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ISBN 0 7559 1278 0 (Web only publication)

Research Specification
Scottish Executive Health Department
Analytical Service Division
April 2005

This document is also available in pdf format (83k)

ESTABLISHING THE EVIDENCE BASE FOR AN EVALUATION OF THE IMPLEMENTATION AND IMPACT OF THE FREE PERSONAL CARE POLICY

INTRODUCTION

1. Free Personal Care was introduced in Scotland in July 2002 together with Free Nursing Care. The operation of this flagship policy has generated substantial interest in the UK and beyond and now that the policy has bedded down, the Scottish Executive Health Department wishes to evaluate the implementation and impact of Free Personal Care in Scotland. A flexible strategy has been developed to meet this requirement (see Annex 3 for further information). The main aims of the strategy are to:

• evaluate the implementation, operation and impact of Free Personal Care,
• identify and disseminate good practice in the operation of the policy, and
• consider any implications for the further development of policy and practice within the wider policy context, reflecting both the care home and care at home sectors.

2. The evaluation will be conducted in 3 phases:

Phase 1Establishing the evidence base

This phase will provide a baseline against which progress with the implementation and impact of the policy can be measured. It will bring together available evidence which informed the initial implementation of Free Personal Care in 2002, identifying and filling any gaps and updating on the basis of current evidence. It will also provide the current context for the Free Personal Care policy, identifying and analysing research and statistics on the implementation of the policy and its operation since 2002 and mapping the relevant policy context.

Phase 2Evaluating Free Personal Care

The main stage evaluation will:

• evaluate the implementation, operation and impact of Free Personal Care from the perspectives of local authorities and care providers (including voluntary organisations and commercial/private service providers), examining definitions of Free Personal Care, assessment processes, management arrangements, charging policies, costs and projections; and
• examine service users' and carers' experiences of Free Personal Care.

This stage will be informed by the baseline work, emerging findings from other relevant research and the views of key stakeholders.

Phase 3Overview

The final phase will bring together and review the findings of the evidence base work and the main stage evaluation, drawing out the implications for the future development of the policy and practice in providing long term care for older people.

3. This specification outlines work involved in Phase 1 of the evaluation, which will inform, and provide a platform for, the work to be conducted in Phase 2 of the evaluation;

• establishing the evidence base for the implementation of Free Personal Care, and
• establishing the context for the operation of the policy.

BACKGROUND

4. In 1999, the Royal Commission on Long Term Care, established to examine the funding of long-term care for the elderly, recommended that personal care should be provided free of charge both in residential settings and at home. The Care Development Group was set up in 2001 to take forward the recommendations in the Royal Commission report ¹ in Scotland, the purpose of the Care Development Group being to ensure that older people in Scotland have access to high quality and responsive long-term care, in the appropriate setting, and on a fair and equitable basis. At this time, charging for personal care services was means tested which meant that a number of older people received personal care services without charge, whereas others were required to pay for the services they received. In some cases, personal care services were already provided free of charge to older people assessed as requiring them, without means testing.

5. The Care Development Group report Fair Care for Older People ² was considered by the Scottish Executive and in September 2001 an announcement was made by the First Minister to accept the Care Development Group's recommendations in full, including the implementation of free personal and nursing care in Scotland. The Free Personal and Nursing Care policy was implemented in July 2002, enabling eligible older people to receive personal and nursing care services free of charge, without means testing. The aims of the Free Personal Care policy are to:

• improve the availability of personal care services to older people at home;
• encourage and help older people to stay in their homes for as long as possible where it is practicable and reasonable to do so;
• provide older people throughout Scotland with the same range and standards of personal care services in the same circumstances, irrespective of where they live;
• provide personal care services on a fair and equitable basis based on an assessment of people's needs and to provide these without charge to everyone that requires them;
• provide nursing care free for all who need it;
• remove discrimination caused by charging for care provided to elderly people in the community, bringing that care into line with the NHS where the principle of free care based on need is accepted and applied.

6. Guidance ³ for local authorities, the NHS and other service providers was published in April 2002 (see Annex 1) and has since been kept under review and revised. The Care Development Group developed their recommendations on the basis of a thorough examination of available evidence and analysis at the time and they also commissioned a programme of research to inform their conclusions which was published in 2001 ⁴ (for further information, see Annex 2). The supporting research included work investigating public attitudes to Free Personal Care, independent home care providers' perspectives on Free Personal Care, the demand for and use of personal care services and informal care of older people. The research findings raised a number of issues including:

• what services Free Personal Care should cover;
• concerns about the quality of services;
• mixed opinion about whether the provision of funding for personal care for the elderly should be means tested;
• the extent of unmet need; and
• how far people would switch from informal to formal care if personal care services were available without charge.

7. The following statistical data is currently available:

• the numbers of people receiving personal care without charge
• expenditure by local authorities on Free Personal Care
• expenditure by local authorities on Social Work Services
• Scottish Household Survey
• Home Care survey
• Scottish Care Homes Census
• Direct Payments survey
• Patients ready for discharge - quarterly publications by ISD

8. The research commissioned by the CDG to inform their proposals provides a partial baseline at July 2002 when Free Personal Care was implemented. Other data from the time of Free Personal Care implementation is now available, which may have affected the assessments of the CDG (such as Census 2001) and the baseline will be updated to incorporate this. The findings from this part of the study will provide the baseline against which progress with the implementation and operation of Free Personal Care can be measured, and will also inform the development of the later phases of the evaluation.

9. In order to provide the context for the operation of the policy, evidence since 2002 will be identified and analysed and the relevant policy context will be mapped out. This will help to identify key issues for following up during the main stage of the evaluation.

AIMS AND OBJECTIVES

10. The main aims of the study are to:

• provide a baseline against which progress with the implementation and operation of Free Personal Care can be measured, and
• provide the context for the operation of Free Personal Care since 2002.

11. The specific objectives are grouped together under separate headings, as below.

Establishing the baseline at July 2002

• develop a framework outlining the baseline information required to evaluate the policy;
• review the data to identify how much information is readily available;
• contact Local Authorities to establish whether they hold the necessary information to fill in gaps;
• map out availability of baseline data;
• collate all available information to establish the baseline
• identify gaps or weaknesses in the baseline data;
• suggest how these gaps might be filled or weaknesses overcome.

Establishing the context for the operation of the Free Personal Care policy

• map out and explore the relationship between Free Personal Care and other relevant policies, such as Direct Payments, Supporting People, deferred payments, joint futures;
• review relevant research, statistics and economic data since implementation to present time;
• identify any gaps and weaknesses in the available evidence.

SCOPE OF THE RESEARCH

12. This study will draw on evidence relating to costs, statistics, social research and the policy context of Free Personal Care, including the research commissioned to inform the Care Development Group. The research to be included in this study will have been published in the last 4 years. The study will include evidence relating to the following areas:

• the range and quality of personal care services available before and after the implementation of Free Personal Care;
• the cost of personal care to Local Authorities before and after the implementation of the policy;
• unmet need for personal care services and the switch from informal to formal care;
• the equity of the availability of personal care services;
• numbers of older people staying in their homes (and the reasons for this) now and before the policy was introduced;
• integration of personal care services with other forms of care;
• the adequacy of personal care services to meet demand/need;
• the experience of service users in seeking access to personal care services (e.g. waiting times for assessments and for delivery of services).

13. The policy context at the time of the implementation of Free Personal Care in July 2002 will be explored and mapped, along with policy changes since the implementation. Where possible the study will also map anticipated policy changes which may have an impact on the Free Personal Care policy.

RESEARCH DESIGN AND METHODS

Establishing the baseline

14. This part of the study will be predominantly desk-based, with the successful contractors being expected to identify relevant statistics and economic data to be collated and reviewed. Some contact with Local Authorities may also be required to fill in gaps in the data.

Establishing the context

15. This part of the study will be desk-based, with the successful contractors being expected to identify relevant statistics, economic data, social research and policies to be analysed.

16. Tenderers should provide a clear indication of the methods they propose to use to meet the requirements set out in the specification. Tenderers should also provide a clear indication of what sources, such as electronic databases and data sets they will consult to identify relevant literature, statistics and economic data for this study and what measures they will take to ensure comprehensive coverage of all evidence in this area. The tenders should demonstrate how the proposed methods will contribute to meeting the aims of the research and identify any limits on the findings due to research design or other factors.

RESEARCH ETHICS AND EQUALITIES

17. It is the responsibility of the potential contractor to ensure that the proposed methodology does not contravene the provisions of the Data Protection Act 1998. Contractors are also expected to abide by appropriate professional guidelines, including the Social Research Association's Code of Ethics ( http://www.the-sra.org.uk/ethics03.pdf ). The contractors should address project specific ethical considerations, for example, enabling participation for vulnerable groups, informed consent, protecting the interests of subjects, safety for field researchers and maintaining confidentiality.

18. The research will be required to address equalities questions, identifying the ways in which Free Personal Care is experienced by different groups, including minority ethnic groups, people of different ages, gender, sexual orientation, social class and religion. Further guidance on this is provided in the Scottish Executive Equality Strategy ⁵ and the 'Mainstreaming Equality' website which can be accessed through the Scottish Executive Social Research Website.

DISSEMINATION AND RESEARCH OUTPUTS

19. The main outputs from the work will be a brief and accessible report of no more than 100 A4 pages and a research finding paper. The final report should provide a full account of the conduct of the study, address the aims and objectives, discuss the findings setting them in the wider research context and discuss the implications of any issues arising. Any limitations on the conclusions resulting from the nature of the study or the availability of material should be clearly outlined. The report should include an executive summary.

20. Submission of an interim report summarising the initial findings of the research will be required, as will a map showing the availability of all baseline evidence. The draft final report should be supplied in hard copy and on disk. The final report and research findings should be consistent with the Scottish Executive Social Research Group's format for research reports and research findings, details of which are provided in the document 'Writing for the Social Research Series' available on the Scottish Executive website at www.scotland.gov.uk/socialresearch

OWNERSHIP AND PUBLICATION OF THE REPORT

21. Ownership of all research material including final reports and any data produced as a result of the research will vest in the Scottish Ministers. There is a presumption in favour of publication of final reports and research findings documents in the Social Research Series subject to the agreement of Ministers and on a date to be determined by the Health Department.

TIMETABLE AND COSTS

22. Tenders should include all costs for this research. Tenderers liable for VAT on government funded research projects should indicate this in their proposal. Tenderers are asked to submit a fully costed proposal itemised under the following headings:

• staff including research and administrative staff;
• stationery, equipment and materials;
• travel and subsistence expenses directly associated with the research;
• overheads indicating the rate at which these are charged;
• VAT.

23. It is anticipated that the research will take place over a period of 6 months from the end of May 2005. Tenderers should provide a clear timetable for the study indicating the dates for completion of the work including as appropriate obtaining ethical approval, identification of background material, development of instruments, analysis of statistical information, data analysis and writing up. A brief interim report will be required by mid August 2005. A full report of the research is required by end November 2005. A four-page summary of the key findings should be submitted with the final research report. Payments will be linked to the successful completion of key stages of the research.

24. Outputs are required as follows:

• Framework outlining the baseline information required to evaluate the policy- by mid June
• Brief interim report highlighting key emerging findings and map of available baseline data- mid August
• Draft final report- mid October
• Final report- end November

RISK ASSESSMENT

25. Contractors should outline potential risks to successful completion of the project within the timescale and budget. These could be organisational (e.g. staff moving or IT systems), specific to the project, or general. Tenders should outline strategies to tackle potential risks, general contingency arrangements and disaster recovery plans as appropriate.

PROJECT STAFF

26. This project will require staff with knowledge of the community care policy in Scotland and with the technical skills required to conduct the research. Tenders should:

• identify all staff to be associated with or employed on the study (with CVs)
• specify the role and expertise of all staff
• provide details of how staff will be managed and supervised

PROJECT MANAGEMENT

27. A research advisory group will be set up by the SEHD Health and Community Care Research Branch to oversee the study and provide advice and guidance as required. It will include Scottish Executive colleagues and representatives of other organisations as appropriate. The successful contractor will be expected to attend meetings of the advisory group which will be arranged to coincide with key stages of the research. The research will be managed on a day to day basis by Ruth Whatling in Health and Community Care Research Branch, Health Department Analytical Services Division, who can be contacted on 0131-244-3533. The contractor will be expected to liaise closely with the research manager at all stages of the study.

RESPONSIBILITIES OF THE CONTRACTOR

28. Details of the responsibilities of contractors are outlined in the Scottish Executive Social Research Group's Standard Conditions for Research and Consultancy Contracts (reference SR/SC/09/02) ⁶ which will apply to this research, a copy of which is attached.

SUBMITTING A TENDER

29. Tenderers are invited to submit detailed costed proposals which address the points raised in the specification. Tenders should specify clearly and in detail the overall design and methods proposed demonstrating how these will ensure the research objectives are met. Further information can be obtained from Ruth Whatling, Health and Community Care Research Branch, on 0131-244-3533. Following submission of the tenders by 12 midday 23 rd May 2005, tenderers will be informed of the outcome of the tendering process with a view to a contract start date later that month.

Please inform me by 5pm 6 th May whether you will be submitting a tender and submit your tender in hard copy, and electronically to ASDHDResearch@scotland.gsi.gov.uk

30. The criteria according to which the tenders will be assessed are as follows:

• understanding of the Department's requirements and the research brief
• understanding of and sensitivity to policy area
• capability in all necessary technical aspects of the work
• assessment of research ethics
• experience, knowledge and skills in this and related fields
• management capability of team leader and suitability of project team organisation - in particular, that of the person with day to day responsibility
• relative inputs from senior staff
• assessment of costs - total and distribution and average cost per person day
• quality control mechanisms
• assessment of the contractor's contingency arrangements for completing the research

31. The following essential information required from tenderers:

• title of the research or consultancy
• name of tenderer, status in the company/institution and name of person for further contact (if different)
• details of the tenderer's previous research skills and experience of relevance to the current application
• two named referees (to be taken up depending on the nature of the competition)
• a clear statement of the tender price and costings for the project under the following subheads:

(a) staff costs

(b) equipment and materials

(c) travelling expenses directly related to the project

(d) overheads

(e) VAT

(f) distribution of costs for each stage of the project and of costs and person days for each member of staff

Analytical Services Division
Scottish Executive Health Department
April 2005

ANNEX 1
FREE PERSONAL CARE GUIDANCE

1. The guidance on Free Personal and Nursing Care stipulates that the implementation of free care can be put into 2 broad categories:

• Care in care homes - arrangements for flat rate payments for personal care for those aged 65 and over in care homes who are able to meet their own care costs and flat rate nursing care payments both for over and for under 65s in care homes who are able to meet their own care costs.
• Care at home - arrangements for adjusting local authority systems for home care charging to individuals to take account of Free Personal Care.

2. The key aspects of the policy are:

For those living in their own home

• personal care without charge is available to those aged 65 and over.
• all eligibility for receiving personal care without charge is subject to an assessment of need by the local authority.
• no local authority charge will be made for such personal care services after 1 July 2002.
• eligibility for receiving personal care without charge is made irrespective of income, capital assets, marital status or the care contribution currently made by an unpaid carer.
• non personal care services will continue to be subject to charges at the discretion of the local authority.
• eligibility for and payment of Attendance Allowance and Disability Living Allowance are not affected by the introduction of Free Personal Care.

For those living in care homes

• the provision of payments towards nursing and personal care will apply to those who pay their own care costs (self-funders).
• transitional arrangements applied for those already in residential or nursing homes on 31 March 2002. For those people no assessment of need was required and they were eligible for a payment of £145 a week for personal care and if receiving nursing care of a further £65 per week.
• for those self-funders entering a care home after 31 March 2002, an assessment of need is required before they become eligible for personal or nursing care payments at the rates above.
• self-funders pay the remainder of their own costs, often described as living or accommodation costs.
• Attendance Allowance and Disability Living Allowance are not payable to those receiving personal care without charge in care homes (but are payable for the first 4 weeks).

ANNEX 2
RESEARCH ON FREE PERSONAL CARE

Research to inform the Care Development Group:

Machin, D and McShane, D Providing Free Personal Care for Older People: research commissioned to inform the work of the Care Development Group (November 2001) Scottish Executive Central Research Unit

Chapter 2-NFO System Three Social Research/ MORI Scotland 'Public attitudes to the provision of free personal care: telephone survey'

Chapter 3- Jones, L, Ridley, J and Anne Robson (Scottish Health Feedback) 'Public attitudes to the provision of free personal care: focus group research'

Chapter 4- Dewar, B, O'May, F and Walker, E (Queen Margaret College) 'Public attitudes to the provision of free personal care: older people's focus group research'

Chapter 5- Matthew, D and Rimmer, L (United Kingdom Homecare Association) 'Providing personal care to older people in Scotland- the perspective of independent home care providers'

Chapter 6- Stearns, S C and Butterworth, S (Health Economics Research Unit, University of Aberdeen) 'Demand for and utilisation of personal care services for the elderly'

Chapter 7- Leontaridi, R and Bell, D (University of Stirling) 'Informal care of the elderly in Scotland and the UK'

Ongoing research:

Bell, D Financing long-term care in Scotland and the UK (ongoing work for the Joseph Rowntree Foundation due December 2005)

As part of its Policy and Practice Development Programme on Long Term care of Older People, the Joseph Rowntree Foundation is currently funding a study entitled 'Financial Models of Care in Scotland and the UK' which is being conducted by David Bell (who was a member of the Care Development Group) and Alison Bowes at the University of Stirling. The study is examining the practical issues encountered during the implementation of Free Personal Care and will consider its longer term sustainability. These issues will be examined in the context of developments in the funding of long term care for the elderly in the rest of the UK.

Statistical publications:

Statistics on Community Care services can be found on the Scottish Executive website at www.scotland.gov.uk/statistics/commcare .

Some reports of particular interest are:

First Report for the Range and Capacity Review: Projections of Community Care Service Users, Workforce and Costs, Scottish Executive 16 July 2004
http://www.scotland.gov.uk/library5/health/pccswc-00.asp

Statistics Release: Free Personal/Nursing Care, Scottish Executive September 2004
http://www.scotland.gov.uk/stats/bulletins/00368-00.asp

Benefits and tax credits in Scotland: report for February 2004 National Statistics Publication for September 2004 http://www.scotland.gov.uk/library5/government/btcsfeb04.pdf

Home Care Services, Scotland 2004
http://www.scotland.gov.uk/stats/bulletins/00387-00.asp

Care Homes, Scotland, September 2004
http://www.scotland.gov.uk/stats/bulletins/00406-00.asp

Direct Payments, Scotland 2004
http://www.scotland.gov.uk/stats/bulletins/00370-00.asp

Delayed Discharges
http://www.isdscotland.org/isd/info3.jsp?pContentID=1208&p_applic=CCC&p_service=Content.show&

David Clark, Amy McKeon, Matt Sutton, Rachael Wood Healthy Life Expectancy in Scotland On behalf of the HLE Measurement in Scotland Steering Group March 2004
http://www.isdscotland.org/isd/files/HLE_report_2004.pdf

Scottish Local Government Financial Statistics 2003-04
http://www.scotland.gov.uk/stats/bulletins/00404-00.asp

Economics related publications:

Wittenberg, R, Comas-Herrera, A, Pickard, L and Hancock, R (2004) Future demand for long-term care in the UK: a summary of the projections of long-term care finance for older people to 2051 Joseph Rowntree Foundation
http://www.jrf.org.uk/bookshop/details.asp?pubID=624

Glendinning, C, Davies, B, Pickard, L and Comas-Herrera, A (2004) Funding long-term care for older people: lessons from other countries Joseph Rowntree Foundation
http://www.jrf.org.uk/bookshop/details.asp?pubID=626

ANNEX 3
SUMMARY OF THE STRATEGY TO EVALUATE THE IMPLEMENTATION AND IMPACT OF FREE PERSONAL CARE IN SCOTLAND

Introduction

This paper provides a summary of the flexible strategy for the evaluation of the implementation, operation and impact of Free Personal Care in Scotland.

The main aims of the strategy are to:

• evaluate the implementation, operation and impact of Free Personal Care,
• identify and disseminate good practice in the operation of the policy, and
• consider any implications for the further development of policy and practice within the wider policy context, reflecting both the care home and care at home sectors.

The strategy

The evaluation strategy is intended to provide a flexible framework to ensure that key issues for the operation of Free Personal Care can be addressed as they emerge, taking into account the perspectives of key stakeholders. The strategy is made up of three phases:

Phase 1 Establishing the baseline

This will bring together available evidence which informed the initial implementation of Free Personal Care, identifying and filling any gaps and updating on the basis of current evidence. It will also review the information currently available from statistics and research on the implementation and management of Free Personal Care since 2002.

Phase 2 Evaluating Free Personal Care

The main stage evaluation will:

• evaluate the implementation, operation and impact of Free Personal Care from the perspectives of local authorities and care providers (including voluntary organisations and commercial/private service providers), examining definitions of Free Personal Care, assessment processes, management arrangements, charging policies, costs and projections; and
• examine service users' and carers' experiences of Free Personal Care.

This stage will be informed by the baseline work, emerging findings from other relevant research and the views of key stakeholders.

Phase 3 Overview

The final phase will bring together and review the findings of the baseline and main stage evaluation, drawing out the implications for the future development of the policy and practice in providing long term care for older people.

A dissemination strategy will run concurrently with the 3 phases, with a series of reports produced throughout the evaluation, culminating in the publication of the final report in late 2006.

Work to be conducted for the evaluation

The evaluation will explore the implementation, operation and early impact of Free Personal Care on both the home care and care home sectors from the perspective of:

• people who currently receive personal care without charge and their carers, as well as wider public opinion;
• those who administer and manage the Free Personal Care policy (including front-line staff and local authority managers);
• service providers (including voluntary organisations, local authorities and private/commercial care service and care home providers).

It will involve modelling work to facilitate projections of the cost and extent of Free Personal Care in the future. The evaluation will also explore understandings and definitions relating to the policy of providing personal care without charge, examining variations in interpretation and measurement (such as variations in definitions of personal and nursing care, assessment processes or differing approaches to the use of community care and Free Personal Care resources). It will include an examination of workforce issues arising from implementation of the policy.

Whilst the main focus of this strategy is the Free Personal Care policy, it will also address the interaction of Free Personal Care with Free Nursing Care in care homes. The evaluation will also map out and explore the relationship between Free Personal Care and other relevant policies. The evaluation will be set in the wider policy and practice context, considering the impact of the development of other policies and their cross cutting aspects, examining whether the policies facilitate or work against successful implementation of Free Personal Care.

The initial phase of work will commence late in May 2005 and the evaluation will conclude in autumn 2006, with provisional findings available from the middle of 2005.

Management of the strategy

A core Scottish Executive team will manage the strategy, a wider Reference Group will ensure effective liaison with stakeholders, and specific Research Advisory Groups will be set up for individual research projects as necessary.

The Scottish Executive team will be responsible for management of the strategy. It will meet periodically to oversee progress and determine the specific operation of the strategy. It will comprise key officials from HD: ASD and Care of Older People Division.

The Reference Group will focus on the objectives of the evaluation and consider the implications of the findings of the 3 phases for policy development, facilitating the implementation of any changes and dissemination of good practice emerging from the evaluation. In the early stages of the evaluation, a dissemination strategy will be developed and implemented by HD: ASD and Care of Older People Division in liaison with the reference group.

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