Personal Social Services Survey of Home Care Users in England aged 65 and over,

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1 Personal Social Services Survey of Home Care Users in England aged 65 and over,

2 Adult Social Services Statistics Price: Free Published by the Health and Social Care Information Centre Part of the Government Statistical Service ISBN: X This publication may be requested in large print or other formats. For further information contact: online: telephone: , The Information Centre, Adult Social Services Statistics. All rights reserved. This work remains the sole and exclusive property of The Information Centre and may only be produced where there is explicit reference to the ownership of The Information Centre. This may only be reproduced in a modified format with the express permission of The Information Centre. This work may only be publicly displayed and/or performed with the express permission of The Information Centre. ii

3 Summary The User Experience Survey is run on an annual basis and is used to target areas of particular interest within Social Services. Opinions are sought over a range of service areas to gain an understanding of users views rather than measuring quantities of care delivered. This survey is targeted at clients aged 65 and over receiving Home Care funded wholly or in part by Social Services. A survey of these clients was last conducted in This survey aims to see how the opinions of these clients have changed in the last 3 years and to gain a better understanding of how different factors effect the overall satisfaction. 59 per cent of clients reported they were extremely or very satisfied with the service that they received. This represents an increase from 57 per cent in when the survey was last conducted. 86 per cent of clients said that their care worker always or usually came at times that suited them compared to 89 per cent of clients in Over a third of clients said they were always kept informed by their home care service provider about changes in the care they receive whilst 10 per cent of clients said they were never kept informed of changes to their care. 65 per cent of clients reported that the care worker always did the things that they wanted done, while 1 per cent said they never do the things they want done. 47 per cent of clients strongly believed they were safe in their own home compared to less than 1 per cent of people who strongly felt unsafe in their own home. 46 per cent of clients feel in control of their daily lives due to the care they receive from social services whilst 4 per cent of clients felt that they had no control over their daily lives. iii

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5 Contents 1 Introduction Coverage Independence Choice and Control Satisfaction Direct Payments Technical Notes Further Information Annex A: Base Questionnaire Annex B: Local Authority Charts and Tables v

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7 1 Introduction Background The survey was initially piloted in early 2005 by 4 councils to assess the suitability of the questions and to overcome any difficulties faced by the clients. For the first time data has been collected at an individual level, allowing for a greater degree of analysis. The survey was carried out by 148 of 150 Councils with Social Services Responsibilities (CSSRs) for completion in early Two councils, Isles of Scilly and City of London, were excluded from the survey as their eligible population was less than 100. The requirement for nationally comparable satisfaction surveys was first announced in the white paper Modernising Social Services published in Two Performance Indicators based on this User Experience Survey of clients aged 65 and over receiving Home care funded wholly or in part by social Services are included in the Personal Social Services (PSS) Performance Assessment Framework (PAF). Previously, different surveys of PSS have been carried out. More details can be found in the Further Information section of this report. This year the user experience survey has been extended from 4 questions in to 9 questions in , based on the care clients receive, together with an additional 7 questions used to ensure a balanced sample was achieved. The analysis in this report is split into several sections, each focusing on key factors and outcomes associated with the White Paper Our Health, Our Care, Our Say. The chapters are outlined below with the questions that appear in each given in italics. Chapter 2 provides information on the coverage and robustness of the responses. Gender Age Ethnicity How many hours of Home Care do you usually receive each week Did you fill in this questionnaire by yourself or did you have help from someone else Chapter 3 on the independence of clients looks at how autonomous clients perceive themselves to be. I feel safe in my home I have as much contact with other people as I want I get up and go to bed at times that suit me Control over daily life Do you know how to make a complaint about the Home Care Service Chapter 4 looks at the choice and control around the package of care that a client receives. Do your care workers come at times that suit Are you kept informed, by your Home Care Service, about changes in your care Do your care workers do the things that you want done Chapter 5 compares the satisfaction of clients by characteristics. Overall, how satisfied are you with the help from Social Services that you receive in your own home How many hours of Home Care do you usually receive each week Chapter 6 considers the awareness of direct payments and its influence on other areas of the care. Has your social worker or care manager told you about Direct Payments Overall, how satisfied are you with the help from Social Services that you receive in your own home 1

8 Performance Indicators Two questions from the User Survey feed into the Performance Indicators published by CSCI. These questions relate to satisfaction (Chapter 5 Satisfaction) and whether or not the carer does the things the client wants done (Chapter 4 Choice and Control). Information on how these indicators were calculated is in the respective sections. The results from these and all other Performance Indicators can be found on the Commission for Social Care Inspection (CSCI) website. rmation_for_councils/paf.aspx Data Quality Surveys, such as this one, are based on a sample of the whole population. They produce statistics that are estimates of the real figure for the whole population. These estimates are always surrounded by a margin of error, therefore care needs to be taken in making comparisons between client groups and councils and over time. (See technical notes). 2

9 2 Coverage The eligible population was defined as those users receiving care in their own homes aged 65 and over when questionnaires were distributed (between January and March 2006 for most councils). In total, forms were distributed to approximately 143,600 clients, compared to 144,100 when the survey was last carried out in Results in this report are based only on valid responses. If a client returned an invalid response they were treated as a non respondent to that particular question. A client was classed as a respondent to the survey if they responded to one or more of the questions. This allows clients to express their views to areas they feel strongly about without having to complete the entire form. Figure 2.1 shows that nearly 6 in 10 forms were returned with answers to one or more questions. 42 per cent of all forms sent to clients were not returned to the councils. The majority of those returned were returned by post. Figure 2.1 Response rate and method of collection for those clients surveyed. Table 2.1 shows there is very little difference in the distribution by gender between those who responded and the eligible population. Women made up the largest proportion of those surveyed (73%) and similarly those who did and did not respond. Population figures for England obtained from the Office of National Statistics (ONS) suggests that the split between men and women aged 65 and over is more equal than in the survey. The bias towards women in the eligible population is likely to be due to the increased life expectancy of women, and the increased level of need as people get older, giving a higher ratio of women to men receiving home care in the age band 65 and over. Table 2.1 Distribution of clients surveyed split by gender compared to the eligible population. Percentages Response Non Response Surveyed Eligible Gender Male Female Not Stated % 1% 0% Post Telephone 57% Face to Face Non Response - less than 0.5 per cent. not applicable Table 2.2 shows that the majority of clients surveyed were 75 or over (83%). Only 16 per cent of clients were aged 65 to 74. This is similar to the proportion in both the eligible population and in the sample who responded thus indicating that the age of the client had little effect on the response rate. The ONS population figures shows that there are more people in the lower age group 65 to 74, in contrast the fewest number of people surveyed fell into this banding. This is likely to be due to the increase dependence on the social care services as people age. 3

10 Table 2.2 Distribution of clients surveyed split by age compared to the eligible population Response Non Response Surveyed Eligible Age Group Not Stated less than 0.5 per cent. not applicable Table 2.3 shows that the majority of clients surveyed considered themselves White. Each ethnic group had a similar distribution of those that responded compared to those that were surveyed. The table shows that for non-respondents, there was a much larger proportion of clients whose ethnicity was unknown. This could be due to the fact that councils did not know what the ethnicity of the client was when they sent out the form. If it is assumed that the distribution of ethnicity of clients where ethnicity is not stated is the same as those where ethnicity is stated then the distributions are fairly similar across the various groups identified in the table. Ethnicity data is collected as part of the Referral, Assessment and Packages of Care (RAP). It is not possible from the RAP data to identify those aged 65 and over receiving home care. Looking at the total numbers of clients receiving care from social services in , it appears as though the survey is a good representation. Table 2.3 Percentage of respondents split by ethnic group Response Non Response Surveyed Eligible 1 Ethnic Group White Mixed Asian Black Chinese Other Not Stated Eligible population based on clients receiving services during Source RAP P4 - less than 0.5 per cent Table 2.4 Percentage of respondents by level of home care Perceived hours of home care during a week Percentage of valid responses Percentage of households 1 2 hours or less More than 2 hours and up to 5 hours More than 5 hours and up to 10 hours More than 10 hours Percentage of households receiving care during a sample week in September 2005 The form asked clients to report the number of hours of home care they receive in any given week. It is accepted that these figures may not be entirely accurate as this relies on clients being able to remember accurately and record the hours of care they receive. Table 2.4 shows the distribution of valid responses compared to the distribution of households by level of home care. It shows that those receiving more than 10 hours of care a week had a lower response rate compared with the actual percentage of households receiving this level of care in 4

11 September This is not unexpected, as these clients would need a greater level of care and may have found it difficult to complete the questionnaire. This is supported by Table 2.5, which looks at the percentage of clients requiring help in completing the questionnaire, split by the hours of Home Care as in Table per cent of clients receiving less than 2 hours of care were able to complete the questionnaire by themselves. This figure reduces to 24 per cent for clients requiring more than 10 hours of care in a week. Table 2.5 Percentage of clients requiring help to complete the form by hours of home care Response Perceived hours of home care during a week I filled it in myself I had help from a care worker I had help from someone else 2 hours or less More than 2 hours and up to 5 hours More than 5 hours and up to 10 hours More than 10 hours There is no indication from the above information to suggest that the group of respondents is an unreasonable reflection of the population as a whole and therefore the analysis provided in the rest of the publication is based on the answers supplied by respondents. 5

12 3 Independence Introduction Increasing the independence of people being supported by Social Services was one of the main aims of the White Paper Our Health, Our Care, Our Say: a new direction for community services. The White Paper has set out a new vision with a shift in the way services are delivered, making them more personalised and flexible around people s lives. Clients will be given a stronger voice so that they will be the drivers of future service improvement. The questions in this section try to evaluate how independent these clients are feeling. This includes questions around how safe they feel, whether they have enough contact with others and their control over their daily life. I feel safe in my home Table 3.1 shows that of all clients who responded 47 per cent strongly agreed that they feel safe in their own home, while a further 50 per cent agreed. Only 4 per cent of clients responded saying they disagreed with this statement. Table 3.1 Percentage of clients who feel safe in their own home, split by response Response Percentage of clients Strongly Agree 47 Agree 50 Disagree 3 Strongly Disagree 1 Figure 3.1 shows that as the clients get older, aged 75 and over, their perceived safety (strongly agreeing) reduces slightly, thus suggesting that clients feel more vulnerable in their own home as they get older. Figure 3.1 Comparison of perceived safety by age group of client 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Strongly Agree Agree Disagree Strongly Disagree I have as much contact with other people as I want Table 3.2 shows that nearly 9 in 10 clients have as much contact with others as they would like. Table 3.2 Percentage of clients who have as much contact with others as they want, split by response Response Percentage of clients Strongly Agree 35 Agree 53 Disagree 10 Strongly Disagree 2 Of those clients aged 65 to 74 who responded, 38 per cent strongly agreed. For clients aged the number that strongly agreed reduced to 36 per cent and then reduced further to 34 per cent for clients aged 85 and over. Conversely, the number of clients that agreed to a lesser extent increased from 50 per cent for clients aged 65 to 74; to 53 per cent for clients aged 75 to 84 and 54 per cent for clients aged 85 and over. 6

13 I get up and go to bed at times that suit me Table 3.3 shows 46 per cent of clients strongly agreed that they go to bed and get up at times that suit them with a further 49 per cent agreeing. 1 per cent of clients strongly disagreed with this question and felt they did not have as much control over this aspect of their life as they wished. Table 3.3 Percentage of clients that get up and go to bed at times that suit, split by response Response Percentage of clients Strongly Agree 46 Agree 49 Disagree 4 Strongly Disagree 1 Control over daily life Clients were asked if they felt they had control over their daily life which included having the choice to do things when they wanted to, for example having meals, going to bed, getting up and going out. Figure 3.2 Percentage of clients that feel in control of their daily lives 11% 4% over their daily lives due to the services they are receiving. Only 4 per cent of those surveyed felt that they had no control over their daily life. Do you know how to make a complaint about the Home Care Service? An important aspect of receiving good quality care tailored to individuals needs is that they have a voice, and should they need to, be able to request changes to the service they are receiving. Of those clients surveyed, 76 per cent knew how to make a complaint and would be happy to do so. A further 8 per cent knew how to make a complaint but didn t feel they would be able to. 16 per cent did not know how to make an official complaint. Figure 3.3 Percentage of clients that feel they are able to make a complaint by ethnicity 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 39% 0% White Mixed Asian or Asian British Black or Black British Chinese Other No Yes but I do not feel that I could Yes and I feel I that I could 46% In control Services help me feel in control Some control No control Figure 3.2 shows that the majority of those clients who responded (96%) felt they had at least some control over their daily lives. 46 per cent of clients felt that they had control Figure 3.3 shows that of clients responding to this question and providing their ethnicity, White clients (76%) feel more able to make a complaint than clients from other ethnic backgrounds. Clients classified as Asian or Asian British have the largest percentage of clients who do not know how to make a complaint to Social Services (26%) and consequently the fewest clients who know how to, and felt able to make a complaint (59%). 7

14 4 Choice and Control Introduction One of the main aims of the White Paper Our Health, Our Care, Our Say is to give clients greater choice and control over the care they receive. There is an increased focus on outcome measures and the User Experience Survey gives the opportunity for clients to express their views on the services they receive. Due to this increased focus the responses to one of these questions have been used to derive one of the PAF Indicators by the Commission for Social Care Inspection (CSCI). Do your care workers come at times that suit? Table 4.1 shows 86 per cent of clients feel that their care worker always or usually came at a time that suited them. 2 per cent of clients feel that the care worker never comes at an appropriate time. In per cent of clients reported that their care workers came at times that suited. The national results for are a significant decrease since (See Annex B for council level data). Table 4.1 Percentage of clients whose care workers come at times that suit, split by response Response Percentage of clients Always 37 Usually 49 Sometimes 12 Never 2 Figure 4.1 shows that for the clients who reported that the care worker never came at a time that suited them, 43 per cent felt that they could make a complaint if they needed to. 57 per cent of clients felt that they were unable to or did not know how to make a complaint. For clients who said that the care worker always came at times that suited, 84 per cent felt they could make a complaint, while 16 per cent did not know how to or felt unable to make a complaint. Figure 4.1 Percentage of clients who reported that their care worker always or never came at times that suit who know how to complain 100% 80% 60% 40% 20% 0% Alw ays Never No Yes but I do not feel that I could Yes and I feel I that I could When this survey was last conducted in a Performance Indicator (PI) was calculated on the responses to this question. Although this question was not used in to calculate a PI, it is still possible to calculate this value. The PI is calculated as those clients responding Always or Usually to the question Do your care workers come at times that suit you? as a percentage of all respondents to this question. Figure 4.2 in Annex B compares this PI between and for each council. The chart shows the possible range of the PI value for each year taking into account the confidence interval around the proportion of respondents answering Always or Usually to the question. Around 76 per cent of councils have decreased however only 30 per cent of councils have decreased significantly (45 councils). Nearly a quarter of councils have increased (36) of which however only three have risen significantly. 8

15 Are you kept informed about changes in your care? Table 4.2 shows three quarters of clients are kept informed of changes to their care including a visit being delayed or to expect a different carer. One in ten clients said they were never told about changes to their care. Table 4.2 Percentage of clients that are kept informed about changes to their care, split by response Response Percentage of clients Always 34 Usually 41 Hardly ever 15 Never 10 Figure 4.3 shows that for the clients who reported that they were never kept informed about changes to their care, over half (55%) felt they could make a complaint if they needed to, 45 per cent of clients felt they would be unable to make a complaint. Figure 4.3 Percentage of clients who reported that they are always or never kept informed of changes to their care that know how to complain 100% 80% 60% 40% 20% 0% Always Never No Yes but I do not feel that I could Yes and I feel I that I could Do your care workers do the things that you want done? A new Performance Indicator (PI) was based around this question; details of individual councils are available in Annex B. The Performance Indicator is calculated as those clients who said their care worker always does the things that they want done as a percentage of all clients that responded to this particular question. Indicator - AO/D71 Choice and control in home care Numerator - Those in the user experience survey answering always to Question 4 (Do your care workers do the things that you want done?) Denominator - All those in the user experience survey answering Question 4 Indicator - The PI is the number of answers always as a percentage of all answers. Table 4.3 shows that 65 per cent of clients felt that their care worker always does what they want done. This increases to over 90 per cent when the Nearly always category is included. Only 1 per cent of clients never get the things they want done by the care worker. Table 4.3 Percentage of clients that feel the care worker does what they want, split by response Response Percentage of clients Always 65 Nearly always 27 Sometimes 7 Never 1 9

16 Figure 4.4 shows that for the clients who reported the care worker never does the things they want over a third (37%) felt they could make a complaint if they needed to, 63 per cent of clients felt they would be unable to or did not know how to make a complaint. Figure 4.4 Percentage of clients that feel the care worker always or never does the things they want that know how to complain 100% 80% 60% 40% 20% 0% Always Never No Yes but I do not feel that I could Yes and I feel I that I could 10

17 5 Satisfaction Introduction When the survey of older people receiving home care was carried out in there were 4 questions, two of which fed into a Performance Indicator. Of these questions the only one to feed into a Performance Indicator in was related to overall satisfaction. As in the indicator is based on clients extremely or very satisfied as a percentage of all clients responding to this question. Clients answering quite satisfied are excluded from the calculations as it was felt they would have a degree of dissatisfaction in their care and the indicator is aimed at identifying clients with minimal or no dissatisfaction with Social Services. Indicator - AO/D52 Older people home care user survey - satisfaction with services Numerator - Those in the user experience survey answering extremely satisfied or very satisfied to Question 1 (Overall, how satisfied are you with the help from [Social Services] that you receive in your own home?) Denominator - All those in the user experience survey answering Question 1 Indicator - The number of answers extremely satisfied or very satisfied as a percentage of all answers to Question 1. How satisfied are you with the help that you receive? Table 5.1 shows the satisfaction of clients responding to the question. Nearly 1 in 4 clients were extremely satisfied with the service they are currently receiving. 59 per cent of clients reported they were extremely or very satisfied with the service that they received. This represents a significant increase from 57 per cent in when the survey was last conducted. (See Annex B for council level data). Table 5.1 Percentage of respondents split by level of satisfaction Response Percentage of Respondents Extremely Satisfied 24 Very Satisfied 35 Quite Satisfied 32 Neither 6 Quite Dissatisfied 2 Very Dissatisfied 1 Extremely Dissatisfied 1 Focus groups carried out by the Personal Social Services Research Unit (PSSRU) revealed that while clients are able to distinguish between levels of satisfaction it is hard to do the same for levels of dissatisfaction. 4 per cent of clients expressed some dissatisfaction at the level of care they received. Figure 5.1 Comparing satisfaction of respondents split by level of satisfaction, and Percentage of valid responses 40% 30% 20% 10% 0% Extremely Satisfied Very Satisfied Quite Satisfied Neither Quite Dissatisfied Very Dissatisfied Extremely Dissatisfied 1.Copyright 2006, reused with permission of the Department of Health Figure 5.1 shows overall there has been a slight improvement in the satisfaction of clients since Figure 5.2 in Annex B compares the performance indicator value between and for each council. The chart shows the possible range of the PI value for each year taking into account the confidence 11

18 interval around the proportion of respondents answering Extremely or Very to the question. Around 59 per cent of councils have increased from (87) although only 20 per cent (29) have increased significantly. Of the 61 councils that have shown a decrease in their PI value only 15 councils have decreased significantly. Distribution of average satisfaction If the satisfaction level is scored on a level from 1 to 7, with 1 being the highest (Extremely Satisfied) and 7 being the lowest (Extremely Dissatisfied) it is possible to calculate an average level of satisfaction. It can be seen from Figure 5.3 that 146 of the 148 councils participating in the survey were in the range 2-3. This equates to them having an average level of satisfaction between very and quite satisfied. The majority of councils are in the upper half of this banding (2-2.4). Two councils scored an average satisfaction in the extremely to very satisfied banding. Figure 5.3 Average level of satisfaction by Council Number of Councils Level of care Satisfaction Range The form asked clients to report the number of hours of home care they receive in any given week. It is accepted that these figures may not be entirely accurate as this relies on clients being able to remember accurately and record the hours of care they receive Table 5.2 Satisfaction of clients by level of care Degree of Satisfaction Extremely Very Quite Not 1 2 hours or less More than 2 hours and up to 5 hours More than 5 hours and up to 10 hours More than 10 hours Include Neither, Quite, Very and Extremely Dissatisfied Table 5.2 shows that there appears to be no relationship between the hours of home care recorded by the client and how satisfied they are with the service, all clients expressed similar degrees of satisfaction. Additional Factors Using the additional information collected from the client records we are able to see how the satisfaction varies across demographic groups. Typically, as clients get older the satisfaction level drops slightly from an average of 2.26 for clients aged to 2.34 for clients aged 85 and over. The responses from male clients were slightly more positive than those from females with average satisfactions of 2.28 and 2.32 respectively. Ethnicity appears to have a bigger impact on satisfaction. Average satisfaction ranges from 2.29 for White clients to 2.72 for Black and Black British respondents Table 5.3 Average Satisfaction by ethnicity Ethnicity Average Satisfaction White 2.29 Mixed 2.49 Asian or Asian British 2.60 Black or Black British 2.72 Chinese 2.35 Other

19 6 Direct Payments Introduction Direct Payments are cash payments made in lieu of social service provisions, to individuals who have been assessed as needing services. The aim of a Direct Payment is to give more flexibility in how services are provided to many individuals who are assessed eligible for Social Services support. By giving individuals money in lieu of social care services people have greater choice and control over their lives, and are able to make their own decisions about how their care is delivered. Increases in direct payments Direct Payments were first made available to clients aged in England in April 1997 under the Community Care (Direct Payments) Act Since 2001 the availability of Direct Payment s has been extended to older people, 16 and 17 year olds, parents of disabled children and carers. The Referrals, Assessment and Packages of Care publication showed that 6,100 clients aged 65 and over were receiving a direct payment at 31 March 2005, an increase of 90 per cent in the previous 12 months. Figure 6.1 Number of clients aged 65 and over receiving Direct Payments, Number 7,000 6,000 5,000 4,000 3,000 2,000 1, Year, as at 31 March Source: RAP While Direct Payment s have risen substantially they account for less than 1 per cent of all services provided to clients aged 65 and over at 31 March Has your social worker or care manager told you about Direct Payments? Table 6.1 shows that 36 per cent of clients aged 65 and over were made aware of direct payments, whereas 27 per cent were not sure. It is possible that the percentage of clients aware of Direct Payments is low because a family member may deal with their care arrangements. Table 6.1 Percentage of clients made aware of direct payments Response Percentage of clients Yes 36 No 38 Don t know 27 No further information on Direct Payments was collected on the form so it is not possible to tell which clients were actually in receipt of Direct Payments and how this affected their satisfaction. Table 6.2 Awareness of direct payments as a percentage of satisfaction level Satisfied Yes 1 Neither No 2 Awareness of direct payments Yes No Don t Know Clients answering Extremely, Very or Quite Satisfied 2. Clients answering Extremely, Very or Quite Dissatisfied Table 6.2 shows that 93 per cent of clients who were aware of direct payments were satisfied with their care, compared with 89 per cent of clients who were unaware of Direct Payments and 92 per cent of clients who did not know if they had been told about direct payments. The lowest level of dissatisfaction is for clients who have been told about Direct Payments. 13

20 7 Technical Notes Introduction This section outlines the methodology for the survey and discusses response rates, interpretation and robustness of the data. Overview of Methodology Councils were asked to conduct a survey of their Personal Social Service clients. Guidance was issued to councils on the methodology to be used to ensure comparability. The population sample was defined as those in receipt of home care services aged 65 or over when the form was distributed. For most councils the forms were distributed between January 2006 and March The method of collection varies across clients with approximately 97 per cent returning by post, 2 per cent carrying out telephone interviews and less than 1 per cent carrying out face to face interviews. Clients who returned the form by post were slightly less satisfied than those users who answered the survey by telephone or face to face. This difference could be due to the number of people being surveyed is lower than by post, or that people are more likely to give favourable answers when speaking to someone, giving a less representative view, Of the total forms received, the satisfaction of users who had help from their carer was higher than users who filled in the form by themselves or had help from someone other than their carer. Approximately 60 per cent of respondents had help in completing the questionnaire, less than 1 in 10 of which was from the carer. Survey Councils were provided with a sample form, which is re-produced at Annex A. However, councils were encouraged to produce their own survey which could include additional questions and local branding. The aim of the guidance issued was to ensure comparability across councils by specifying the wording and ordering of the compulsory questions. Missing Data Two councils did not submit data this year, the Isles of Scilly and City of London. These councils were exempt from the survey as their eligible population was too small to guarantee a statistically significant response. Response Rates Response rates play an important part in the overall value of surveys. Confidence in the estimates derived from the survey will be affected by non-response bias and statistical sampling error if response rates are low (see separate sections on Non-Response Bias and Confidence Intervals). The council tables (Annex B) show the response rates achieved for the survey questions. Overall, the response rate achieved (59%) is what would be expected from a survey of this type. However, there was variation in the rates achieved for different questions and between councils. Response rates were higher for White and Mixed ethnicity clients (61%). Clients from other ethnic groupings had response rates between 47 per cent and 56 per cent. Non-Response Bias Typically, we might expect people who don t reply to surveys to be more satisfied. This means that the lower the achieved response rate, the more likely it is for the results to be subject to non-response bias (probably giving a lower figure for satisfaction than the true figure). 23 councils failed to achieve a response rate of 50 per cent and therefore non-response bias should be borne in mind when interpreting their results 14

21 Confidence Intervals Surveys produce statistics that are estimates of the real figure for the whole population. These estimates are always surrounded by a confidence interval. The confidence interval assesses the level of uncertainty caused by chance occurrences in the indicator value. The 95% confidence interval gives the range in which you would expect the true indicator value to fall 95 times out of 100. Care needs to be taken in making comparisons between England averages. If the confidence interval for a council s indicator value does not overlap with the confidence interval for the England indicator, it is likely that their indicator value is genuinely different from the national figure. Similarly if the confidence interval for the indicator value for two councils does not overlap, it is likely that their indicator values are genuinely different. Confidence intervals surrounding estimates need to be taken into account to assess whether two values are genuinely different or technically speaking that the difference between them is statistically significant. It is Best Value good practice for service specific surveys that the 95% confidence interval for indicators should be no more than plus or minus 4 per cent. That is, we want to be 95% confident that the true figure for satisfaction is within plus or minus 4 per cent of the figure obtained from the sample. So this means that if the survey gives an answer of 60 per cent, for example, we can be confident that the true figure is between 56 per cent and 64 per cent. Calculating Confidence Intervals A standard formula for the calculation of a 95% confidence interval (CI) for the estimate of a proportion p from a sample survey is: ± 1.96 ( p) p 1 n N n N where: p is the sample proportion n is the sample size (number of useable responses) N is the size of the eligible population This formula includes the finite population correction factor and assumes n is reasonably large. This formula can be applied to calculate confidence intervals for estimates derived from the question relating to whether anyone from social services checks that the user is satisfied (question 3) where: p is the value of the performance indicator n is the sum of those that responded yes or no N is the total number of people that were sent questionnaires Example Council A has 274 eligible clients and surveyed them all, 154 were returned by users. The responses received to the question Did anyone contact you from social services to check that you are satisfied with the home care you receive? were: Response Number Yes 123 No 26 Not stated 5 The value of the performance indicator for Council A is 83% (p = 0.83, 123 divided by 149). The 95% confidence interval is plus or minus 4%. This is calculated by inserting the values of p, n and N below into the formula for calculating confidence intervals. p = 0.83 n = 149 (=123+26) N =

22 8 Further Information Contacts For further information on this report or any other areas of Adult Social Services please contact us at Contact Centre The Information Centre 1 Trevelyan Square Boar Lane LS1 6AE Telephone: Previous Publications Previous User Experience surveys carried out by Department of Health including the Home Care Survey are available on their website cs/statistics/statisticalworkareas/statisticals ocialcare/statisticalsocialcarearticle/fs/en? CONTENT_ID= &chk=g2x841 councils. In addition they aimed to assess the suitability of questions as performance indicators and use the results to facilitate further development of a measure of quality of home care services. Results of this survey can be found on the PSSRU website White Paper Our Health, Our Care, Our Say The White paper on improving health and social care services is available online via the Department of Health s website ganisationpolicy/modernisation/ourhealthou rcareoursay/fs/en Related Publications Community Care Statistics 2005: Home Care Services for Adults, England mehelpadulteng Community Care Statistics : Referrals, assessments and packages of care for adults, England: National report and CSSR tables engrepcssr PSSRU Personal Social Services Research Unit An extended version of this survey was available to councils on a voluntary basis. The extension sought to add value to the user experience survey for the participating councils by enhancing comparability between councils across additional questions and enable them to compare the quality of home care providers in their council and with providers used by other 16

23 Annex A: Base Questionnaire Your Home Care Service What we would like you to do We would like you to help us by taking a few minutes to give us your views about the home care services you receive. If you do not wish to answer the questions, this won t affect the services you receive. What to do if you need help If you would like, you can ask a friend or a relative to help you complete the questionnaire. [Councils can mention here any telephone help line they have through which assistance in completing the survey can be arranged] What to do if you have queries or would like to obtain information on the results If you, or your friend or relative, have questions you would like to ask about the questionnaire, please ring on Monday to Friday between a.m and p.m. or between 2.00 p.m. and 4.00 p.m. [Councils can vary these hours or expand this sentence eg to say leave a message and someone will get back to you] [Councils can add a paragraph on the availability of Alternative formats of questionnaire here] Why you were selected Your name is just one of many that have been selected at random from [Social Services ] records. What will be done with the results of the survey The results of the survey will be used by the Commission for Social Care Inspection, the Department of Health and your local [social services department] to see how happy people are with the home care services, to see whether improvements need to be made to local care services and for research purposes. 17

24 Confidentiality Your answers will be treated as confidential: they will not be passed on to your care workers, your social worker or anyone else responsible for providing you with home care or other help (except that they may be provided to your home care provider after being anonymised). If you say on the form that you are being hurt or harmed by anybody, someone (but not your care worker) [Councils can be more specific if they wish] will contact you to talk about it. Sending back the completed questionnaire Once you have completed the questionnaire please return it in the envelope provided by [DATE]. You don t need to put a stamp on the envelope. Thank you for helping us by completing this questionnaire. 18

25 [Councils may include a comments box after some or all questions] 1. Overall, how satisfied are you with the help from [Social Services] that you receive in your own home? I am extremely satisfied I am very satisfied I am quite satisfied I am neither satisfied nor dissatisfied I am quite dissatisfied I am very dissatisfied I am extremely dissatisfied Please tick [ ] one box 2. Do your care workers come at times that suit you? Please tick [ ] one box They always come at times that suit me They usually come at times that suit me They sometimes come at times that suit me They never come at times that suit me 19

26 3. Are you kept informed, by your home care service, about changes in your care? (e.g. your visit will be late or you ll have a different carer) Please tick [ ] one box Someone always lets me know about changes Someone usually lets me know about changes They hardly ever let me know about changes They never let me know about changes 4. Do your care workers do the things that you want done? Please tick [ ] one box They always do the things I want done They nearly always do the things I want done They sometimes do the things I want done They never do the things I want done Please list other things you want your care workers to do in this box 20

27 5. Do you know how to make a complaint about the Home Care Service? Please tick [ ] one box Yes and I feel I could if I wanted to Yes but I do not feel I could if I wanted to No I do not know how to make a complaint 6. Please read the following statements and then put a tick ( ) next to the answer which comes closest to the one you want to give. I feel safe in my home Strongly agree Agree Disagree Strongly disagree I have as much contact with other people as I want I get up and go to bed at times that suit me 21

28 7. Which of the following statements best describes your present situation? By control over daily life we mean you have the choice to do what you want when you want to, for example having meals, going to bed and getting up, going out etc. Please tick [ ] one box I feel in control of my daily life Services help me to feel in control of my daily life I have some control over my daily life but not enough I have no control over my daily life [This is where councils should add optional questions other than about direct payments] [Councils can choose to include this question if they wish] 8. Please write any other comments you would like to make about the home care you receive in this box 22

29 9. Direct payments is the option for you to purchase some or all of the services you are eligible for directly yourself, using money provided by [Social Services]. This should not be confused with welfare benefits that are usually paid directly into an account which are also called direct payments. Has your social worker or care manager told you about direct payments? Please tick [ ] one box Yes No Don t know [This is where councils should add additional satisfaction questions about direct payments for use locally] 23

30 The answers to the next group of questions will be used to make sure that we have a balanced sample of home care users. 10. Do you receive any practical help from any friends, neighbours or family members? Please tick [ ] all those that apply Yes, from someone living in my household Yes, from someone living in another household No 11. During the past month did you use any of the following care services? Please tick [ ] one box for each service Yes No Meals on wheels Day centre Community/district nursing services Other care services (eg short breaks/residential care) Please describe in this box 24

31 12. How many hours of home care do you usually receive each week? Please write your answer in this box [Councils may choose to include this gender question if they are not confident of their current records] 13. Are you male or female? Male Female Please tick [ ] one box [Councils may choose to include this age question if they are not confident of their current records] 25

32 14. How old are you? Please tick [ ] one box Under or over [Councils don t have to include this ethnicity question if they are confident of the quality and coverage of the information about the client s assessment of their ethnic origin in their current records; if they do include the question, they may break the categories down further, if they wish to do so] 26

33 15. To which of these groups do you consider you belong? Please tick [ ] one box a) White (British, Irish, any other white background) b) Mixed (White and Black Caribbean, White and Black African, White and Asian, any other mixed background) c) Asian or Asian British (Indian, Pakistani, Bangladeshi, any other Asian background) d) Black or Black British (Caribbean, African or any other Black background) e) Chinese f) Any other ethnic group 16. Did you fill in this questionnaire by yourself or did you have help from someone else? Please tick [ ] one box I filled it in myself I had help from a care worker I had help from someone else 27

34 [Councils may seek further information on who helped here if they wish. They may also insert additional questions eg about additional services the user would like to meet their needs better or seeking permission for information to be shared to follow up a particular matter] Thank you for helping us by filling in this questionnaire. Please post it back to us in the envelope provided. You don t need to put a stamp on the envelope. For your views to count please return this form by DATE 28

35 Annex B: Council Figures and Tables Table/Figure Content Figure 4.2 Comparison of responses to Question 2 between and Figure 5.3 Comparison of responses to Question 1 between and Table 1 Performance indicators and confidence intervals by council, Table 2 Comparison of Questions 1 and 2 in to the corresponding Questions in Table 3 Response rates by council,

36 Figure 4.2 Comparison of responses to Question 2 1 between and Barking and Dagenham Barnet Barnsley Bath and North East Somerset Bedfordshire Bexley Birmingham Blackburn with Darwen Blackpool Bolton Bournemouth Bracknell Forest Bradford Brent Brighton and Hove Bristol Bromley Buckinghamshire Bury Calderdale Cambridgeshire Camden Cheshire Cornwall Coventry Croydon Cumbria Darlington Derby Derbyshire Devon Doncaster Dorset Dudley Durham Ealing East Riding of Yorkshire East Sussex Enfield Essex Gateshead Gloucestershire Greenwich Hackney Halton Hammersmith and Fulham Hampshire Haringey Harrow Hartlepool Havering Herefordshire Hertfordshire Hillingdon Hounslow Isle of Wight Islington Kensington and Chelsea Kent Kingston upon Hull Kingston upon Thames Kirklees Knowsley Lambeth Lancashire Leeds Leicester Leicestershire Lewisham Lincolnshire Liverpool Luton Manchester Medway Towns Merton Middlesbrough Milton Keynes Newcastle upon Tyne Newham Norfolk North East Lincolnshire North Lincolnshire North Somerset North Tyneside North Yorkshire Northamptonshire Northumberland Nottingham Nottinghamshire Oldham Oxfordshire Peterborough Plymouth Poole Portsmouth Reading Redbridge Redcar and Cleveland Richmond upon Thames Rochdale Rotherham Rutland Salford Sandwell Sefton Sheffield Shropshire Slough Solihull Somerset South Gloucestershire South Tyneside Southampton Southend-on-Sea Southwark St Helens Staffordshire Stockport Stockton-on-Tees Stoke-on-Trent Suffolk Sunderland Surrey Sutton Swindon Tameside Telford and the Wrekin Thurrock Torbay Tower Hamlets Trafford Wakefield Walsall Waltham Forest Wandsworth Warrington Warwickshire West Berkshire West Sussex Westminster Wigan Wiltshire Windsor and Maidenhead Wirral Wokingham Wolverhampton Worcestershire York Percentage of valid responses that answered 'always' or 'usually' Question 2 in and Question 1 in , Do your care workers come at times that suit you? 2. Copyright 2006, reused with permission of the Deaprtment of Health 30

37 Figure 5.3 Comparison of responses to Question 1 1 between and Barking and Dagenham Barnet Barnsley Bath and North East Somerset Bedfordshire Bexley Birmingham Blackburn with Darwen Blackpool Bolton Bournemouth Bracknell Forest Bradford Brent Brighton and Hove Bristol Bromley Buckinghamshire Bury Calderdale Cambridgeshire Camden Cheshire Cornwall Coventry Croydon Cumbria Darlington Derby Derbyshire Devon Doncaster Dorset Dudley Durham Ealing East Riding of Yorkshire East Sussex Enfield Essex Gateshead Gloucestershire Greenwich Hackney Halton Hammersmith and Fulham Hampshire Haringey Harrow Hartlepool Havering Herefordshire Hertfordshire Hillingdon Hounslow Isle of Wight Islington Kensington and Chelsea Kent Kingston upon Hull Kingston upon Thames Kirklees Knowsley Lambeth Lancashire Leeds Leicester Leicestershire Lewisham Lincolnshire Liverpool Luton Manchester Medway Towns Merton Middlesbrough Milton Keynes Newcastle upon Tyne Newham Norfolk North East Lincolnshire North Lincolnshire North Somerset North Tyneside North Yorkshire Northamptonshire Northumberland Nottingham Nottinghamshire Oldham Oxfordshire Peterborough Plymouth Poole Portsmouth Reading Redbridge Redcar and Cleveland Richmond upon Thames Rochdale Rotherham Rutland Salford Sandwell Sefton Sheffield Shropshire Slough Solihull Somerset South Gloucestershire South Tyneside Southampton Southend-on-Sea Southwark St Helens Staffordshire Stockport Stockton-on-Tees Stoke-on-Trent Suffolk Sunderland Surrey Sutton Swindon Tameside Telford and the Wrekin Thurrock Torbay Tower Hamlets Trafford Wakefield Walsall Waltham Forest Wandsworth Warrington Warwickshire West Berkshire West Sussex Westminster Wigan Wiltshire Windsor and Maidenhead Wirral Wokingham Wolverhampton Worcestershire York Percentage of valid responses that answered 'extremely' or 'very' satisfied Question 1 in and Question 4 in , Overall how satisfied are you with the help from Social Services that you receive in your own home? 2. Copyright 2006, reused with permission of the Deaprtment of Health 31

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