Conference Paper Social Policy Association Conference, 5-7 July 2010, University of Lincoln, UK
Understanding variations in area level service outcomes in social care for older people in England ** draft - do not cite
Area level service outcomes in domiciliary and residential care service provision - such as the number of admissions to permanent care or the number of households receiving intensive home care - are routinely recorded in England for diverse purposes including performance monitoring in the context of central government targets. Despite consistent policy guidance over a long period of time, large variations in such outcome measures can still be observed between local authorities. Our aim is to understand these variations in a small selection of key indicators using multiple regression models. Drawing on multiple data sources and pursuing a two-step strategy, we first identify the explanatory power of a set of structural predictors (such as the age structure of an area) and then add to the models a set of specific care management policy recommendations (such as the implementation of intensive case management). We find that structural factors beyond the control of local authority care management explain a considerable share of variation in area level service outcomes. The additional explanatory power of care management characteristics is small in comparison. Therefore, our findings suggest that caution must be taken when area level service outcomes are used for performance monitoring purposes, as a degree of autonomy over outcomes may be implied which in light of the empirical evidence is unrealistic. In discussing this finding we will emphasise the problems local authorities might face in implementing policy guidelines and the implications for service users and the uniformity of service delivery across England.