Relative values.

THE ANNUAL state of social care report was a publication I looked forward to reading each year because it provided comprehensive information on how services were doing, and allowed the reader to make comparisons year-on-year, standard-by-standard.

Relative values.

NEWS THAT local authorities are responding to the threat of big cuts in their budgets for next year by putting restrictions on their services now is unsurprising.

Relative values.

The care quality commission (CQC) consultation on proposals for the assessment of commissioners and providers of health and adult social care has now closed.

Relative values.

THE MONTHS since the change of government have been filled with a steady stream of policy announcements. The white paper spells the end for primary care trusts and an increased role for GPs in commissioning services for patients, only a few years after a major reorganisation aimed at sharpening their focus on planning services for local populations.

Commit to dignity.

INTEREST IN dementia has broken out beyond professional circles recently. An actor, a newsreader and a television presenter have described their personal experiences on prime time television, while author Terry Pratchett has presented two TV programmes on his response to diagnosis of the disease. This makes a welcome break from the diet of neglect and abuse regularly offered by parts of the media on the subject of older people's care. But all this, when set alongside the recent publication of the National Dementia Strategy for England ( Department of Health 2009 ) and parliamentary inquiry into training, is something of a sideshow.

Relative values.

THE BIG Care Debate ( http://careandsupport.direct.gov.uk ) offers everyone the chance to have their say on the green paper Shaping the Future of Care Together ( Department of Health 2009 ). It is intended to stimulate all of us - professionals and the wider population - to consider the critical issues facing adult care and support in England now and in the future so that a white paper can be prepared that may lead to new legislation.

Relative values.

A recent study of the use of medicines in care homes revealed a worrying level of mistakes ( Barber et al 2009 ). A sample of 256 residents, drawn from 55 homes across three areas, enabled the researchers to observe a variety of systems used to administer drugs. They were also able to examine the prescribing practices of a wide range of GPs, and dispensing by a similarly diverse range of pharmacists. The residents, reflecting the complex needs of much of the care home population, had a mean age of 85 and were taking a mean of eight medicines.

The art of listening.

THE CARE Quality Commission (CQC) has made an early commitment to listen to what service users have to say about their experiences of health and social care ( CQC 2009 ). Its 'Voices into Action' charter outlines the new regulator's plans. The CQC aims to conduct studies to find out users' experiences of health and social care services, involve users in inspections, set up user panels, consult widely on CQC policy, work with Local Involvement Networks (LINks) and assess how providers and commissioners of services involve users. This is an ambitious set of goals, reflecting the growing demand for wider community and consumer involvement across public services generally.

Time for action.

PANORAMA'S RECENT undercover report, 'Britain's Homecare Scandal', lived up to its name. Aspects of domiciliary care identified in the programme should be of grave concern to us all. While poor staff behaviour, slipshod recruitment procedures and woeful lack of training and preparation may not be representative of the field, the themes and patterns were sadly all too familiar.

All change?

THE LAUNCH of the Care Quality Commission (CQC) in April, responsible for the regulation and inspection of all health and adult care services, marks the end of three bodies. The Healthcare Commission and the Commission for Social Care Inspection (CSCI) began operating in 2004, while the Mental Health Act Commission was created 25 years ago to safeguard the interests of people detained under the Mental Health Act 1983.

The right consistency.

EVERY CHANGE made to the structures, systems and tools for inspectors is intended to deliver a more effective and consistent approach.

Relative values.

THE ANNUAL survey of the market in care services for older people is full of facts and reasoned opinion ( Laing & Buisson 2009 ). Most of us are unlikely to see it, as, at more than £700 a copy, it is destined for the desks of senior executives of stock market-listed companies, more interested in 'business' than care. But the projections made are likely to capture the interest of managers and practitioners in public and independent sectors whether they commission or provide services.

Can clinicians benefit from patient satisfaction surveys? Evaluating the NSF for Older People, 2005-2006.

BACKGROUND: A transformation of healthcare is underway, from a sellers' market to a consumers' market, where the satisfaction of the patient's needs is part of the definition of quality. Patient satisfaction surveys are widely used to judge service quality, but clinicians are sceptical about them because they are too often poorly designed measures that do not lead to improvements in the quality of care. AIM: To explore the use of patient satisfaction survey data in identifying problems with the provision of inpatient care for older people. METHODS: A case study using secondary analysis of postal survey data about older people's experiences of health and social care services, obtained during the evaluation of the National Service Framework for Older People in 2005-2006. The survey asked about experiences of inpatient care and of discharge from hospital, and sought perceptions of the avoidability of the admission. SETTINGS AND PARTICIPANTS: A total of 4170 people aged 50 years and over returned a postal questionnaire in six local authority areas of England. Responses from 584 who had experienced a recent overnight stay in hospital are reported and discussed. FINDINGS: The response rate was 35%, ranging from 26% to 44% in the six areas surveyed. The great majority of those who had recent direct experience of inpatient care reported that they had been engaged in decision-making, that staff promoted their independence and maintained their dignity. There were widespread examples, however, of the opposite experiences. Discharge from hospital was problematic for about one-third of survey respondents with this experience, and there were different accounts of poorly managed discharges from all areas. CONCLUSIONS: Case studies using local survey data can be used as formative assessments of services. The response rate to the survey and the likelihood of responder bias mean that patient satisfaction survey data of this sort cannot be used to judge or compare services in a summative way, but can highlight areas where remedial action is needed. Small-scale local surveys may seem to lack the robustness of larger studies, but do identify similar areas of concern. Commissioners and clinicians could use the findings of such surveys to inform dialogues about the quality of hospital care for older people.