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Appendix 2: Study methods

A) Systematic review protocol

1. Mapping the scope of the area to be reviewed

The Scottish Executive's research specification outlines the scope of the research (p5). The areas on which the study should include evidence are identified in Point 12 of the research specification and reproduced in Table 1.

Table 1. Subject areas to be included in the systematic literature review (From Scottish Executive research specification)

2. Sources of evidence

The research specification calls for a methodology that will ensure 'comprehensive coverage of all evidence' in the subject areas set out in Table 1. In pursuit of this objective the systematic literature review will bring together both academic and 'grey' literature identified through four principal means; searches of electronic literature sources (bibliographic databases); searches of relevant websites; requests for relevant information sent to Scottish local authorities; and use of the personal resources of the research team. These are detailed further below.

2. 1 Electronic literature sources

Table 2 details the electronic literature sources that will be searched as part of the systematic literature review and Table 3 lists the search terms that will be employed with each database.

Table 2. Electronic literature sources to be searched for systematic literature review

Table 3. Search strings to be employed when searching electronic sources of information

The search strings have been expressed using Boolean notation and with '*' denoting a truncated search term. Most electronic bibliographic databases allow for these types of search. Where this is not the case, appropriate multiple searches will be formulated to achieve a similar coverage of material held in the database and the exact search strings used will be recorded.

2. 2 Relevant websites

Many organisations involved either directly or peripherally with care of older people host websites that may provide access to or references to research or other information relevant to the literature review. In order to ensure comprehensive coverage of all available evidence the websites of those organisations detailed in Table 4 will be searched as part of the data gathering process.

Table 4. Organisations whose websites will be searched as part of the evidence gathering process

2. 3 Requests for relevant information from Scottish local authorities

In order to include in the literature review any research work undertaken by or involving Scottish local authorities a section on 'Research into aspects of domiciliary care services provision' will be included in the 'Domiciliary Care of Older People - Questionnaire for Scottish Local Authorities' to be administered as part of this research.

2. 4 Personal resources of the research team

In order to ensure that the widest possible range of evidence is included, the systematic literature review may also include literature drawn from the personal resources of research team leaders Professor David Bell and Professor Alison Bowes.

3. Search and data handling strategies

3. 1 Data from the searches of electronic literature sources (bibliographic databases)

The collection and review of data from electronic literature sources is envisaged as a multiple stage process as illustrated in Figure 1.

In the first stage, individual ProCite5 databases will be established for each of the electronic source searches to hold bibliographic details of literature that matches the Protocol search strings listed in Table 2 below. In the second stage the literature lists produced in stage 1 will be merged. Duplicated records will then be identified and removed. Records in the 'cleaned' single literature list will then be individually examined, with those meeting the subject area inclusion criteria forming a further Procite database, the 'Elder Care Bibliography'.

In stage 3 'Review Proformas' will be completed for all literature included in the Elder Care Bibliography. All records will be coded to indicate both the project research specification subject area and the geographical area to which they relate. Literature will then be assessed in relation to the Review inclusion criteria, with those meeting the criteria forming the 'Systematic Review Bibliography'.

In the next stage records included in the Systematic Review Bibliography will be subject to further analysis. This will involve recording the research methods used, the key conclusions reached, the timing of the research in relation to the implementation of Free Personal Care and carrying out a research quality assessment. All Review Proforma and Systematic Review Bibliography coding information will be kept on a database constructed using Microsoft Access.

Figure 1 Systematic Review Process Diagram

3. 2 Data from all other sources

Details of all research identified following the search of websites, the return of questionnaires from local authorities or from the personal resources of the research team will be recorded on a Procite database and then subjected to the processes detailed in stages 3 and 4 of the systematic review process diagram in Figure 1.

4. Inclusion criteria

Inclusion criteria will be associated with the first three stages of the systematic literature review process and are detailed in Table 5.

Table 5. Inclusion criteria used in the systematic literature review

5. Synthesizing and reporting the findings of the review

Review proformas will be completed for all literature included in the Systematic Review Bibliography. The proformas set out the bibliographic details of the literature, indicate their research-related subject areas of concern and geographic coverage and evaluate the literature in terms of clarity of aims, suitability of methods and coherence and persuasiveness of findings. The proformas, together with electronic and/or hard copies of the literature, will be used by the research team in the preparation of the project report.

The systematic review protocol together with a summary of the results of the systematic review process will be provided as an Appendix to the project final report

B) Systematic Review - Summary of results

The results of the systematic review are summarised in Figure 2, and Table 6 provides a breakdown by topic area of references meeting the systematic review bibliography inclusion criteria.

Figure 2 Numbers of records matching/meeting different search and inclusion criteria

Table 6. References from Elder Care Bibliography meeting Systematic Review Bibliography inclusion criteria, categorised by topic heading

NB The Systematic Review Bibliography contained 430 references in total. Individual references may be categorised under up to three different headings

C) Domiciliary Care of Older People Questionnaire for Scottish Local Authorities

Establishing the evidence base for an evaluation of the implementation and impact of the free personal care policy

Domiciliary Care of Older People

- Questionnaire for Scottish Local Authorities

The University of Stirling has been commissioned by the Scottish Executive to carry out research to establish the evidence base for an evaluation of the implementation and impact of the Free Personal Care policy introduced to Scotland in July 2002. This questionnaire is a part of that research. Its main purpose is to find out about Local Authority costs of provision, charging for, and levels of unmet need for domiciliary care in Scotland for clients aged 65 and over. The data requested relate primarily to two years; 2001/2002 and 2004/2005 and are not currently included in returns to the Scottish Executive.

The questionnaire is arranged in four main sections

1. Costs of service provision. We are seeking to broadly assess the costs to and incomes generated by local authorities in the provision of personal and non-personal domiciliary care services. We are asking for estimations of the numbers of clients receiving services, together with the volumes, unit costs to the Authority and unit charges to clients of different services. We are aware that data on the total numbers of clients aged 65 or over in receipt of domiciliary services are collected by the Scottish Executive for the purposes of compiling Community Care Statistics and data on gross expenditure on, and receipts for, home care provision for the over 65s were requested as part of the Scottish Executive's Survey of Expenditure on Free Personal Care and Free Nursing Care 2003. We are not asking you to repeat this information.

2. Charging systems employed by local authorities for domiciliary care services. The questions in this section relate to different Local Authorities' treatments of Disability Living Allowance and Attendance Allowance benefits paid to, and disability-related expenditures of, clients aged 65 and over in calculating individual clients' charges for services. The Scottish Executive's Survey of Expenditure on Free Personal Care and Free Nursing Care 2003. asked Local Authorities to provide brief details of their charging policies in 2001-2002 and in 2002-2003 following the introduction of free personal care / free nursing care, and in 2004 COSLA carried out a Homecare Charging Survey that collected similar but updated data. We are seeking data on issues that were not specifically addressed by those surveys.

3. Levels of unmet need and numbers of clients waiting for assessment or services. Our questions in this section have two purposes. The first set is intended to broadly assess levels of unmet need for domiciliary care services, data on which should be based on assessments of levels of need by care managers. The second set of questions seeks to gather data on the numbers of clients who are 'in the system' but whose needs have either not yet been assessed or have been assessed but who are waiting to receive the services that they have been assessed as needing.

4. Evaluation and research. These questions are designed to gather information on local authorities' evaluations of their domiciliary care services. Included in this section are questions about the Authorities' progress in the implementation of SSA- IoRN and about the external commissioning or internal execution of research relating to the Authority's provision of services to older people.

Where research has been conducted we would be grateful if you would send us copies of reports with the returned questionnaire using the pre-paid return label provided.

Please return this questionnaire as soon as possible and no later than 21 October 2005. Should you have queries about any of the questions or how you should respond then please contact Dr Alison Dawson, Department of Applied Social Science, University of Stirling on 01786 466328 or e-mail asfd1@stir.ac.uk.

Section 1. Costs of Service Provision

We have been asked to collect data on the breakdown of domiciliary services provision and costs between personal care provision and other 'non-personal' domiciliary services provision for 2001-2002 and 2004-2005. These data have not been collected elsewhere. Please supply the data requested below and if specific data are unavailable please indicate this in the appropriate boxes.

We would be grateful if you could supply lists of task classifications for tasks included in this Authority's domiciliary care service provision (For Example, tasks classified as 'personal care', those classified as 'housing support' and so on). Please attach these to the completed questionnaire before returning it.

Section 2. Charging systems

We are collecting data on Local Authorities' charging policies specifically in relation to clients aged 65 or over in receipt of Disability Living Allowance ( DLA), clients aged 65 or over in receipt of Attendance Allowance, and the treatment of disability-related expenditure of clients aged 65 or over. These issues were not specifically addressed by previous Scottish Executive or COSLA surveys of Home Care charging policies.

Section 3. Unmet need and numbers of clients waiting for assessment or service provision

3. 1 Unmet need

(a) We are aware that there may be differences in what is understood by the term 'unmet need'. Please provide the definition of unmet need used in your Authority and on which you will base your responses to the following sections:

(b) How would you assess the level of unmet need in the Authority area last year (2004/2005) in relation to:

(c) How does this compare to your assessment of the level of unmet need in the Authority area in year 2001/2002) in relation to:

(d) Based on your understanding of the situation to date, how do you think that your assessment of the level of unmet need in the Authority area for the current year (2005/06) will compare with that of last year (2004/05) in relation to:

3. 2 Numbers of clients waiting for assessment or service provision

We wish to collect data on the numbers of clients aged 65 and over in your Authority who were either waiting for assessment or who had been assessed but were awaiting different types of service provision, for example waiting for home care services or care home places, as at 31 March for the years 2002 to 2005 and as at 31 September 2005. These data have not been collected elsewhere. Please supply the data requested below. If you are unable to provide exact numbers it would still be helpful if you were able to provide us with comparative estimates for the four dates in question. Please do this by using the numbers of clients waiting as at 31 March 2002 as the figure for comparison and stating 'HIGHER', 'LOWER' or 'SAME' for all subsequent years compared to the 2002 figure.

Section 4. Evaluating domiciliary care services provision.

(a) Evaluation / Review of domiciliary care services provision for older people

(b) Single Shared Assessment Indicator of Relative Need ( SSA- IoRN)

The SSA- IoRN (formerly the Resource Use Measure ( RUM)) is a standardised measure of relative need. Its main aims are to support service delivery at practitioner and local levels. In addition SSA- IoRN will provide Local Authorities and NHS partnerships with information relevant to service planning and budgeting; it will enable the Scottish Executive to monitor access to and equity of service provision nationally; and it will provide data to underpin future policy development in respect of domiciliary care services.

(c) Research into aspects of domiciliary care services provision

We would very much appreciate copies of any research into aspects of care of older people, and particularly any research that is related to the Scottish Executive's Free Personal Care Policy carried out by or for the Authority, or with which the Authority has been involved.

Please attach paper copies of research documents and forward them to us with the completed questionnaire. Alternatively, where the research reports are in electronic format, please indicate where we may access the research (For example via the Authority's website) or attach documents and e-mail them to the contact e-mail address given at the start of the questionnaire.

Thank you for taking the time to complete this questionnaire. Before you return it can you please check that all questions have been completed and that you have attached the lists of task classifications within the Authority's domiciliary care services provision requested in Section 1. Then return it and any accompanying documents to us using the pre-paid reply label supplied.

Telephone 01786 466328
E-mail: asfd1@stir.ac.uk

D) Databases and Statistical Releases used

Scottish House Condition Survey ( SHCS)
Scottish Household Survey ( SHS)
Family Resources Survey ( FRS)
British Household Panel Survey ( BHPS)
General Household Survey ( GHS)
Department of Work and Pensions ( DWP) - Attendance Allowance Data
Scottish Executive Care Homes, Home Care Services, Direct Payments and Housing Statistical Bulletins
Audit Scotland Performance Indicators (Housing and Social Work)

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