Table 4.12.2
PSS GROSS EXPENDITURE, 2000-01 PRICES
| England |
| | | |
| | | | £m
|
| 1990-91 | 1994-95
| 1994-95 | 1995-96 | 1996-97
| 1997-98 | 1998-99 | 1999-2000
| 2000-01 |
| (with unallocated | (with unallocated
| (with allocated | (with allocated
| (with allocated | (with allocated
| (with allocated | (with allocated
| (with allocated |
| central admin) | central admin)
| central admin) | central admin)
| central admin) | central admin)
| central admin) | central admin)
| central admin) |
| Service strategy | — |
106.3 | 135.4 | 137.9
| 135.9 | 137.9 | 155.5
| 164.9 | 126.3 |
| Children and families |
| | | |
| | | |
|
| Assessment and care management | —
| 450.1 | 615.4 | 642.0
| 640.8 | 660.4 | 697.7
| 771.9 | 788.8 |
| Residential care | 599.5 |
636.5 | 723.9 | 721.9
| 728.4 | 742.1 | 758.3
| 809.7 | 779.7 |
| Non-residential care | 652.6 |
805.5 | 932.7 | 961.9
| 1,005.5 | 1,023.8 | 1,124.8
| 1,287.4 | 1,296.1 |
| Total | 1,252.1 | 1,892.2
| 2,272.0 | 2,325.9 | 2,374.8
| 2,426.3 | 2,580.8 | 2,868.9
| 2,864.6 |
| Older people (aged 65 or over) |
| | | |
| | | |
|
| Assessment and care management | —
| 308.9 | 418.1 | 436.8
| 469.2 | 460.9 | 452.2
| 481.5 | 497.6 |
| Residential care | 1,280.7 |
2,042.8 | 2,234.9 | 2,610.9
| 2,977.5 | 3,164.2 | 3,328.7
| 3,529.7 | 3,591.7 |
| Non-residential care | 1,022.6
| 1,365.7 | 1,543.6 | 1,608.1
| 1,625.8 | 1,657.9 | 1,679.9
| 1,757.3 | 1,810.1 |
| Total | 2,303.3 | 3,717.4
| 4,196.7 | 4,655.8 | 5,072.5
| 5,283.0 | 5,460.7 | 5,768.6
| 5,899.4 |
| Adults aged under 65 with a physical disability or sensory impairment
| | | |
| | | |
| |
| Assessment and care management | —
| 83.3 | 111.7 | 125.3
| 125.9 | 130.8 | 136.1
| 138.9 | 152.8 |
| Residential care | 81.6 | 140.4
| 155.1 | 175.0 | 200.5
| 214.8 | 228.2 | 247.8
| 257.9 |
| Non-residential care | 153.5 |
281.3 | 326.4 | 381.7
| 395.7 | 411.0 | 420.7
| 464.4 | 448.0 |
| Total | 235.1 | 505.0
| 593.1 | 681.9 | 722.2
| 756.6 | 785.0 | 851.1
| 858.7 |
| Adults aged under 65 with learning disabilities
| | | |
| | | |
| |
| Assessment and care management | —
| 64.7 | 91.8 | 104.7
| 103.4 | 108.0 | 106.5
| 108.0 | 104.8 |
| Residential care | 269.2 |
516.2 | 575.9 | 641.4
| 736.8 | 792.8 | 877.3
| 942.5 | 1,015.3 |
| Non-residential care | 304.4 |
400.5 | 460.9 | 492.0
| 499.6 | 523.4 | 581.1
| 618.8 | 631.8 |
| Total | 573.6 | 981.4
| 1,128.6 | 1,238.1 | 1,339.8
| 1,424.2 | 1,565.0 | 1,669.2
| 1,751.9 |
| Adults aged under 65 with mental health needs
| | | |
| | | |
| |
| Assessment and care management | —
| 98.5 | 124.2 | 134.8
| 143.9 | 148.1 | 161.6
| 181.7 | 192.0 |
| Residential care | 54.6 | 122.0
| 136.7 | 168.4 | 205.2
| 223.5 | 234.1 | 246.9
| 259.6 |
| Non-residential care | 39.9 |
117.8 | 138.1 | 161.5
| 169.6 | 181.8 | 194.8
| 218.2 | 225.5 |
| Total | 94.5 | 338.2
| 399.0 | 464.8 | 518.7
| 553.4 | 590.5 | 646.8
| 677.2 |
| Asylum seekers and other adults | 111.5
| 96.4 | 103.4 | 100.1
| 106.7 | 157.8 | 218.2
| 345.2 | 669.5 |
| Field Social Work | 728.9 |
— | — | —
| — | — | —
| — | — |
| Area Officers/Senior Managers | —
| 140.5 | — | —
| — | — | —
| — | — |
| Unallocated central admin | 987.9
| 1,050.8 | — | —
| — | — | —
| — | — |
| Total | 6,286.6 | 8,828.2
| 8,828.2 | 9,601.5 | 10,270.6
| 10,739.3 | 11,355.7 | 12,314.8
| 12,847.6 |
| Included in the above: |
| | | |
| | | |
|
| Training | 74.9 | 99.3
| 99.3 | 92.3 | 86.2
| 90.1 | 79.8 | 85.6
| — |
| Occupational Therapy | 29.6 |
47.6 | 47.6 | 43.7
| 50.6 | 51.0 | 69.7
| 80.1 | — |
Source: RO3 and PSS EX1 returns.
4. PERSONAL SOCIAL
SERVICES RESOURCES
AND ACTIVITY
4.13 Could the Department provide details of any forthcoming
changes to statistical information the Department collects on
personal social services? [5.10]
CHANGES TO
CURRENT COLLECTIONS
PSS user satisfaction survey
1. In 2002-03 all local authorities will be required
to undertake a new user satisfaction survey. This will cover elderly
home care users rather than those that were recently assessed
and then went on to receive services. As in the past information
from this survey will be collected by DH and will produce two
of the Best Value indicators and will also be included in the
Performance Assessment Framework indicator set. Local authorities
will include additional questions in their surveys for their own
use. This survey will be repeated in three years time, in the
meantime surveys of the satisfaction of users from other client
groups will take place.
Workload and performance of registration and inspection units
2. The results of the Registration and Inspection survey
for 2000-01 was published in August and are given at www.doh.gov.uk/public/regandinspect3.htm
and www.doh.gov.uk/public/regandinspect4.htm. Responsibility for
these data has now transferred to the National Care Standards
Commission.
Ethnic origin data
3. As the committee was advised last year, ethnic data
in DH central collections is collected on a basis consistent with
the 2001 census categories; with a transition period for datasets
where ethnic data are already being collected in whatever form
(generally based on 1991 census categories, or variants of them).
The first dataset to report ethnic data on the new basis was the
Children in Need census 2000.
Internet Data Collection (IDC) Facility for PSS Returns
4. This facility is not strictly a data collection but
is a key development as part of DH's contribution to the e-government
initiative.
5. This year DH has made most social services returns
available in electronic format over the Internet—either
as downloadable Excel spreadsheets or as part of the IDC system.
This is consistent with the e-government initiative for handling
returns electronically. These returns will have the advantage
of including validations that will enable data providers to check
on the accuracy of the data provided, at source. The following
returns are currently included in the IDC facility:
— Children on Child Protection Registers (CPR3)
— Number of homes and places in residential care
homes (RA Form A, Parts 1,2 3)
— Independent sector nursing care homes registered
under Section 23 of the Registered Homes Act 1984 (RH(N) Summary,
Parts A/1 to A/3)
— Local authority supported residents (SR1)
— Register of Deaf or hard of hearing (SSDA910)
— Personal Social Services Expenditure (PSS EX1)
— Home help/home care services (HH1)
— Outcome Indicators for looked after children (OC2)
— Annual PSS Staffing return (SSDS001)
— Referrals, Assessments and Packages of care (RAP)
census 2001-02
Note: examples of the returns and the publications referred
to above can be viewed on the DH Internet site: www.doh.gov.uk/public/stats1.htm
NEW COLLECTIONS
Care leavers on their 19th birthday
6. Local authorities have been asked to provide data
about the occupation and accommodation of their care leavers after
they have left care. Starting in April 1999 this scheme required
councils to keep in touch with young people leaving care aged
16 and provide data on a proportion of them when they reach 19
years old. Data collection began in 2001-02 with results due
in November 2002.
4. PERSONAL SOCIAL
SERVICES RESOURCES
AND ACTIVITY
4.14 Could the Department provide details of any research
work not reported last year that is currently being sponsored
by the Department on the outcomes and effectiveness of social
care? [5.11]
Summary
(This includes both new research and new developments of work
reported on last year).
1. New Research Initiative on "Valuing People:
Inclusion, Partnership and Services for People with Learning Disabilities"
[new work].
This new research Initiative is designed to underpin the
implementation, and assess the impact, of Valuing People.
10 projects have been funded to date, reflecting between them
the central themes of: Inclusion, choice and control, quality
services and making change happen. All will indirectly inform
assessment of effectiveness of services, but three focus explicitly
on this dimension (more detailed information can be found at the
end of this summary section):
— An Evaluation of the Impact of Person Centred
Planning;
— The Effectiveness of Cognitive Behavioural Treatment
for Men with Learning Disabilities at Risk of Sexual Offending;
— Developing Measures of Core Competency to Inform
Performance Assessment of Residential Support Staff.
2. New Programmes of Work in the Personal Social
Services Research Unit (PSSRU). [new work]
Building on earlier work on related themes, strands of the
new research programme (2002-05) focus on the factors affecting
performance, effectiveness and service outcomes. Three projects
are of particular relevance (more detailed information can be
found at the end of this summary section):
— An Exploration of the Links between Commissioning
Arrangements and Performance;
— The Costs and Consequences of Different Commissioning
Arrangements;
— Relationship between Costs, Efficiency and Service
Outcome.
3. Research and Development Work at the Social Policy
Research Unit (SPRU) on Outcomes Focussed Practice. [new development]
A long-standing programme of work has been undertaken by
the SPRU on the identification of service user-defined outcomes
and the implementation of an outcome-focus in routine practice.
This work continues with three new areas of research and development
activity (more detailed information can be found at the end of
this summary section):
— Developing Outcome-focused Care Management and
User Surveys;
— Outcomes for Disabled Service Users;
— Outcomes for Disabled Children and their Families.
4. Findings from the "Outcomes of Social Care
for Adults" Research Initiative. [new development]
Covering the full range of adult service user groups, but
with particular emphasis on Older People, this large-scale research
programme had three central themes:
— Developing Outcome Measures;
— Implementing an Outcome-focused Approach;
— Evaluating the Outcomes of Specific Services.
The report for 2001 noted that the individual research projects
had completed their work. An overview report has now been produced
which pulls together the findings from the individual projects
and identifies the central policy and practice messages (more
detailed information can be found at the end of this summary section).
5. New Research Initiative on Quality Protects
[new work]
This new research initiative contributes to the evaluation
of the impact of Quality Protects on services for children
who are looked after by local authorities, children in the child
protection system and other children in need. The initiative includes
the assessment of the effectiveness of services and outcomes for
children and their families in relation to their welfare and quality
of life. Eight projects are being commissioned and are concerned
with placement stability; children's protection from significant
harm; the life chances of children looked after, young people
leaving care and children in need; and services to disabled children
and their families. All studies within the initiative will indirectly
consider the outcomes and effectiveness of services, but five
have a particular focus on these dimensions: (more detailed information
can be found at the end of this summary section). They are studies
of:
— the reunification of looked after children with
their parents: patterns, interventions and outcomes;
— children placed with relatives and friends: placement
patterns and outcomes;
— outcomes for children placed with family and friends
as a result of care proceedings;
— participation of disabled children and young people
under Quality Protects;
— services to enhance placement stability.
6. New Programme of Work at Thomas Coram Research
Unit (TCRU) [new work]
Elements of TCRU's new DH-sponsored programme (2001 to 2005)
consider the effectiveness and outcomes of services for children's
social care. (more detailed information can be found at the end
of this summary section.) Three studies are especially relevant.
They are studies of:
— repeated use of accident and emergency departments
by young people.
— teenage conception among young people looked after
by local authorities.
— advocacy for looked after children and children
in need.
7. Research and Development Work at the Centre for
the Child and Family Research (CCfR) [new work]
CCfR is continuing its long-standing DH-funded programme
of work on outcomes for children in need and vulnerable children.
The Looking After Children research and development programme
on assessing outcomes in child care is now incorporated into the
work of the Centre. New phases of longitudinal studies have begun
examining:
— outcomes for looked after children: transforming
data into management information.
— outcomes for children in need: an in-depth study
of babies who entered care and accommodation before their first
birthday.
Other outcomes-related development work includes projects
to:
— help local authorities make better use of information
on children in need.
— link the Looking After Children materials
with those related to the new Framework for Assessment of Children
in Need and their Families to develop the Integrated Children's
System.
DETAILED INFORMATION
ON RESEARCH
DEVELOPMENTS LISTED
ABOVE
1. Research Initiative: Valuing People: Inclusion, Partnership
And Services
Background:
Valuing People set out the government's plans for
better services for people with learning disabilities. In the
autumn of 2000, the Department of Health announced a £2 million
funding initiative for research to inform and assess the implementation
of Valuing People. A total of 144 initial research applications
were received, with ten being initially selected for funding.
These reflect between them the central themes of: Inclusion, choice
and control, quality services and making change happen.
Projects:
The following three studies have a central focus on the assessment
of the impact and effectiveness of services:
— An Evaluation of the Impact of Person Centred
Planning Provider: Institute for Health Research, University
of Lancaster. The study will examine the impact of person-centred
planning (PCP) on the quality of life of people with learning
disabilities, in respect of their independence, social inclusion
and health status. Analysis will be made of the organisational
factors that facilitate or impede the impact of PCP. Start: 1
November 2001. Duration: 36 months.
— Effectiveness of Cognitive-Behavioural Treatment
for Men with Learning Disabilities at Risk of Sexual Offending.
Provider: Tizard Centre, University of Kent at Canterbury. This
study will examine the extent to which cognitive behavioural group
treatments that have been proven to be effective with the male
population generally are effective with males who have learning
disabilities. Start: 1 November 2001. Duration: 12 months.
— Developing Measures of Core Competencies and
Job Performance in Residential Support Staff Working with People
with Learning Disabilities. Provider: Institute for Health
Research, Lancaster University. This project seeks to develop
a set of core competencies for residential support workers in
consultation with service users/relatives, residential support
workers and managers. Based on these competencies, parallel job
performance measures will be devised to develop an evidence base
for the assessment of job performance. Start: 1 October 2001.
Duration: 15 months.
Service User Involvement:
From the outset, the research initiative has reflected the
participatory approach of Valuing People by involving individuals
with learning disabilities and their carers/supporters in all
stages of the process. In addition to their involvement in the
commissioning process, people with learning disabilities are members
of the reference group overseeing the progress of the initiative,
with full support and funding being provided as necessary. A group
of learning disabled researchers has been commissioned to work
with those people with learning disabilities who are being involved
in each of the individual research teams and describe the nature
and quality of their involvement in the research. Their summary
of this experience, and recommendations about good practice in
respect of the involvement of learning disabled people in research,
will form part of the final overview report on the work.
A central objective is to ensure the direct flow of information
from the research to those who can influence policy and practice.
As this may not need to await the completion of the projects,
an infrastructure is being established from the outset to communicate
the early findings of ongoing work to relevant audiences. These
emergent findings, moreover, may not be the product of researchers'
perspectives alone, but may be generated in partnership with people
with learning disabilities.
2. PSSRU RESEARCH
ON COST,
EFFECTIVENESS AND
OUTCOME
Exploration of the Links between Commissioning Arrangements
and Performance and the Costs and Consequences of Different Commissioning
Arrangements
Research Provider: PSSRU at the University of Manchester
Abstract: Commissioning behaviour is at the heart
of the mixed economy of care, being the means by which local Councils
turn local and central government plans into action. Surprisingly,
relatively little is known however about current commissioning
arrangements. The PSSRU team is undertaking regular comprehensive
surveys of social care commissioning arrangements in English local
authorities. Based on these data, and routine collections undertaken
by the DH and other bodies, the team will undertake two related
research investigations:
— an examination of the relationship between commissioning
arrangements (at local authority and provider levels) and performance
(market or locality-wide and provider-specific) and the changes
in this relationship over time, focusing on residential services
in the first instance. Analysis will be largely statistical, including
regression and cluster analysis. There will be a need to check
the robustness of categorical proxy variables.
— a comparative assessment of the costs and consequences
of a range of different commissioning arrangements, based on calculations
of authority-level total transaction costs (by client group) and
the labour and capital inputs of local commissioning activity.
Multiple regression analysis will then be used to map the relationship
between the magnitude/type of inputs and the costs of commissioning.
The Relationship between Costs, Efficiency and Service Outcome
Research Provider: PSSRU at the University of Kent
Abstract: This work represents a new strand of the
long-term funded programme on the Costs and Outcomes of Social
Care. If the new national Performance Assessment Framework is
to provide incentives for local Councils to improve efficiency
and the quality of outcomes, it should contain indicators of cost
and outcomes that provide clear messages about relative efficiency.
Currently the indicators used are generally "proxy"
indicators, focused largely on process rather than outcome, raising
concerns about the interpretation of any observed variations in
unit costs. The drive to improve efficiency may result in unmeasured
drops in quality, while missing genuine efficiency gains. The
current project aims to improve understanding of how to improve
efficiency whilst maintaining or improving key aspects of quality
and outcome. In the first instance, the research will look at
efficiency in home care services, but will subsequently extend
across a range of services, guided by policy and practice requirements.
The work will employ a mixed method approach, combining literature
reviews, secondary data analysis and discrete choice conjoint
analysis with a range of statistical and econometric modelling
techniques.
Outputs and dissemination: The work should be completed
by December, 2003. It will contribute to the derivation, interpretation
and development of performance indicators and more generally improve
the measurement and wider understanding of the relationship between
cost, quality and outcome. A series of reports to the DH will
describe the results of key stages in the research.
3. Research and Development Work on User-Focused Social
Care Outcomes
Research provider: Social Policy Research Unit at
the University of Kent. The SPRU has undertaken a long-standing
programme of research and development on ways to incorporate the
views and experiences of service users into outcome measures and
to implement these measures in routine practice. Three new research
studies have developed from this work:
Development of Outcome-based Care Management and User Surveys
This involves the production of a resource pack, containing
evidence-based guidance and practical resources, to encourage
the development of an "outcomes focus" in social care
practice and information systems. It addresses two key areas of
activity:
Care management: seeking to integrate models of best
practice, including a person-centred approach, with the routine
collection of evidence on the impact of services;
Feedback from users and carers: developing ways of
surveying users/carers in ways that focus meaningfully on outcomes
(rather than satisfaction). Developed in conjunction with two
local authorities, the aim is to contribute directly to the modernisation
agenda by assisting those responsible to:
— refocus individual practice and service provision
on outcomes that are of greatest significance to users and carers;
— develop their performance management systems
to incorporate the collection, interpretation and use of outcomes
information.
Outcomes for Disabled Service Users
This project is about improving the quality of services for
people of working age with physical or sensory impairments by
the development and testing of tools for incorporating a greater
focus on outcomes in assessment and review. The proposal builds
on three previous pieces of work undertaken by the SPRU:
— research examining the views of disabled people,
staff and managers on outcomes;
— working with older people to identify and record
intended outcomes at assessment and produce tools to support care
managers;
— surveying the outcomes of equipment and adaptations.
Tools suitable for practice with disabled people of working
age will be developed collaboratively with the involvement of
all local stakeholders, subject to trial implementation and feedback
from all involved. Once developed, the effectiveness of the tools
will be compared with more conventional approaches.
Outcomes for Disabled Children and their Families
There is little research on the outcomes that disabled children
and their families seek from support services. Whilst the Looked
After Children (LAC) system provides an initial framework within
which to investigate such outcomes, there are problems with its
applicability to disabled children, whose development may be compromised
in one or more areas by their impairment. Building on the LAC
framework and earlier SPRU research with adults, the study has
four central aims:
— to identify desired outcomes of social care from
the perspectives of disabled children and their parents;
— to explore managers' and practitioners' perspectives
on outcomes;
— working with local authority staff, children and
parents, to develop ways of collecting outcome information that
can be used in practice;
— to pilot and evaluate the use of outcomes assessment
in practice.
4. Dissemination of the Messages from the "Outcomes
Of Social Care For Adults" [OSCA] Research Initiative
Background: Commissioned in 1997-98, the OSCA Initiative
comprised thirteen research studies focusing on outcome measures
in social care adult services. It was complemented by related
work undertaken by the Social Policy Research Unit [SPRU] as part
of its DH funded programme. The studies approached the subject
of outcomes in various ways: some dealt with the conceptual problems
involved in the definition of outcome measures in social care,
some set out to develop new, or evaluate existing, measures, others
focused on the assessment of outcomes in specific adult services.
One examined the role played by systematic reviews in developing
evidence-based policy and practice more generally.
Studies:
— Developing a measure of outcomes of social care
for elderly people: PSSRU, University of Kent
— Subjective and objective quality of life assessment,
Applied Research Unit, University of Wales;
— Carers' and users' expectations of mental health
services [CUES], Royal College of Psychiatrists;
— Dementia Action Research and Education [DARE],
University of Wales;
— The management and effectiveness of home care
assistants, SWRADU, University of York;
— Goal attainment in community learning disability
services, Mancunian Community Health Trust;
— Outcomes in social care practice, SPRU, University
of York;
— 12 years On: the Outcomes and Costs of Community
Care, Tizard Centre, University of Kent;
— Carers' needs and the impact of the Carers' Act,
SPRU, University of York;
— The routine use of a standardised assessment for
measuring outcomes, Centre for Health Service Studies, Kent;
— The role of systematic reviews in developing evidence,
University of Salford;
— Costs and outcomes of alcohol detoxification services,
N. Regional Alcohol and Drug Service;
— Integrating social and health care for older people
and their carers, National Institute of Social Work;
— Caring relationships over time: predicting outcomes,
SPRU, University of York.
Findings:
The main findings of the studies are described below under
three headings: "developing outcome measures"; "implementing
outcome measurement" and "evaluating service outcomes".
Defining Social Care Outcomes
— outcomes in social care are inherently contestable;
it is important therefore to involve the full range of stakeholders
(especially service users/carers) in their definition and assessment,
even though this is methodologically challenging;
— outcomes in social care are multi-dimensional
and, insofar as they involve inputs from more than one professional
group/agency, it may be difficult to isolate the particular aspect
of any intervention that leads to change or improvement;
— it is important to differentiate maintenance outcomes
(where there is no end point to the intervention and the objective
is to maintain existing levels of health/social functioning) from
change outcomes (where there is an identifiable end point and
the opportunity to assess achieved change against desired outcomes);
— process outcomes (focused on service delivery)
are as important to many service users as change outcomes and
may provide the concepts of need etc against which a service can
be judged;
— outcomes can be differentiated by whether they
operate at the individual (eg improved personal social care) or
aggregate (eg more accessible and consistent services) level;
— it is possible also to identify both "subjective"
(meanings) and "objective" (observations) measures;
focusing only on subjective measures may be difficult with some
service user groups due to low expectations or issues of comprehension,
memory and/or expression.
Implementing Outcome Measurement
— there is a range of ways in which outcome measures
can be used in practice, including assessment/review, the aggregation
of individual data for strategic planning and the comparison of
different service models;
— measures could also contribute to cost-utility
analysis, in both research and service settings, in conjunction
with appropriate costing information;
— it is possible to maximise the involvement of
service users with learning disabilities via individualised approaches
involving collaboration with speech and language therapists, within
a total communication strategy;
— it also proved feasible to apply a self-rated
measure of the expectations and experiences of users in mental
health services, although this was not tested as an measure of
outcome impact over time;
— the use of the minimum data set-home care (MDS-HC)
proved practicable, albeit with social work reservations about
the medical model on which it was seen to be based;
— the use of Goal Attainment Scaling in community
learning disability services was not successful, proving slow
and difficult to use and of little obvious benefit to staff and
service users; it did however appear to encourage a greater "outcome
discourse" at all service levels;
— changing a service culture from a process/activity
focus to an outcomes focus takes time; introducing such a focus
into care management took two years from initiation to implementation,
and longer to enter routine practice;
— to facilitate implementation, measures should:
demonstrate clarity of purpose and the benefits of their use;
minimise the demands on social care staff and maximise their sense
of ownership of the measures used; be clearly written and easily
understood; reflect issues important to service users/carers;
be tailored to local needs and circumstances purpose rather than
general "blueprints";
— barriers to implementation include: the limited
capacity of local authorities to analyse and interpret data; the
lack of incentive structures and management ownership/support
or, conversely, the perception that the measures are a "management
tool", imposed from above; involve tools that are too highly
structured with too medical a focus.
Evaluating Service Outcomes
— characteristics of residential services associated
with better outcomes included: "homeliness"; community
integration, an individual orientation and high levels of staff
attention;
— after controlling for resident characteristics,
private sector provision appeared less likely to deliver positive
outcomes than statutory provision but there appeared to be no
association between quality of outcomes and size of the residential
setting or staff-resident ratios;
— early primary care interventions for people with
dementia and their carers did not appear to be associated with
improved outcomes; effective targeting of interventions was difficult
to achieve as was establishing the effects of early intervention;
— in particular, there is no support for the idea
that screening for dementia will identify a population receptive
to psychosocial intervention;
— the role of dementia care specialist appeared
to be of value however; intervention with those with acknowledged
difficulties is likely to be more productive and any intervention
that successfully delays residential placement, without adding
to carer strain, is seen to be worth pursuing;
— the influence of home care organisers and individual
home care staff on the quality of home care services was greater
than that of higher level management; this may make it difficult
for an organisation to influence the quality of outcomes;
— the levels of user satisfaction with home care
services were generally high, despite major variations in the
organisational characteristics of providers; concerns related
to the lack of reliability, the amount of help provided and the
speed with which it was given, the lack of predictability of,
or control over, which workers arrived;
— assuming the role of carer is associated with
adverse effects on the individual's mental health, with increased
levels of psychiatric distress that disproportionately affect
women and rise progressively with the number of hours spent caring;
— few carers knew of their right to an assessment,
most lacked awareness that an assessment had taken place, were
inadequately consulted about the assessment arrangements, experienced
difficulties in completing self-assessment forms and/or felt that
little consideration had been made of their willingness to continue
caring;
— carers wanted the assessment process to be more
explicit, to be given sufficient information and time to prepare
for it, to have an informed choice in respect of separate assessments
and for forms not to be used as a substitute for discussion.
— the long-term provision of community care services
for adults with learning disabilities or mental health problems
appears overall to have been cost-effective and good value for
money;
— the most frequently reported positive aspects
of these service users' quality of life were the living environment,
the social milieu and independence; the most frequently reported
negative aspects were bullying, the social regime and physical
condition of the social milieu and feelings of loneliness and
boredom;
— many receiving care in the community could not
answer a question about their future; those that could wished
for greater independence, more outings and the need for sexual
and personal relationships;
— the most important service development issue in
both learning disability and mental health concerned the changing
demands associated with ageing;
— systematic reviews of social care outcomes require
an integrated approach that combines both the causally oriented
research characteristic of much health research with studies that
examine the context, meaning and perceptions of participants.
Dissemination
A final overview report has been produced, that brings together
the findings from the individual studies and identifies the key
policy messages. This, and stand-alone executive summaries, will
be disseminated widely to policy and practice audiences. A series
of regional workshops will also be held.
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