A new measure that will shake up adult social care

Until now, adult social care has struggled to demonstrate its worth and to quantify the return on government investment in it. The Ascot could change all that, says David Brindle

Smarter commissioning of public services will be vital in the coming years of austerity. And no sector needs to do more to get smarter than does social care. For too long, local authority commissioners have relied on crude cost comparisons, or have simply followed historical patterns, and have lacked the most basic evidence of service quality or efficacy.

Personal budgets have begun to expose the sector’s weakness. Given choice and control, individual users have delivered often conclusive verdicts on services that commissioners had never thought to question. But relying on the aggregate effect of hundreds of thousands of personal decisions cannot be the best way to plan the future provision of care and support for older and disabled people.

From this week, commissioners have a new and valuable tool at their disposal. It is, almost, a “social care Qaly” – the equivalent of the quality-adjusted life year measure used in healthcare to gauge the benefit of interventions in terms of increased life expectancy and general wellbeing. The adult social care outcomes tool (Ascot) does not stretch quite so far, but it does make a first stab at systematic assessment of the relative value of services to the individual.

This is important not least for the sector as a whole. Until now, it has struggled to demonstrate its worth and to quantify the return on government investment in it. When the Office for National Statistics published figures for productivity in adult social care, showing an average annual fall of 2.1% between 1996 and 2005, there was nothing to demonstrate the changes in care quality or complexity of needs over that period.

The new Ascot measure starts to fill that gap. It has emerged from the continuing work on public service productivity, specifically from a three-year project researching outcomes for service users, funded by the Treasury at a cost of £2m. Other aspects of the project looked at early years education and the voluntary sector’s contribution to public services delivery.

Developed by the Personal Social Services Research Unit, the Ascot gauges the effect of a social care service on the individual’s quality of life as measured by eight factors ranging from personal safety to dignity. The factors can then be weighted according to perceived importance: in the first version of the tool, available on the PSSRU website to both commissioners and providers of services (at pssru.ac.uk/ascot), this has been done on the basis of a survey of general public opinion ranking “control over daily life” first, and food and nutrition last. A survey of service users might well yield rather different weightings.

Road-tested in 170 care homes, the tool has produced an average quality of life finding of 0.57 on a scale from 0 to 1, meaning that care home life enhances wellbeing by 57%. While homes rated good or excellent by the Care Quality Commission did achieve better results, the attributed variation was marginal. Results from tests among 135 providers of day care services show an average score of 0.09, meaning that day care enhances wellbeing by 9%.

Does this show that day care is a relatively poor investment? No. These results need to be married with cost data before any such conclusions can be reached. A 57% wellbeing gain for one individual at a price of perhaps £400 a week may not be as cost-effective as a 9% gain for four or more people at a price of less than £100 each. On the other hand, the individual in the care home may be very frail indeed.

Such are the dilemmas that commissioners must wrestle with in the difficult days ahead. A thankless task, maybe, but never a more crucial one.

David Brindle is the Guardian’s public services editor. He will be chairing the National Commissioning Conference in Manchester next Tuesday and Wednesday. guardian.co.uk/nationalcommissioning