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Performance measurement in adult social care: looking backwards and forwards
- Author:
- CLARKSON Paul
- Journal article citation:
- British Journal of Social Work, 40(1), January 2010, pp.170-187.
- Publisher:
- Oxford University Press
Approaches arising from the publication of performance data for adult social care in the UK nationally have led to unintended and often perverse consequences. A case is made in this paper for examining locally-based models, which offer substantial benefits to both managers and practitioners, and by extension, service users. Whilst there is no shortage of statements outlining the intentions behind monitoring performance in this setting, actual evidence as to its benefits is lacking. Different approaches to performance measurement (both in the UK and elsewhere) and their relevance to recent debate, particularly that which advocates the wholesale abandoning of performance monitoring, are examined. This review of existing evidence, as opposed to rhetoric, suggests that a different approach, involving the local collection and interpretation of data, offers an opportunity for workers to foster a culture of enquiry. Such a change in emphasis may require the implementation of a different set of incentives to those previously in operation.
Systematic review: effective home support in dementia care, components and impacts - Stage 2, effectiveness of home support interventions
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Journal of Advanced Nursing, 74(3), 2018, pp.507-527.
- Publisher:
- Blackwells Publishing
AIM: The aim of this study was to explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research. BACKGROUND: Most people with dementia receive support at home. However, components and effectiveness of home support interventions have been little explored. DESIGN: Systematic review with narrative summary. DATA SOURCES: Electronic searches of published studies in English using PubMed, Cochrane Central Register of Controlled Trials, PsychINFO, CINAHL, Applied Social Science Index and CSA Social Services Abstracts. Databases and sources were searched from inception to April 2014 with no date restrictions to locate studies. REVIEW METHODS: The PRISMA statement was followed and established systematic review methods used. Using 14 components of care for people with dementia and their carers, identified previously, data across studies were synthesized. Interventions were grouped and described and effectiveness ratings applied. Qualitative studies were synthesized using key themes. RESULTS: Seventy studies (four qualitative) were included. Most were directed to carers and of high quality. Seven interventions for carers and two for people with dementia were identified, covering 81% of studies. Those relating to daily living, cognitive training and physical activity for people with dementia were absent. Measures of effectiveness were influenced mainly by the intensity (duration and frequency) of interventions. Those containing education, social support and behaviour management appeared most effective. CONCLUSION: These interventions reflect emergent patterns of home support. Research is required to identify effective interventions linked to the stage of dementia, which can be applied as part of routine clinical care. (Edited publisher abstract)
Priorities for long-term care resource allocation in England: actual allocation versus the views of directors of service and older citizens
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Journal of Long-Term Care, September 2018, pp.13-23. Online only
- Publisher:
- King's College London
- Place of publication:
- London
Context: Decisions about resource allocation in long-term care are a perennial issue. The basis for deciding between different needs in prioritising allocation is contested. In England, this debate has crystallised with the advent of selfdirected support, where individuals’ expressed preferences drive resources. Objectives: To compare perceptions of the priority given to needs for resource allocation in long-term care of older people by two stakeholder groups, compared with actual resource allocation. Methods: Survey data, eliciting perspectives of senior service managers and older citizens, were used to rank the perceived importance of eight needs-related outcomes. Actual resource allocation from 17 local authorities was also modelled against these outcomes. A variable importance metric was used to rank the importance of these outcomes in determining actual resource allocation. Findings from each data collection were compared. Findings: Differences in prioritisation of needs emerged between stakeholders compared with actual allocation. Older citizens and actual allocation prioritised basic and instrumental activities of daily living (ADLs). Directors’ rankings were more distinct, still prioritising basic ADLs, but ranking psychological well-being higher and instrumental ADLs lower. Limitations: The model of actual allocation could not account for political and bureaucratic factors influencing resource allocation, nor the complexity of certain needs that might incur greater resources. Implications: Discretion continues to influence resource allocation, which remains a contested area. Directors must account for overall spend and other extrinsic factors to maintain sustainability, whereas older citizens prioritise instrumental ADLs, despite these being considered lower priority in eligibility decisions. Overall, ADLs remain important drivers of allocation. (Edited publisher abstract)
Healthcare support to older residents of care homes: a systematic review of specialist services
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 19(1), 2018, pp.54-84.
- Publisher:
- Emerald
Purpose: A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues. Design/methodology/approach: This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness. Findings: In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161). Originality/value: There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners. (Publisher abstract)
Overview of systematic reviews: effective home support in dementia care, components and impacts - stage 1, psychosocial interventions for dementia
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Journal of Advanced Nursing, 73(12), 2017, pp.2845-2863.
- Publisher:
- Blackwells Publishing
Aim: To synthesize evidence to identify the components of effective psychosocial interventions in dementia care to inform clinical practice, policy and research. Background: With population ageing, dementia represents a significant care challenge with 60% of people with dementia living at home. Design: Overview of systematic reviews with narrative summary. Data sources: Electronic searches of published systematic reviews in English using Cochrane Database of Systematic Reviews, DARE and EPPI-Centre, between September 2013 - April 2014. Review methods: Systematic reviews were appraised against Cochrane Collaboration levels of effectiveness. Components of psychosocial interventions were identified with their theoretical rationale. Findings were explored with a Patient, Public and Carer Involvement group. Results: Thirty-six systematic reviews were included. From interventions, 14 components were identified, nine for people with dementia and five for carers, mostly undertaken in nursing/care homes. For people with dementia, there was evidence of effectiveness for cognitive stimulation and cognitive training, but less evidence for sensory stimulation, reminiscence, staff education, behavioural therapy and ADL training. For carers, there was evidence of effectiveness for education and training, psychotherapy and counselling. Conclusion: There was a lack of definitive evidence of effectiveness for most psychosocial interventions. Further studies with stronger methodology or replication of existing studies would strengthen the evidence base. Few interventions were undertaken with people with dementia and their carers living at home. Further work will investigate the extent to which components identified here are present in models of home support for people with dementia and carers and their effectiveness. (Edited publisher abstract)
Cost-effectiveness of a pilot social care service for UK military veterans
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Journal of Care Services Management, 7(3), 2013, pp.95-106.
- Publisher:
- Taylor and Francis
This paper investigates the cost-effectiveness of a pilot social care service for military veterans, a group relatively ill-served by traditional forms of social and health care. The service involved caseworkers signposting veterans, experiencing multiple difficulties, to sources of advice designed to assist with issues such as employment and training, education, debt, legal problems, and housing. Routinely generated data were collected on 202 veterans, concerning their characteristics, types of problem, and resources identified, and on a sub-set (n = 21) of these, regarding their outcomes in terms of well-being, measured by routine administration of the General Health Questionnaire. Costs, in terms of caseworkers' time commitments, were modelled across this sample of veterans. The additional costs as against the additional effects of the service, against usual care (the standard primary care response to this population), were modelled in terms of the Incremental Cost Effectiveness Ratio. There was a statistically significant reduction in symptoms after receipt of the service at an average cost of £155 per unit improvement in well-being. Analysis of uncertainty revealed a high probability of cost-effectiveness when set against a benchmark value of standard social care for adults. These findings are discussed in terms of the future priority given to the after-care of veterans, in particular regarding social care interventions, which remain under-evaluated. (Publisher abstract)
The identification and detection of dementia and its correlates in a social services setting: impact of a national policy in England
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 11(5), September 2012, pp.617-632.
- Publisher:
- Sage
Policy addressing the under recognition of dementia has tended to focus on the role of general practice-based staff. But, the authors believe closer collaboration between community health and social services could reap benefits. This study examined the impact of a national policy in England, the Single Assessment Process (SAP), introduced across these agencies from April 2004, aimed at improving assessments by the use of shared procedures and assessment tools. Impact of the policy was measured in terms of the reliability with which dementia, and associated conditions, were identified and correctly detected in Manchester’s statutory community care assessments. Recognition of dementia, grooming, toileting and incontinence difficulties were significantly improved after the policy. However, depression was an exception. Existing communication difficulties made it more likely that dementia would be identified and correctly recognised. The findings from this study confirm a general improvement in the reliability with which dementia and associated difficulties were detected within statutory community care assessments in one area after the introduction of the SAP in England. This is discussed in terms of more closely involving care managers in detecting dementia.
Involving specialist clinicians in policies for integrated care
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Journal of Integrated Care, 19(6), 2011, pp.14-22.
- Publisher:
- Emerald
Drawing on a survey examining the impact of the Single Assessment Process for Older People, a policy aimed at integrating assessments, this article discusses issues concerning the involvement of clinicians in integrated approaches to assessment. Cross-sectional surveys of specialist clinicians (geriatricians and old age psychiatrists) were undertaken in 2004 and 2005 as part of a study examining the initial impact of the single assessment process. This article presents a review of the data, exploring the involvement of specialist clinicians in assessment practice. It reports that clinician involvement was limited, with changes to assessment predominantly related to paperwork, and little involvement of older people. The authors suggest that clinicians have previously not been engaged in policies around integrated assessments, that factors that can help engagement include development of a shared vision and appropriate systems to promote information sharing, and that there are lessons to learn in terms of the factors that may help or hinder the achievement of integrated practice.
Targeting, care management and preventative services for older people: the cost-effectiveness of a pilot self-assessment approach in one local authority
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- British Journal of Social Work, 40(7), October 2010, pp.2255-2273.
- Publisher:
- Oxford University Press
This paper details a pilot project in a local authority that aimed to target access to assessment for older people with low needs who would normally have failed eligibility thresholds. Self-assessment was used where these older people could identify their preferences for a range of preventative services. The study evaluated the costs and benefits, in terms of reported satisfaction, of the approach compared with the usual care management assessment. Although self-assessed cases were offered more advice as to a wider range of preventative services, which generated greater costs, total costs were lower for this group. This cost saving arose from the use of staff with a lower unit cost who also spent less time on administrative duties and gathering information. Satisfaction with self-assessment was comparable to a professional assessment, therefore representing a cost-effective approach. The project offered evidence of how councils can target resources through assessment and how self-assessment approaches may be appropriately configured to offer value for these users.
Comparing how to compare: an evaluation of alternative performance measurement systems in the field of social care
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Evaluation, 16(1), January 2010, pp.59-79.
- Publisher:
- Sage
This article provides an overview of performance measurement systems and compares the different performance measurement systems in practice for older people receiving community care services in England, Northern Ireland and Japan. Over time, there have been changes in England with current systems concentrating on national systems of regulation with top-down implementation of standards and measures. In contrast, Northern Irish organisations are compared descriptively without the use of national targets. A third type of approach used in Japan, with organisations providing similar services utilising local information collected in a bottom-up manner, used service user generated data. The authors use the Performance Indicator Analytical Framework, a ‘logic model’ which compares the different systems in use, concentrating on aspects of system design and the use of measures. Comparing how to compare must, say the authors, be sensitive to the different aims ascribed to performance evaluation in the three countries. In England, the aim is one of control of subordinate agencies by central government while in Northern Ireland description of the complexity of outputs allow local Trusts to compare their provision with others and plan locally. In Japan, monitoring of the long-term insurance system by the municipalities provided detailed data at the local level. The authors conclude the choice of performance measurement system can constrain or enhance relationships with other evaluative activities, thereby affecting social care provision.