Invited plenary presentation, Technical Forum, National Institute for Health and Clinical Excellence, London 18 April 2011
Social care services, which include care and support in private households and care homes, are concerned with primarily with compensating for the effects of health states on individuals rather than changes in those health states. Current QALY indicators are based on health-related quality of life (HRQOL) measures that do not distinguish the impact of such interventions. The Adult Social Care Outcome Toolkit (ASCOT) provides a variety of techniques to capture the outcomes of social care. The measure generated is intended to provide a utility index that captures all domains relevant to social care interventions and have credibility in the social care community.
A series of projects have fed into the development of the toolkit and measure. The presentation will draw on these to describe the conceptual underpinnings of the basis for the measure: social care related quality of life (SCRQOL), the eight domains or attributes of the measure and how the response options are intended to reflect both ‘functionings’ and ‘capabilities’. Innovative approaches developed to meet some of the particular challenges in terms of attribution and establishing outcome in social care establishing outcomes in social care will be described and illustrated.
A number of studies have been undertaken to investigate and establish preference weights for the measure. Most recently an HTA funded project (currently under peer review) included a survey of the members of the general population and service users using Best Worst Scaling (BWS) techniques. In addition, a Time Trade-Off (TTO) exercise was undertaken with a subsample of members of the general population that had participated in the BWS survey, in order to anchor the scale to 0 ‘being dead’ and 1 ‘ideal’ SCRQoL state. The preference weight estimates from these exercises and previous work are very consistent, giving us some confidence in the final estimates, which are based on a nationally representative sample of about 1000 members of the general population.
Since ASCOT was launched with a variety of instruments and provisional weights in June 2010 there has been considerable national and international interest. From 2011, the items form part of the Adult Social Care Survey (ASCS), which is undertaken annually by local councils. The equally weighted measure and two of the items that make it up have been proposed as part of the Adult Social Care Outcomes Framework (ASCOF), proposals that received considerable support in a recent consultation exercise. This should provide a valuable source of comparative data in the future, but there are risks attached. Further work is needed to develop further ways of establishing outcomes for groups currently excluded and to facilitate use and interpretation of the measure, but ASCOT does provide us with the basis for a ‘social care QALY’.