In 2011, the Department of Health asked PSSRU to undertake a project to (primarily) identify a means by which data collected during the annual Adult Social Care Survey (ASCS) could be used to generate a ‘gain’ measure that reflects the impact of social care support on service users’ quality of life. The very clear association between this new project – called identifying the impact of adult social care (IIASC) – and QORU activities led this project to be funded as a variation to QORU’s contract.
As outlined above, social care-related quality of life (SCRQoL) is the key outcome of social care services for adults with long-term illness, disability or needs associated with older age. The ASCS includes the Adult Social Care Outcomes Toolkit (ASCOT) measure of SCRQoL (Netten et al 2012; Malley et al, 2012), which is one of the overarching indicators in the Adult Social Care Outcomes Framework (ASCOF).
Unpaid (family/friend) carers play a crucial role in supporting individuals with social care needs, and the support of carers is a key policy objective. Carer social care-related quality of life is also included in the Outcomes Framework (ASCOF), but draws on a separate survey of carers conducted biennially by councils
On their own, measures of SCRQoL give an indication of overall experience of quality of life, but this is not clearly attributable to any one factor. To be a fairer measure for accountability in social care, the measure should be able to demonstrate the impact of services on quality of life. Ideally we need a ‘value-added’ (or ‘gain’) equivalent measure, which is able to distinguish the impact of services from other factors known to affect quality of life.
Aims and methods
The aims of the project were to:
- Develop a measure of social care-related quality of life (SCRQoL) ‘added value’ which reflects the impact of the support provided by councils on service users and uses data collected in the Adult Social Care Survey in order to minimise burden
- Explore the potential to reflect the ‘value added’ of the support provided on carers’ quality of life and the implications of this for measuring outcomes and attributing value to social care interventions
- Measure the validity and reliability of the carer SCRQoL measure
- Further test the validity of the ASCOT measure
The project comprised two strands:
Strand 1: IIASC development
In the first development stage we drew on the literature and previous work to identify ways to address the particular challenges of identifying and measuring carer outcomes. We tested the approaches developed through in-depth interviews with 31 unpaid carers in three local authorities.
Strand 2. IIASC: measuring the impact of social care
The findings of this first stage informed the second stage of the work: that is, main fieldwork and analysis. Local authorities in England were invited to participate. . In the 22 participating councils, services users (and where possible their unpaid carers) were interviewed to capture data on outcomes, service use, and socio-demographic characteristics. The data were analysed using multivariate regression analysis to explore and compare different methods of statistical ‘adjustment’ to derive a measure of the impact of social care on quality of life.
Timing and outputs
The project ran from January 2012 to December 2014. The results of the study should be valuable for the purposes of: informing the development, interpretation and use of measures in the Adult Social Care Outcomes Framework; and assisting local councils to make use of local ASCS data and the ASCOF.
Outputs include a final report with summary ‘findings’, as well as a planned series of topic-focused peer-review articles. In addition, the resulting dataset will provide a uniquely valuable resource for social care analysis and will be used in on-going research.
Julien Forder, Juliette Malley, Stacey Rand, Florin Vaden, Ann Netten, Karen Jones