used to gather the data is outlined in section 3. In section 4 we report on the findings from the fieldwork and draw some conclusions and recommendations for the national survey in section 5. The topic guides for the focus groups and interviews are included in the appendices along with a brief discussion of the findings from the focus groups and a copy of the final extended questionnaire.</p

The factors associated with care-related quality of life of adults with intellectual disabilities in England: implications for policy and practice

Over the last three decades, quality of life (QoL) has been advocated as an indicator of social care outcomes for adults with intellectual disabilities. In England, the Adult Social Care Survey (ASCS) is conducted annually by local authorities to contribute to the evidence base of the care-related QoL of people receiving publicly-funded adult social care. This study explores relationships between QoL and non-care related factors to identify relationships that could inform social care policy and practice. Cross-sectional data collected from 13,642 adults who participated in the 2011 and 2012 ASCS were analysed using regression to explore the factors associated with QoL measured using the Adult Social Care Outcomes Toolkit (ASCOT). Self-rated health, rating of the suitability of home design and anxiety/depression were all found to be significantly associated with ASCOT. Other individual and survey completion factors were also found to have weak significant relationships with ASCOT. The models also indicate that there was an increase in overall ASCOT-QoL and in five of the eight ASCOT domains (Personal comfort and cleanliness, Safety, Social participation, Occupation and Dignity) between 2011 and 2012. These findings demonstrate the potential value of QoL data for informing policy for people with intellectual disabilities by identifying key factors associated with QoL, the characteristics of those at risk of lower QoL, and QoL domains that could be targeted for improvement over time. Future research should establish causal relationships and explore the risk-adjustment of scores to account for variation outside of the control of social care support

Filling the gaps - can research play a more innovative role in adult social care?

The interface between research and the contexts in which it is used are often taken as a given. Discussing findings from a study into research use in adult social care, Annette Boaz, Juliette Malley and Raphael Wittenberg suggest that in areas where research use is low, researchers would benefit from developing target organisations’ ability to use research findings and linking their work into existing innovation and evidence use practices

Adult social care research and practice collaboration evidence synthesis

This document was produced based on the POSTnote approach (please see here for more information) to synthesising academic literature and stakeholder insights on a topical issue within policy and practice. This document was written by Hannah Kendrick (Care Policy and Evaluation Centre, LSE) with support from Juliette Malley (Care Policy and Evaluation Centre, LSE) and Annette Boaz (King’s College London) – members of the Creating Care Partnerships project. The intention was to develop a resource on behalf of the adult social care partnership community as a whole and so draws on a wide range of insights and expertise from all contributors (names & affiliations listed on p. 27 of the document). The document draws on studies funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (Grant Reference Numbers: NIHR31335, NIHR131373, NIHR131345, NIHR 131358, NIHR13110, NIHR133629). The views expressed in this document do not necessarily reflect the views of the NIHR or the Department of Health and Social Care

Adjusting for unobserved and observed heterogeneity in survey-based performance indicators: an application to adult social care in England

This thesis is concerned with the statistical adjustment of survey-based indicators to account for unobserved and observed sources of heterogeneity. Recent years have seen a growth in the use of survey-based indicators to measure performance, but questions have been raised over their legitimacy due to high levels of nonresponse, particularly among certain groups, and the influence of factors unrelated to organisational performance, which complicate their interpretation. In light of this, this thesis uses a range of methods that go beyond those ordinarily applied to performance assessment, to explore the role that nonresponse and factors unrelated to performance, i.e. case-mix, have on indicators. The empirical analysis focuses on the Adult Social Care Outcomes Framework (ASCOF) indicators drawn from the English Adult Social Care Survey. The core concerns of this thesis are whether (i) nonresponse and (ii) adjusting for factors beyond the control of organisations affects the interpretation of indicator scores. Nonresponse has a limited effect on inferences about performance, but conclusions depend on the method used to explore the effects of nonresponse, the level of nonresponse, the importance of unobserved factors and the value placed on accuracy over intelligibility of indicators. Adjustment for case-mix has an important effect on the interpretation of indicators, but the adjustment method used was less critical for inference, at least where the aim is to compare organisations. This thesis suggests that the accuracy of some of the ASCOF indicators would be improved by adjusting for case-mix and, possibly, for nonresponse. It is important for future studies to explore the effect of nonresponse on indicators. Policymakers may also wish to consider amending the survey design to improve its representativeness of the adult social care population. Future studies of survey-based performance indicators would benefit from using a wider range of methods similar to those applied here

Future demand for long-term care, 2002 to 2041: projections of demand for long-term care for older people in England

The financing of long-term care raises a great many questions. How many older people are likely to require long-term care services in the coming decades? How much are these services likely to cost? Will the cost to public funds prove affordable? Who should pay? How should costs be divided between public expenditure and private sources of finance? In order to address these issues, reliable projections are needed of future demand for long-term care and future long-term care expenditure. This paper presents projections of demand for long-term care for older people in England to 2041 and associated future expenditure. The projections were produced using an updated and expanded version of the Personal Social Services Research Unit’s (PSSRU) long-term care projections model. The version of the model used here has a base year of 2002 and incorporates the 2004-based official population projections. The first part of the paper describes the PSSRU long-term care finance research programme and recent associated projects. The second part of the paper describes the updated and expanded PSSRU long-term care projections model, including details of the data used in this updated version. The third part presents a set of base case assumptions and the projections obtained using those assumptions. The fourth part investigates the sensitivity of the projections to changes in those assumptions. Section five discusses the findings. A final section sets out some conclusions

What is the relationship between the quality of care experience and quality of life outcomes? Some evidence from long-term home care in England

Quality of care has multiple dimensions, including safety, experience and effectiveness. Understanding the relationship between these dimensions is important for policy and practice, since there may be both synergies and trade-offs that occur when attempting to maximise them. For long-term care effectiveness is understood as care that promotes a good quality of life (QoL). Here we investigate the relationship between care experience and QoL in long-term home care. Data from a cross-sectional survey conducted in 2008/09 were analysed using fractional response regression models to explore the relationship between experience, measured through items capturing perceptions of the care delivery process, and patient-reported QoL-outcomes, measured using ASCOT, controlling for relevant individual characteristics. The analysis included 14,172 people aged 65 and over using home care services from across England. After controlling for the confounding effect of individual characteristics, a ten percentage point increase in overall process quality is found to be associated on average with a 2.13 percentage point increase in ASCOT. Interpersonal aspects of care, such as the responsiveness and caring behaviour of staff, have a stronger relationship with ASCOT than those related to the organisation of care by the provider, such as timekeeping and continuity of care, with a ten percentage point increase in the former associated on average with a 1.9 percentage point increase in ASCOT and a ten percentage point increase in the latter associated on average with a 0.3 percentage point increase in ASCOT. Perceptions of care experience, particularly those related to the interpersonal care aspects, have an important association with QoL-outcomes. Measures of the experience of interpersonal aspects of care may therefore be useful indicators of QoL-outcomes for the routine monitoring of long-term home care services. Although associated, the two dimensions are distinctive and for policymakers there is value in assessing both care experience and QoL-outcomes