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APPENDIX FOUR CASE STUDIES

Methodology

The case studies were the principal means by which the evaluation's main research objectives were addressed. They provided quantitative and qualitative evidence to assess the implementation and operation of the FPC policy and address specific issues in relation to the service users' transition from application to receipt of a service from the perspective of the local authority, the service provider and service users, their carers and families.

A key objective of the case studies was to identify and analyse variations in practice between local authorities in the operation and delivery of FPC.

The case studies consisted of 3 elements:

1. Local authorities

2. Service users, their families and informal carers

3. Independent sector (private and voluntary) Care Homes and Home Care providers

Six case study areas were chosen, taking account of a diverse range of factors. The six case study areas and the principal characteristics that contributed to them being chosen were:

Local Authorities

In each case study area we interviewed the Chief Social Work Officer and the senior officer with overall responsibility for FPC. These interviews focused on strategic policy matters in relation to the implementation, operation and impact of FPC and explored the local authority's overall perspective of FPC.

We also interviewed the senior officers who have day-to-day operational responsibility for differing aspects of managing, delivering or commissioning FPC, home care and care home services including officers with responsibility for FPC assessment, care home managers and managers of home care services. These interviews covered top-level operational issues, drilling down into the detail of how FPC is delivered in each local authority, seeking clarification and explanation for variations in procedures and provision of FPC.

The third group of local authority staff consulted during the case studies were frontline officers involved in processing applications, undertaking assessments and delivering care services.

Two or three group discussions with such staff in each area considered operational matters relating to the four key stages of FPC and were used to gather views on users' transition from application to receipt of a service from the local authority perspective. We also explored issues in relation to the impact of FPC on service users and the quality of services provided.

In all, 102 local authority staff contributed to the research. The total number of people interviewed in each category in each case study council is shown in Table A4.1.

Table A4.1: Local authority staff included in the research

Service users and carers

Infusion Cooperative conducted individual and group interviews with service users and carers in the six case study areas. Interviewees were recruited by asking local authorities and voluntary and private sector service providers to give out leaflets inviting people to participate. Day care centres were particularly helpful in facilitating contact with their members. People were also invited to participate with the help of care homes, sheltered housing wardens and voluntary organisations. Carer organisations readily agreed to send leaflets to members but the response was variable. Where possible, the views of local activists or groups with an interest in older people's services were also sought.

The intention was to interview 60 care home residents, 60 people getting care at home and 60 relatives or unpaid carers. Although the overall target of 180 was reached, some service users were found not to have personal care needs or were not able to provide relevant information about their services, and these interviews were excluded from the analysis. Individual interviews proved more successful than group ones because of the detailed and sometimes personal nature of the information being sought.

Participants were asked to describe personal and other care services they or their relative received, who provided the services, and whether or not they paid for it. Further questions were asked about their experience of the application, assessment and review processes. They were then asked to comment on how well services met their needs, any changes that had taken place in provision, and any changes they would like to see to any aspect of the service. They were also asked how much they knew and understood about FPC and, in a few cases, why they chose not to use FPC.

The tables below provide details about the users and carers who took part in the research.

The total number of interviews providing useful information was 134 (Table A4.2), involving 142 service users and carers (Table A4.3). The range of needs and level of service provided is summarised in Tables A4.4, A4.5 and A4.6. Fifty six of the service users successfully interviewed were in long term residential care (Table A4.7).

The majority of service users did not have experience of using personal care services prior to the introduction of FPC. In only nine cases had the service user been paying for local authority personal care services prior to the introduction of FPC which meant we heard little about the transition to free services. In a further seven cases free services had been provided before the introduction of FPC. Only one interviewee had experience of Direct Payments (a carer who had arranged this for their parent).

Table A4.2: Characteristics of interviewees (Service Users and Carers)

Table A4.3: Status of interviewees (users/carers)

Table A4.4: Service users' needs

Note: people may have been in more than one category

Table A4.5: Level of free personal care provided to service user's own home
(hours per week)

All home care users

Table A4.6: Level of free personal care provided to service user's own home
(days per week)

All home care users

Table A4.7: Nature of residential care

All care home residents

Independent Sector Providers' Survey

Survey questionnaires were issued to independent sector (private and voluntary) home care providers and care homes in the six case study areas.

The questionnaires covered the following topics:

• Background information about the organisation
• Services provided
• Charges
• Relationship with the local authority
• Experience and views about Free Personal Care.

A total of 300 questionnaires were issued and 64 completed questionnaires were returned (representing a response rate of 21%). (Tables A4.8 and A4.9)

Whilst the responses did not provide robust quantitative evidence, the survey did provide qualitative evidence about the views of independents sector providers which has informed the evaluation and this report.

Table A4.8: Independent Sector Care Homes Survey

Table A4.9: Independent Sector Home Care Providers' Survey

* Note: no questionnaires were issued to independent sector home care providers in Angus as almost all personal care services are provided by the in-house home care service.

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