Measuring the outcomes of low-level services: final report

<p>Decisions about how limited resources are used in social care must reflect some underlying set of aims and objectives that act to prioritise which people with needs receive support, the form of this support, and its intensity. The Government and the sector have clearly signalled that a key aim should be the improvement of the <em>outcomes</em> of people using services (Commission for Social Care Inspection, 2006; Department of Health, 2006; Office of the Deputy Prime Minister, 2006; Wanless, 2006). Broadly speaking, outcomes are the valued consequences of social care support for service users and other people. The outcome of service use in this case is the improvement in <em>wellbeing</em> that people experience. Therefore, measuring wellbeing outcomes, rather than units of service <em>outpu</em>t (e.g. the numbers of care home placements), gives us a much better indication of <em>value</em>. Estimates of the value of services and support can then be set against their costs to inform <em>cost-effectiveness</em>, access and equity issues when prioritising resource use. In particular, an outcomes measure would have at least three uses in social care:

<p><p><ul><p><p> <li>to allow outcomes-based commissioning</li><p><p> <li>to support the regulation of providers of social care that ensures a minimum standard of care according to the outcomes the care generates for service users</li><p><p> <li>to allow the National Accounting of social care spending to be adjusted for the outcomes-related quality of care provided</li><p><p></ul><p><p><p>The challenge is finding a way that enables us to robustly and consistently measure outcomes, where we anticipate that social care can impact not only on people&rsquo;s personal care, dignity and safety, but also on their emotional wellbeing and quality of life more generally. The focus for this project is on how outcome tools can be developed and applied to low level services. Other PSSRU projects in the Quality Measurement Framework (QMF) project are considering applications to care homes and to information and advice services. The QMF project is being jointly funded for three years by the Treasury under Invest to Save and by the Office of National Statistics (ONS). &nbsp;

<p><p><p>The focus on low level services is highly relevant because these services impact on the more intangible outcomes, but very little research has been undertaken in this area. More intensive services, such as care home services, have a stronger <em>prima facie</em> impact on personal care outcomes even if to date there has been little research work actually quantifying the impact. Care home services impact on the more fundamental outcomes, such as being clean, fed, and transferred out of bed or out of a chair. Low level services do not attend so closely to these basic needs, but offer potential outcomes by improvements in people's social life, activities, sense of independence and so on. There is also an argument that low level services can have a &lsquo;preventative effect&rsquo;, that is, rather just helping people to overcome impairment and need, they help delay the onset of greater need by encouraging people to stay independent and give people the confidence to undertake activities of daily living by themselves (see annex 1). However, while low level services are important the present prioritisation of resources by councils (e.g. applying eligibility criteria on the basis of need) imply relatively low resourcing of these services.