Quality in home care: client and provider views

This paper reports on the findings of a small-scale study that investigated the meaning and delivery of quality in home care in four local authorities from the perspective of informal carers, users and providers and explored the views of users about proposed changes in the ethos of home care stipulated in the National Care Standards for Domiciliary Care (2003). We start by outlining the method used and then describe the characteristics of the consulted provider agencies and the characteristics and needs of the service users. Section 5 reports users’ experience of the home care service and section 6 the important aspects of quality from the perspective of users and providers. Finally, the report addresses the implications of our findings on the future development of home care provision

Guidelines for the closure of care homes for older people: prevalence and content of local government protocols

The rise in the number of care home closures in recent years has raised concerns about the way in which residents and their relatives and carers are being affected by such relocation and the way in which it is managed. Currently there is no statutory guidance in England aimed specifically at the way in which care homes close. This paper presents a review of local government guidelines and protocols for the closure of care homes for older people. The objectives of the study were to identify the prevalence of written guidelines and the nature of existing principles and recommendations for good practice. Thirty-three documents were analysed to identify their purpose and scope, the ways in which roles and responsibilities were defined and allocated, and suggestions and recommendations for good practice

Valuing PSS outputs and quality changes

The Gershon review of efficiency recommended that target improvements in efficiency should be met both through financial savings and through improvements in quality of outputs. This paper reports on a pilot project designed to feed into an approach for local authorities to quantify in monetary terms quality gains in the provision of personal social services (PSS), with a specific application to the provision of home care for older people. There are a number of practical and theoretical problems with attributing monetary values to aspects of quality. The approach described here builds on ongoing work into the measurement of PSS outputs for the purposes of National Accounts and measuring changes in productivity and efficiency more widely. This approach distinguishes what services could provide (capacity for benefit) from the quality of what is provided in practice. By attaching a financial valuation to capacity for benefit we are able to attribute a monetary valuation to changes in the quality of provision measured (in the case of home care) through service user experiences of their care. Capacity for benefit (CfB) is defined in terms of eight domains of outcome that services address and four levels of need (no needs, all needs met, low needs, high needs) within these domains. In addition we identify whether people are living in their own homes, as a key attribute of care provision. The characteristics of the service (in terms of domains of outcome and whether living at home) and service users (in terms of level of need that need to be met) determine the CfB of a given service

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 Rate, Causes and Consequences of Home Closures

One of the attributes of a mixed economy of care is that inevitably some homes will go out of business, with consequent costs for the individuals involved and the regulating authorities. However, the rise in home closures during recent years has given rise to concerns about the capacity of the care home sector and the effects on current residents. This report describes the results of the first phase of a study on the causes, processes and consequences of home closure. A survey of registration and inspection (R&I) units was conducted to identify rates of closure, the proportion of closures that were due to business reasons, changes in registration, the consequences for supply and the views of unit managers. A follow up telephone interview was conducted with those units that covered areas included in a 1996 survey of homes. This interview was used to collect more detailed information about the two most recent closures

Costs of regulating residential care services for children. Funded/commissioned by: Department of Health and Welsh Office

There are a number of important planned changes in the way that the regulatory function is to be conducted in Englandand Wales in the future (Department of Health, 1998). These include the setting up of independent regional authoritiesresponsible for regulating care services, the extension of regulatory requirements to services not currently covered byregulatory legislation and the setting of standards at a national level. An important issue to consider in this context is thesetting of fees to those who are being regulated. A key recommendation of the Burgner report on regulation and inspectionof social services was that the cost of regulation should be independently reviewed with a view to relating fee levels moreclosely to the actual costs of regulation (Burgner, 1996; p8). This report describes the results of an extension to a Department of Health and Wales Office funded study of health andlocal authority inspection units in England which had investigated the costs of regulating care homes for adults (Netten,Forder and Knight, 1999a). The principal aim of this study was to establish the costs of regulating residential care servicesfor children, in a way that could be used to identify cost-based fees to establishments. Residential care services forchildren were taken to include residential homes, family centres, boarding schools, foster care agencies, and adoptionagencies. Of these services Units currently have statutory responsibility for inspecting homes registered under the Children’s Act1989 and independent boarding schools. The Social Services Inspectorates of the Department of Health and Wales Officeinspect voluntary homes and voluntary adoption agencies. There are no statutory requirements to regulate the otherservices. Under the Children Act 1989 local authorities have the power to charge a “reasonable” fee for registration andinspection of private children’s homes, but voluntary homes, local authority homes and boarding schools do not pay fees. The main data collection was a survey of local authority and joint inspection units undertaken during the autumn of 1999.The data collection built on data collected in the previous survey (Netten, Forder and Knight, 1999a). For this studysupplementary data were collected about unit policies and practice with respect to services for which they had no statutoryresponsibilities, children’s services’ inspector characteristics and a sample week’s time use; and a sample of recentlyundertaken inspections and registrations. Information was also collected about enforcement actions undertaken during theprevious year. SSI inspectors involved also provided equivalent information on the amount of time spent on inspecting andregistering voluntary homes

Quality of care: testing some measures in homes for elderly people

In this national study of 17 residential homes, 309 residents were interviewed, 264 members of staff completed an anonymous survey, and 228 relatives responded to a postal questionnaire. The data were collected between January andSeptember 1995. The aim of the study was to suggest promising measures of quality of care, looking particularly at depression as a possible indicator. It also served as a follow-up study of the Caring in Homes Initiative, although its timing ruled out evaluation of the impact of this development programme, because changes occurred in the homes before this study began. No strict definition of quality was adopted a priori, but a pragmatic approach was taken, addressing the perspectives of residents, health and social care professionals, home staff, managers, and relatives