Calls for an overhaul of the social care system were back in the headlines last week after a short absence, with the publication of a new report from the King’s Fund which revealed links between poor community care and high rates of emergency hospital admissions for the elderly.
Interestingly, the King’s Fund report found that those PCTs with lower rates of hospital bed use also had the highest rates of patient satisfaction with social care services provided in the home. As health and social care services move towards a more integrated way of working, using composite sources of information in this way to build an accurate picture of the holistic ‘patient experience’ (ie which crosses both health and social care services) will become increasingly important and meaningful.
MHP Health Mandate’s recent report, An atlas of variations in social care, exposed the variations that exist in people’s satisfaction with care services, as reported in the Adult Social Care Survey and Personal Social Services Survey of Adult Carers in England. The report found a 20% difference between the best and worst performing local authorities in the proportion of people describing themselves as either ‘extremely satisfied’ or ‘very satisfied’ with the care and support services available to them. In addition, only 54% of carers reported that they were either ‘extremely satisfied’ or ‘very satisfied’ with the support or services both they and the person they cared for received from social services.
Last month’s publication of the Care and Support White Paper shed some light on how the Government intends to tackle these problems. The White Paper makes clear commitments to transforming people’s experience of care and support, acknowledging the linkages between the three key components of a high quality care system: safety, effectiveness and a positive experience of care. In short, you can’t (and shouldn’t attempt to) achieve success in one area without the other two. In practical terms, the Government has committed to strengthening the ways that people can provide feedback on their experiences of care and support and ensuring that people are empowered to choose the care and support that “best enables them to meet their goals and aspirations”.
Recognising the linkages between safety, effectiveness and a positive experience of care is absolutely crucial in building a rounded picture of personal experience, across both health and social care services. With this also comes the challenge of ensuring that the information that is collected via surveys and feedback websites is helpful and provides a useful basis for formulating a targeted response to specific problems in the future.
One of the key challenges highlighted in An atlas of variations in social care around measuring improvements in social care user experience is that different service users will have different wishes for the outcomes resulting from their care. These outcomes are unlikely to be easily captured through a generic form such as the Adult Social Care Survey. One of MHP Health Mandate’s key recommendations was therefore that the NHS Information Centre should look to develop both social care reported outcome measures and social care reported experience measures to ascertain the quality of outcomes and experience of social care services from a user and carer perspective.
The Government’s information revolution in health and care has a long way to go before its impact will be apparent in social care. The inadequacy of current data collection on social care user and carer experience is illustrated by the relative difference in the number of indicators included in Domain 4 of the NHS Outcomes Framework and the corresponding Domain 3 of the Adult Social Care Outcomes Framework (ASCOF); the former has ten indicators whilst the latter has just four. In addition, there are limitations to both the adult social care survey, whose coverage (although far broader than previous national approaches) is limited to people who receive state-funded social care and are known to the council, and the carers survey, which is also limited to those known to local authorities. As a result, the experience of those who have been failed by care services is simply not being captured. At a time when local authorities are struggling to deliver services within budget, there is a real danger that the information being collected about user experience isn’t telling us the real story.
Over the coming years, as the ambitions of the Care and Support White Paper (hopefully) come to fruition, and the wrangling over funding is (hopefully) resolved, the Government must ensure that user and carer experience is properly tracked and benchmarked, and that improvements are recorded across all four indicators in the third domain of the ASCOF. Without effective systems in place to capture information, resources can’t be directed where they are most needed.