Qureshi, Hazel,

1999,

Methodology

This paper discusses the findings of three studies, conducted by the Social Policy Research Unit in York, designed to investigate attitudes towards outcome information amongst social service managers, experts working in the field of outcomes and service user organisations.  The study of managers’ views involved group and individual interviews with 39 participants, not all of whom were social service managers – 8 were from community health services, the voluntary sector or user groups.  In the second study, expert views were obtained in a series of 5 seminars involving 50 participants.  The experts included service users, policy makers and managers.   Data for the first two studies were collected and analysed using qualitative techniques.  In the third study, a postal questionnaire was sent to 44 organisations for older people, disabled people and carers, with a response of 40.

The aim of the paper was to draw together selected findings from the three studies in order to discuss some of the underlying conceptual and policy issues raised in the studies.

Critical appraisal

The aim of the paper has been achieved.  The author predominantly reflects on complex conceptual issues surrounding social care that have already been documented, for example the numerous stakeholders with differing values of what should be considered an outcome.  She charts changes in policy that have been shown to have an impact on how outcomes are valued in social care, including the use of performance indicators, the purchaser-provider relationship and recently a move towards service user involvement in decision-making.  She then draws on the findings of the three qualitative studies in order to illustrate these conceptual and policy-related issues.

Very little information is given in this paper about the methodologies of the three studies, other than that qualitative techniques were used to collect and analyse the data.  It is not clear how the participants were chosen, and readers should be aware that the users and carers involved are articulate and in some cases were nominated by social service departments to take part in the studies.  In the third study, user organisations were canvassed which does not necessarily indicate that the voices of users themselves were heard.

As such, this paper cannot be considered as evidence of attitudes towards outcome information in social care as it represents the author’s opinions based on selected findings from the studies that fit with existing ideas in the literature.  Whilst one would need to review the individual studies reported here to determine the usefulness of findings in practice, the author highlights that the field of outcomes in social care is so complex and undefined that without considerable further research no firm conclusions can be drawn.

Key findings

Only selected findings from the 3 studies discussed were presented in this paper.  These were divided into 3 categories in the results section: Users’ views towards outcome information, managers’ views, and reasons why an outcome focus is not generally implemented in social care.

Users were reported to have a positive attitude towards the use of outcome information. They identified that outcomes should provide information about the impact of services on their lives, not just about the effectiveness of services at an organisational level. Outcomes were viewed as useful to highlight deficiencies and inequalities in service provision. Some users rejected the need for outcome information on the basis that if the user held their own care budget to spend as they wished, outcome measurement would not be necessary.

Managers valued consultation with users in evaluating the outcomes of social care.  They felt that just using outcome information to evaluate the cost-effectiveness of services was inadequate, but that they should be used to ‘test’ policy and practice achievements.  The process of care was seen as important to evaluate, not just the end result, for examples issues such as availability and choice of care.  Competition between providers of services was considered a reason for collecting information about outcomes.

Barriers to implementing an outcome-focused approach to social care included anxiety about assessment of effectiveness and accountability, conceptual and technical difficulties associated with evaluating the effectiveness of social care, and issues about the professional culture and organisation of social services. 

The author concludes that the implementation of outcome-focused care will be complex to achieve.  There are numerous stakeholders involved all with differing levels of power and knowledge.  She calls for further research and development in this field.

Social work practice/ policy implications

This paper is highly relevant to social work practice as it highlights the complexities surrounding outcome measurement in social care and barriers to its implementation in practice.  Practitioners will be encouraged to read that social service managers and service users may share similar attitudes towards the use of outcome measurement.  The paper also serves to demonstrate how social policy is increasingly driven by the involvement of service users and carers, although the author warns against making assumptions about their level of involvement and what their views might be