Health and Care Experience Survey 2013/14 Volume 1: National Results

13 Care Support and Help With Everyday Living

Summary

• Many people who get support for everyday living receive this outwith formal services - 41 per cent indicated that their help did not come from formal services.

• Overall rating of care services - 84 per cent of respondents rated the overall help, care or support services as either excellent or good.

• Users of care services were most positive about some person-centred aspects of care - 932 per cent reported that they were treated with respect.

• Users of care services were least positive about coordination of health and care services - only 79 80 per cent reported that services were well coordinated.

• Outcomes from care - 865 per cent reported that the help, care or support improved or maintained their quality of life.

• Services users who rated their quality of life more favourably tended to be more positive about their experiences of and impact from care services than those who rated their quality of life less favourably.

• There was considerable variation between CHPs on experiences of care services, especially around coordination of health and care services and on the impact of support on quality of life.

Introduction

13.1 The survey was widened beyond primary care services to include aspects of care and support and caring relating to a number of the aspirations underpinning the integration of health and care in Scotland proposed under the Public Bodies (Joint Working) (Scotland) Bill^[17]. The integration of health and care is part of an ambitious programme of reform to improve services for people who require health and social support. The Act will require Health Boards and Local Authorities to integrate their services with the aspiration that that health and social care provision is joined-up and seamless, especially for people with long term conditions and disabilities, many of whom are older people.

13.2 The health and care survey therefore asked users of social care about aspects of integration - whether health and care services were well coordinated - and the impact of services on outcomes (described below).

13.3 The Act will also require health and care services to focus on outcomes not just system inputs or processes. An outcomes approach to assessment, planning and review aims to shift engagement with people who use services away from service-led approaches. This involves everyone working together to achieve the best possible impact on the individual's life. The philosophy of this approach is one that emphasises the strengths, capacity and resilience of individuals, builds upon natural support systems and includes consideration of wider community based resources.

13.4 Locally, use of personal outcomes approaches such as Talking Points^[18], provides a focus for tailoring services to improve people's quality of life, and at a service level the information can potentially be used to understand where more support is needed.

13.5 To support a shift in focus towards outcomes the draft Regulations^[19] for the Public Bodies (Joint Working) (Scotland) Bill proposes a series of health and wellbeing outcomes to provide a consistent framework for health and care partners to plan for, report and account for its activities associated with improving outcomes locally. The draft outcomes, which are currently subject to consultation^[20], are:

Outcome 1: People are able to look after and improve their own health and wellbeing and live in good health for longer.

Outcome 2: People, including those with disabilities, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

Outcome 3. People who use health and social care services have positive experiences of those services, and have their dignity respected.

Outcome 4. Health and social care services are centred on helping to maintain or improve the quality of life of service users.

Outcome 5. Health and social care services contribute to reducing health inequalities.

Outcome 6. People who provide unpaid care are supported to reduce the potential impact of their caring role on their own health and well-being.

Outcome 7. People who use health and social care services are safe from harm.

Outcome 8. People who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide and feel engaged with the work they do.

Outcome 9. Resources are used effectively in the provision of health and social care services, without waste.

13.6 Some questions were added to the survey about the impact of care services on outcomes 2, 4, 7 above - independent living, feeling safe, and quality of life to capture improvements at population level.

13.7 Outcome 3 relates to experiences of using services and also reflects wider policies and legislation such as the Self-directed Support (SDS) strategy^[21], Social Care (Self-directed Support) (Scotland) Act 2013^[22] and the Person-centred Health and Care Portfolio^[23]. Taken together these aim to ensure that support is based around personal preferences, needs and values, not the service, and individuals and families have informed choice about how their support is provided. The survey therefore asks a series of questions around experiences of using care services such as being treated with respect, and with compassion and understanding; whether the things that mattered to people were taken into account; and having a say in care and support provision.

Use of care services

13.8 Respondents were asked to indicate if they had received any help or support for everyday living in the last 12 months and the type of support they received. Of those surveyed, 21 per cent indicated that they had they had received support and this is broken down in the table below by different types of support. Seventy nineEighty per cent indicated that they did not receive any help and of these 3 per cent indicated that they felt they required help.

Table 20: Support including type of support for everyday living

In the last 12 months have you had help or support with everyday living	%
Yes personal and or household tasks	8
Yes adaptations/equipment for home	5
Yes activities outside home	4
Yes, help to look after someone else	3
No not had any help, but felt I needed it	3
No not had any help	767

13.9 Respondents who indicated that they received help and support for everyday living were asked to indicate whether this was from formal services (ie statutory, private or voluntary organisations including help they paid for). Fifty nine per cent indicated that their help was provided by services, suggesting that a sizeable proportion of people (41%) receive assistance with everyday living outwith formal service provision, perhaps from friends and family (Figure 21). This finding underlines the important contribution of unpaid carers to society in providing care to those that need it. In recognition of this, a major policy focus in recent years has been to enhance ways of protecting and supporting carers (see Section 14 on carers' experiences).

Figure 21: Did you get help from the services provided by, for example, the Council, NHS, voluntary organisations, or private agencies - including services you paid for?

Experiences of Care services

13.10 Respondents who indicated that they had received help and support for everyday living from services were asked to rate their overall experiences of these services. In total 84 per cent of respondents rated the overall help, care or support services as either excellent or good, with 4 per cent rating it as poor or very poor (Figure 22)

13.11 There was considerable variation between Community Health Partnerships (CHPs), with results ranging from 74 to 92 per cent.

Figure 22: Overall, how would you rate your help, care or support services

13.12 The survey also asked respondents about their experiences of care services by asking them how much they agreed or disagreed with the following eight statements:

• People took account of the things that matter to me
• I had a say in how my help, care or support was provided
• I was treated with respect
• I was treated with compassion and understanding
• My health and care services seemed to be well coordinated
• I was supported to live as independently as possible
• I felt safe
• The help, care or support improved or maintained my quality of life

13.13 Respondents were most positive about some aspects of person-centred care - 932 per cent reported that they were treated with respect, while 89 per cent indicated that they were treated with compassion and understanding (Table 21). Respondents also tended to be positive about service providers taking account of their preferences and values - 88 per cent reported that people took account of the things that matter to them.

13.14 On the other hand, respondents were less positive about other aspects of person-centred care, for example influencing how care is provided - 834 per cent indicated that they had a say in how their help, care or support was provided. These findings suggest that while many people are positive about the way they are treated, more could be done to ensure that people have a say in how their support is provided.

13.15 Respondents were least positive about the coordination of care - only 8079 per cent indicated that their health and care services seemed to be well coordinated. A key aspiration of integration is to ensure that health and social care provision across Scotland is joined-up and seamless. However it appears that as the implementation of the integration policy and legislation approaches, one aspect of care about which users of care services are less positive is the co-ordination of that care.

13.16 Interestingly this is a consistent finding from the carers' questions in the survey; 19 per cent of carers felt that services were not well coordinated for the person they look after (see next section). Going forward it will be important to continue to monitor people's experiences of this aspect of care to assess whether the aspirations of joined-up care and seamless care are being realised.

13.17 On the questions around impact of services on user outcomes, 856 per cent indicated respectively that they felt safe and that the care or support improved or maintained their quality of life, while a similar proportion (84%) reported that they were supported to live as independently as possible (Table 21).

13.18 There was considerable variation between CHPs for all of these statements. The areas where there was most variation was on the coordination of health and care services - results ranged from 64 to 89 per cent across CHPs, and on the impact of support on quality of life - results ranged from 73 to 98 per cent.

13.19 The areas where there was least variation related to person-centred aspects of care for example 'people taking account of the things that matter to me' - results varied from 82 to 93 per cent. Similarly results to the statement about being treated with compassion and understanding varied from 81 to 95 per cent.

13.20 It's not clear the reasons for such variation between CHPs and whether they can be explained by differences in quality of services or in differences in individual respondent/ population characteristics such as deprivation and age within different CHPs or a combination of both. Further analysis of the data will be undertaken to explore the factors which influence variation in the experiences of social care service users.

Table 21: Summary of results of experiences of social care services

Statement	Strongly agree/agree (% positive)	Neither agree/disagree (neutral)	Strongly disagree/ disagree (% negative)
People took account of the things that matter to me	88	9	3
I had a say in how my help, care or support was provided	83	12	4
I was treated with respect	93	6	2
I was treated with compassion and understanding	89	9	2
My health and care services seemed to be well coordinated	79	13	7
I was supported to live as independently as possible	84	12	3
I felt safe	85	11	3
The help, care or support improved or maintained my quality of life	85	11	3

The impact of quality of life on experiences

13.21 We also looked at the influence of self-reported quality of life on the experiences of social care service users. In general positive scores tended to be higher amongst those who rated their quality of life more positively (Table 22). Perhaps unsurprisingly, the biggest difference can be seen in the responses to the statement 'the help care or support improved or maintained my quality of life'; 91 per cent of those who rated their quality of life as very good indicated that their support improved their quality of life compared to 68 per cent of those who rated their quality of life as very bad.

13.22 Similarly, 90 per cent of those who rated their quality of life as very good rated their care services positively compared to 69 per cent of those who rated their quality of life as very bad (Table 22). Further analysis of the data will be undertaken to explore whether other factors influence variation in the experiences of social care service users.

Table 22: Breakdown of social care users positive scores by self-reported quality of life responses

	How would you rate your quality of life as a whole?
Question/ Statement	Very good	Good	Alright	Bad	Very bad
How would you rate your help care and support services?	90	87	81	76	69
People took account of the things that matter to me	91	90	87	84	77
I had a say in how my help, care or support was provided	88	85	80	80	74
I was treated with respect	94	95	91	89	86
I was treated with compassion and understanding	91	91	87	84	84
My health and care services seemed to be well coordinated	87	83	76	72	67
I was supported to live as independently as possible	89	87	83	75	75
I felt safe	90	89	83	76	73
The help, care or support improved or maintained my quality of life	91	89	82	76	68