Does spending more on adult social care result in higher social care related quality of life scores? Apparently not, suggests Adrian Scaife, Health and Social Care Programme Manager, Tunstall Healthcare UK.

There has been much written about excellent patient involvement initiatives from a health perspective. For example, Tim Kelsey’s blog.

Relatively little attention has been paid to user reported measures of social care. However, the annual Adult Social Care Outcomes Framework (ASCOF) includes a measure of user reported social care related quality of life. The measure is based on a stratified sample of 60,000 people receiving adult social care services from all councils with social services responsibility in England. The score is a composite measure based on questions related to eight domains (control, dignity, personal care, food and drink, safety, occupation, social participation and accommodation).

The ASCOF definitions handbook includes this comment:

The score will be influenced by a range of factors, one of which is the services provided by the authority. Some of the other factors that are likely to have had an influence are the needs of individuals, age and whether people receive informal care. Therefore, in its current form this measure does not solely reflect the impact of social care services but does capture people’s experience in aspects of life relevant to social care.

Having read this I wondered if the social care related quality of life score was related to adult social care expenditure. Intuitively, I expected higher quality of life scores to be related to higher expenditure on services.

Chart 1, below, plots each authority against the quality of life score and expenditure per adult on adult social care services. This includes expenditure on residential and nursing care, home care, direct payments and day services. (Here is a full description.) In total this accounts for £13.7bn of expenditure. This of course makes a number of assumptions, notably that funding allocation for service provision is fairly distributed across all authorities. A similar measure has been used in the Audit Commission Value for Money Profiles.

Chart 1 QoL

Contrary to expectations each local authority data point appears to be randomly distributed and plotting a line of best fit shows no real relationship between the two factors. (An r2 score of 1 means that the line accounts for 100% of the variation in the data and is a perfect fit.)

Looking at the graph there are an interesting group of authorities that appeared to have high quality of life score and low expenditure per head. This is better illustrated in Chart 2, below.

Authorities in the top left quadrant have higher quality of life (QoL) scores and lower spend per head when compared to the England average. In effect these authorities could be described as delivering the most effective services per £1 spent. A somewhat crude and perhaps blunt measure of effectiveness…

Chart 2 LAs

So, who are the top performers? While a little subjective I have tried to identify the top 10 authorities that appear to be furthest from the English average in this top left quadrant.

(Download a complete listing of all authorities.)

Top 10 v 2 8

The big question that remains is how do these organisations ensure high levels of customer satisfaction while at the same time spending less per head on services and what can we learn?


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