Sue's background

Sue has undertaken many different projects in the field, including an evaluation of one of ExtraCare's villages and writing a technical document for professionals on the provision of care in extra care housing. In the past, Sue has worked for local authority social services departments in various posts, and then for a specialist housing provider which had an extensive housing with care programme. For more information about her background and experience, you can visit her website at www.suegarwood.co.uk

Study Background

In recent years, the government has changed the way in which social services provide and fund social care, and this affects the arrangements that ExtraCare has with some of our local authority partners.

Recent social policy emphasises that individuals should have as much choice and control as possible over the services they receive to meet their support needs. This whole policy shift is called "personalisation". A key aspect is that, in the future, people who are eligible for support from social services will be given a personal budget - an amount of money to be used to buy services of the individual's choice to meet the outcomes that have been agreed in their assessment. This budget can either be given in the form of a "direct payment" (a transfer of the amount in the personal budget directly to the person to buy services) or it can be a "managed budget", or a mixture of both. In a "managed budget", the individual knows how much money can be spent, and can choose how to spend it, but the money is not actually transferred to the individual.

Previously, in housing with care developments such as the villages run by the ExtraCare Charitable Trust, the local authority typically "block contracted" (bought in a block) all the care to be provided at the village from a single provider. In the case of the Extra Care Charitable Trust this was usually a fixed number of care packages in each of four or five bands.

St Oswald's Village is the first of ExtraCare's villages where instead of a block contract, residents who are eligible for care funded or subsidised by social services are receiving it in the form of a personal budgets. Residents can use their personal budget on services provided by ExtraCare or choose a different provider.

This new way of purchasing care can have an effect on various aspects of the service.

The study Sue is undertaking is going to compare the service at St Oswald's Village with the previous block-contracting approach to see how it affects the provision of the services, and the people who use them. The village being used for the comparison is Beacon Park Village in Lichfield.

The Research Questions

The following are the questions that the study will be designed to answer:

St Oswalds

• What is the take-up of care and support via personal budgets at St Oswald's, and what are the deployment  mechanisms (i.e. managed budget or direct payment or mixture)?
  
  
• How are residents using their personal budgets, which providers are they choosing and are the budgets being used in full to meet their care and support needs?
  
  
• What is the profile of care package levels being delivered at St Oswald's by ExtraCare?
  
  
• What is the impact of personal budgets and hours-based contracts on:
  
  1. Individual personal budget holders;
  2. Type, level and quality of services provided by ExtraCare?

Both St Oswald's and Beacon Park Village

• How do the outcomes compare for:
  
  1. A resident at St Oswald's using his/her personal budget to purchase support from ExtraCare;
  2. A resident at St Oswald's using his/her personal budget to purchase support from an alternative provider, and;
  3. A resident supported under the banded block contract system applied in other ExtraCare villages?

• What are the advantages and disadvantages of the personal budget-based approach to care and support procurement and delivery, compared to the block contracted band approach, including;
  1. Levels of flexibility and responsiveness in service delivery
  2. Degree of flexibility in the nature and range of services that can be purchased/provided using social services funds - how holistic is it?
  3. Effect on quality
  4. Perceived cost-effectiveness and value for money
  5. Supporting independence, choice and control
  6. Service user satisfaction and outcomes

In the context of personal budgets, the findings of the study will be used to help ExtraCare and their local authority partners to set things up in such a way as to maximise identified benefits and minimise drawbacks.

Research methods

To do this work, Sue will gather and analyse anonymous factual information provided by ExtraCare and each local authority. She will also interview a sample of residents in both villages to find out about the care that they receive and what they think about it. She will write a report which combines the anonymous information from these interviews with the views of staff, as well as the desktop analysis, to answer the research questions.

Interviews with residents

Letters will be sent to residents who have care funded by the local authority inviting them to volunteer to take part in the study. Of those who offer to take part, Sue will select ten at each village from an anonymised list. She will want to get a mix of genders, need levels and ages. At St Oswalds she will want to be sure to include both direct payment holders if there are any, and managed budget holders. The sample will also aim for a mix of those who receive their care from external providers and those who use the Extra Care Charitable Trust insofar as these differences apply.

The interviews will be structured but friendly and informal.  Participants will be free to withdraw at any point and/or decline to answer specific questions if they choose. The confidentiality and anonymity of interviewees' views is assured.

There will be two parts to the interview. The first will ask questions directly relevant to the research. It will cover information and views about:

• the care and support received
• the particular funding approach used (Sue will explain this in detail, so interviewees do not need to worry that they don't understand)
• how the care fits in with other services at the village

The second part will use the short version of something called the "Outcomes Star" to look at whether interviewees feel their lives are as good as they can be, and how much the care they receive helps in this. You can find out more about this at the following links:

The questions: http://www.outcomesstar.org.uk/storage/older-persons-star-short-version/Older-Persons-Star-Quiz.pdf

The star: http://www.outcomesstar.org.uk/storage/older-persons-star-short-version/Older-Persons-Star-Chart.pdf

The interview framework will be tested out with one person at each village before Sue does the main interviews to make sure that the questions make sense to the interviewees and that the answers yield the information needed for the research.

Ethics

The highest ethical standards will apply to this study. Participants need to give informed consent to take part. If the information received by residents in the letter leaves them with queries or concerns, they should discuss these with the village manager before volunteering to take part. Neither taking part in the study, nor not taking part, will have any effect on an individuals' care. Similarly, the information from the interviews will be used for research purposes only, so if a participant wants their care to be changed, s/he would need to speak to the relevant person in the village as a separate process.

The local authorities

Gloucestershire County Council and Staffordshire County Council were asked to give their agreement to this research because it focuses on a service they fund (or subsidise), but the focus of the research is not on the local authority as such.  Each authority has given their permission for the study to take place with certain qualifications.