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The Range and Availability of Domiciliary Care Services in Scotland - Research Findings

DescriptionThis study examines the availability and range of domiciliary care provision.
ISBN (Web Only)
Official Print Publication Date
Website Publication DateDecember 24, 1998
Social Work Research Findings No. 11(1998)
The Range and Availability of Domiciliary Care Services in Scotland
Main FindingsIntroductionMapping Exercises
The Balance of CareService UsersRange of Provision
Flexibility of ServicesAccessibility of ServicesCharging
Funding and Competition
Domiciliary care services are generally agreed to be the most important in respect of enabling older people and others with severe disabilities, to remain in their own homes where this is their choice. This study represents Stage 1 of a two stage programme of research into domiciliary care provision. The study identified domiciliary care providers in Scotland and a sample of one in two of these was surveyed in order to examine the availability and range of domiciliary care provision across all sectors. Stage 2 of the research will investigate the extent to which domiciliary services for very dependent older people (including those with dementia) present a viable alternative to residential care.
Main findings'
•The study identified 590 domiciliary care providers. Forty-one per cent of these were in the statutory sector (social work and health) and 59 per cent were in the independent sector (voluntary and private).
•Despite the abundance of private and voluntary providers, the market share of the independent sector was found to be relatively small. The survey found that 76 per cent of the total hours of domiciliary care provided per week in Scotland were provided by social work providers, 15 per cent by the independent sector and the remaining 9 per cent by health providers i.e. NHS Trusts.
•Sixty-nine per cent of providers offered personal/nursing and domestic care. A small minority of providers (11%) said that they only provided assistance with domestic tasks. This suggested that domiciliary care had moved on from its traditional role of assisting only with domestic tasks.
•Despite the provision of more personal care, social work providers were the most likely to say that there were tasks which they would not undertake. The private sector appeared to offer the most flexible service in terms of the types of tasks undertaken.
•Few local authorities had initiated a tendering process when arranging services with independent providers, indicating that competition between independent providers for contracts with authorities was not yet well developed.
Introduction
The research aimed to identify all statutory, voluntary and private agencies which provided domiciliary care in Scotland and to survey a sample of those agencies in order to describe the availability and range of domiciliary care service provision across all sectors in Scotland. Information was collected from a sample of 182 domiciliary care providers and key informants from all regional authorities and health boards on: the balance of provision of statutory and independently provided domiciliary care; the features of domiciliary services provided in each sector; and social work and community health service policies in relation to the promotion and use of the independent sector in providing domiciliary care.
Mapping exercise
The study identified 590 domiciliary care providers of which the private and voluntary sectors combined accounted for 59 per cent. A one in two sample of all identified providers was selected for the main survey. The response rate to the survey was 66 per cent.
The Balance of Care
Despite the abundance of private and voluntary providers, the market share of the independent sector was found to be relatively small (See Figure 1). The statutory sector was still by far the major provider of domiciliary care in Scotland. Seventy-six percent of the total hours of domiciliary care provided per week in Scotland were provided by social work providers. The private and voluntary sectors combined represented 15 per cent of the total hours of care provided, and the health sector accounted for the remaining 9 per cent. A similar pattern emerged in the policy interviews, where, for the majority of informants, the proportion of need met by the independent sector in their area was less than 20 per cent.
Figure 1 : Proportion of total hours provided by each sectorService users
Figure 1 : Proportion of total hours provided by each sector Around one-third of domiciliary care providers surveyed catered for all community care groups. Over 75 per cent of providers in the health, social work and private sectors said that their largest user group was older people, compared with only 43 per cent of voluntary sector providers. The voluntary sector was more likely to provide services for people with: mental health problems; dementia; and physical disabilities than the other sectors.
Range of provision
The majority of providers of domiciliary care surveyed (69%) provided both personal or nursing and domestic care. Domiciliary care appears to have moved on from its traditional role of assisting only with domestic tasks. Very few (11%) of the providers surveyed provided a domestic only service. Of all the providers surveyed, 82 per cent provided assistance with everyday domestic tasks, but heavier domestic tasks were undertaken by a much smaller proportion of providers.
The type of personal care provided by health and social work services differed. The health sector provided more of those services regarded as nursing competencies and the social work sector provided more assistance with everyday care needs, such as toileting, bathing/washing and eating/drinking. The voluntary sector had a significantly higher proportion of agencies which did not provide either personal or nursing care.
The study found that the independent sector has increased choice in terms of the range of domiciliary care services available, although in some areas the independent sector was only approached by statutory purchasers as a last resort. Other limiting factors on choice were charges for private sector services and the fact that access to voluntary sector services was generally through the statutory sector.
Flexibility of services
Despite the provision of more personal care, social work providers were the most likely to say that there were tasks which they would not undertake. In contrast, the private sector appeared to offer the most flexible service in terms of types of task undertaken, and were the least likely to say there were tasks which they would not undertake.
Private providers were significantly more likely to provide services 24 hours a day, seven days a week than other providers. However, in respect of flexibility in timing of provision, independent providers, and the private sector in particular, were more likely to follow a minimum unit of time procedure. In addition, the minimum unit of time imposed by independent providers was more likely to be hourly, indicating less flexibility in this respect than in the social work sector, where half hourly was more common.
Accessibility of services
Most providers, across all sector received requests from a wide range of sources, suggesting that the lines of communication both between sectors, and with the general public, were fairly well established. The requirement for potential users to undergo assessment was high in all sectors. However, almost a quarter of social work providers said that users would only be required to undergo a home care assessment to access their services.
Despite the fact that a high proportion of independent sector providers said that they received referrals from the statutory sector, most were keen to encourage more referrals from health and social work agencies. This was also reflected in the independent sector's attempts to publicise their services suggesting that there may be unused capacity in the independent sector.
Charging
No statutory health providers made a charge for any of their services, but around half of the social work providers said that they charged for all or some of their services. (All but one of the new local authorities have since introduced charging (SWSI, 1996).) Not surprisingly, almost all private sector providers said that they charged service users for their services. This compared with only 31 per cent of voluntary sector providers.
Funding and competition
Few authorities (the former Scottish Regions) had initiated a tendering process when arranging services with independent providers, indicating that competition between independent providers for contracts with authorities was not well developed. In general, social work departments viewed independent services as being complementary to their own, using them to "plug gaps" in their provision, rather than competing with them for contracts.
Most local authorities were making use of the independent sector, but in a specialist way and to a limited extent. They appeared to be exercising more caution towards the use of the private than the voluntary sector. The types of purchasing used may have reinforced the selective use of the voluntary and private sectors. Block contracts tended to be given to the voluntary sector, whilst spot contracts were more commonly used with the private sector.
Although stimulation of the market by local authorities was found to be unevenly developed, local authorities were indirectly shaping the market as funders of independent sector providers. Forty per cent of private domiciliary care providers received local authority funding. This finding is consistent with the characteristics of a social care market as a quasi-market, largely publicly funded.
The study was conducted jointly by the Nuffield Centre for Community Care Studies at Glasgow University in collaboration with The Scottish Office Central Research Unit. It was funded by the Social Work Services Group of The Scottish Office.
Lisa Curtice, Fiona Fraser and Tracy Leca.
'The Range and Availability of Domiciliary Care Services in Scotland', the research report summarised in this Research Findings, may be purchased (price £6,00 per copy).
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