Improving outcomes of social care services: the impact of ASCOT
Submitting InstitutionUniversity of Kent
Unit of AssessmentSocial Work and Social Policy
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Economics: Applied Economics
Summary of the impact
This research improved policy-makers' and practitioners' understanding of
well-being among residents of social care facilities by identifying the
factors contributing to residents' quality of life. This research resulted
in the development of the Adult Social Care Outcomes Toolkit (ASCOT),
whose use is rapidly increasing both in the UK and internationally.
Evidence from beneficiaries including policy-makers, experts and service
practitioners, as well as interviews with service users, indicates that
ASCOT captures aspects of well-being that are highly valued by service
users and policy-makers alike.
This research was led by Netten (who joined Kent in 1987 and
became a Professor in 2003) and involved other Personal Social Services
Research Unit (PSSRU) researchers at Kent and LSE who have contributed to
the development, testing and analysis of datasets generated by multiple
studies and surveys relating to the outcomes of social care.
The research underpinning this case study developed a measure of social
care outcomes for older people [see reference 3.1], followed by
Department of Health commissioned work on social care which fed into the
2005-06 Atkinson Review of the measurement of public sector productivity
in National Accounts [ref 3.5]. Collectively, the research
- That existing measures were inadequate for establishing the outcomes
of existing social care services.
- That a robust measure was needed that captured social care related
aspects of quality of life (i.e. dignity, autonomy, comfort, safety,
personal cleanliness, social participation, occupation, food and drink).
- That any measure needs to take account of individual preference
weightings to allow for comparison across cases.
- That measures need to be anchored to an equivalent health state
(`being dead') to facilitate a wide range of applications.
The measure developed as a result of this initial research was used in
the major collaborative Individual Budgets Evaluation Network which
evaluated Individual Budget pilot projects (2006-08), allowing the
applicability of the measure to be compared across service user groups [ref
3.6]. Following the Atkinson Review, further developmental work was
supported by the Measuring Outcomes for Public Service Users (MOPSU)
project, funded by the Treasury and led by the Office for National
Statistics. This project, led by Forder (who joined Kent in 2007
as a Professor and became Director of PSSRU in 2013), included an approach
to measuring outcomes for residents of care homes [ref 3.7] and for
measuring outcomes of low-level services (such as day care) [ref 3.2].
A National Institute of Health Research (NIHR) funded methodological
study, undertaken in parallel to the MOPSU study [ref 3.4], tested
different preference elicitation methodologies by surveying 500 members of
the general population and 450 service users [ref 3.3].
Based on this research the Adult
Social Care Outcome Toolkit (ASCOT) was launched in June 2010, and
made available online. Subsequent research has been commissioned to
support the use of ASCOT in the national Adult Social Care Survey (ASCS)
and Outcomes Framework. Feedback about use of ASCOT in practice, and
demand for a care home version, have also resulted in the commissioning of
further projects, funded through NIHR School for Social Care Research,
testing and developing these approaches.
References to the research
3.1 - Emerson, E., Robertson, J., Gregory, N., Hatton, C., Kessissoglou,
S., Hallam, A., Järbrink, K., Knapp, M., Netten, A. and Noonan Walsh, P.
(2001) `Quality and Costs of Supported Living Residences and Group Homes
in the United Kingdom' American Journal on Mental Retardation 106
3.3 - Malley, J., Towers, A.M., Netten, A.P., Brazier, J.E., Forder, J.E.
and Flynn, T. (2012) `An Assessment of the Construct Validity of the ASCOT
Measure of Social Care-Related Quality of Life with Older People' Health
and Quality of Life Outcomes 10 (1): 21 [submitted to REF2,
output ID SSPSSR172].
3.4 - Netten, A., Burge, P., Malley, J., Potoglou, D., Towers, A.M.,
Brazier, J. and Forder, J. (2012) Outcomes of Social Care for Adults:
Developing a Preference Weighted Measure NIHR London: Health
Technology Assessment Report [submitted to REF2, output ID SSPSSR126].
3.5 - Netten, A. and Forder, J. (2010) 'Measuring productivity: an
approach to measuring quality weighted outputs in social care' Public
Money and Management 30 (3): 159-166.
3.6 - Netten, A., Jones, K., Knapp, M., Fernández, J-L., Challis, D.,
Glendinning, C., Jacobs, S., Moran, N., Stevens, M. and Wilberforce, M.
(2012) `Personalisation through Individual Budgets: does it work and for
whom?' British Journal of Social Work 42 (8): 1556-1573 [submitted
to REF2, output ID SSPSSR125].
3.7 - Netten, A., Trukeschitz, B., Beadle Brown, J., Forder, J., Towers,
A. and Welch, E. (2012) `Quality of life outcomes for residents and
quality ratings of care homes: is there a relationship?' Age and
Ageing 41 (4): 512-517 [submitted to REF2, output ID SSPSSR127].
This research was funded through a variety of awards totalling over
£2,500,000 following the initial award from the Department of Health to
develop a measure of outcomes of social care for elderly people in 1997.
The most significant awards include the following:
• Financial valuation of PSS outputs, Department of Health,
• Provision of research services in support of the Invest to Save Bid
project titled "Quality measurement framework" (Ann Netten and Julien
Forder), Office for National Statistics, £950,950 (2007-2010).
• Outcomes of social care for adults: developing a preference weighted
measure (Ann Netten and Julien Forder), HTA, £436,884 (2008-2011).
• ASCOT Feedback Intervention Study (AFIS): exploring the feasibility of
an outcomes- focused intervention on care home practice (Ann-Marie Towers,
Nick Smith and Ann Netten), NIHR School for Social Care Research,
• Developing a care home quality indicator based on residents' social
care related quality of life (Ann-Marie Towers, Jacquetta Holder, Nick
Smith and Ann Netten), NIHR School for Social Care Research,
• Development of a care home quality indicator based on residents' social
care related quality of life: formats and interpretation of reported
results, (Jacquetta Holder, Ann-Marie Towers, Lizzie Welch and Ann
Netten), NIHR School for Social Care Research, £30,000 (2013-2014).
• Policy research unit in quality and outcomes of person centred care:
estimated funding for stream of work to support ASCOT, (Ann Netten and
Julien Forder), Department of Health, £400,000 (2011-2016).
Details of the impact
David Brindle, writing in The Guardian in 2010, suggested that
ASCOT would `shake up adult social care' by enabling social care providers
to measure the worth and value of the work they perform [see
corroboration 5.1]. The beneficiaries of ASCOT are hence multiple,
and include local authorities, independent providers and other
stakeholders looking to improve the effectiveness of workplace practice,
with the key impacts being as follows:
Development of a robust measure of quality of life integrated into
At a policy level the Department of Health has used ASCOT `in the
development of policy proposals for the Caring for Our Future
White Paper to understand the variation in outcomes at a local level' [corrob
5.2]. In 2011 the Department of Health commissioned a national
Policy Research Unit in Quality and Outcomes of Person Centred Care, which
has an agreed stream of activity designed to explore the use and
application of ASCOT and related measures. This workstream has resulted in
website development and support, responses to individual requests, annual
workshops in the UK, and training. Partly as a result of the inclusion of
ASCOT in the Adult Social Care Statutory Survey and its key role in the
Department of Health's Adult Social Care Outcomes Framework [corrob 5.3],
councils including Bolton, Cumbria, Slough, Redbridge and Hertfordshire
are making increased use of the toolkit and its developments for the
purposes of enhancing professional practice and improving the
effectiveness of workplace practices. For example, in Cumbria ASCOT has
been introduced with the aim of `supporting cultural change in focusing on
outcomes and person-centred care planning and review', generating data
that has supported their planning and management of services. Cumbria's
Head of Social Care attests that `ASCOT is proving an invaluable tool in
helping us move to more outcome focused practice' [corrob 5.4]. The
Senior Monitoring Officer, Quality Monitoring Team East Sussex County
Council states `ASCOT has transformed the way we audit care homes. In the
past it used to be a paper- based exercise, with very little focus on the
client. Now we spend much more time observing and we feel that the
evidence we use is much more robust' [corrob 5.5].
Influence on professional practice and standards:
Feedback from workshops and training has indicated that reporting
qualitative and quantitative information based on the ASCOT measure
changes the focus of care work, resulting in improved quality of care and
outcomes for residents. For example, Saga now conduct regular surveys of
their service users and are collecting ASCOT data both for the purpose of
demonstrating outcomes to commissioners and for monitoring and improving
practice. In this light, PSSRU are currently conducting a feasibility
study, funded through the NIHR School for Social Care Research, to examine
how feeding back scores derived through ASCOT results in improved quality
of care. In total there are 806 registered users (an increase of over 160%
between 2012 and 2013), including many users from local councils and
service providers. At least 25 organisations have used ASCOT. Training and
workshops have proved popular: between 2011 and 2013 training was provided
to over 160 people from 45 different organisations. In addition, 177
people have attended workshops about ongoing developments and use of
Influence on planning and managing services:
ASCOT has provided a means for benchmarking cost effectiveness across the
social care sector, with the structure and basis of the measure
(for example, domains of quality of life used) having fed into quality
assurance procedures by both local authorities and independent providers
of services. For example, the Social Care Institute for Excellence (SCIE)
use ASCOT as a basis for defining excellence in social care to support
improving practice, and recommends its use in evaluating the cost
effectiveness of social care interventions [corrob 5.6]. Hence,
while ASCOT is still relatively new in terms of developing an evidence
base, it is designed to be used in economic evaluation and thus to provide
evidence of cost-effectiveness of services. When used in the economic
evaluation of personal health and social care budgets ASCOT provides
evidence which supports better resource management resulting in improved
A network has been set up to facilitate international communication and
collaboration in the use of ASCOT. Given this, international interest has
been widespread with attendees at workshops from Israel and Japan, with
considerable interest from Scandinavia (there is a Finnish section on the
ASCOT website) and Europe. Similar policy and practice impacts to those in
England are therefore starting be felt internationally. A recent OECD
report [corrob 5.7] identified that `other OECD countries, such as
Denmark, Austria, Finland and the Netherlands, are starting to use ASCOT'.
For example, a Finnish evaluation of outcome measures reports ASCOT as
`exceptional as it can be used as a research tool and also as a practical
tool in improving service production and social care practices' [corrob
5.8]. In Denmark, two large scale ASCOT studies of home care and
care homes for older people have been conducted on behalf of the
government, with a leader of the principal NGO for older people calling
for the measure to be included in regular national surveys [corrob 5.9].
ASCOT has also been translated into Dutch and here and elsewhere proposals
are being developed to undertake preference studies to reflect national
preferences in scoring for different countries and cultures. A version has
also been developed for the Austrian Home Visits and Counselling Programme
[corrob. 5.10]. Individual providers are taking an active interest,
among them NGOs in Australia (Domiciliary Care Adelaide) and
Finland (Solutos Oy mental health and substance abuse service), while in
Israel ASCOT is `serving to better think through policy and program
objectives' [corrob 5.11]. These examples demonstrate the
wide international influence of ASCOT on the planning of social care.
Sources to corroborate the impact
5.1 - As cited in Brindle, D. (2010) `A
new measure that will shake up adult social care' The Guardian
9 June 2010.
5.2 - Statement provided by ID 1 (Statistician, Department of Health),
corroborating the uptake of ASCOT as a measure which provides
accountability for outcomes in adult social care for Ministers and
parliament at a national level.
5.3 - ASCOT is the preferred measure of quality of life for people with
support and care needs in the Department of Health's Adult
Social Care Outcomes Framework 2013-14.
5.4 - Statement provided by ID 2 (Research and Information Officer, Adult
and Local Services Directorate, Cumbria County Council). See also
Quality of Life Questions at Assessment and Review'. This
corroborates the use of ASCOT in local authority assessment and review
processes in the UK.
5.5 - Statement provided by ID 3 (Senior Monitoring Officer, Quality
Monitoring Team, East Sussex County Council) corroborating use of ASCOT in
the evaluation of social care services.
5.6 - The recommended use of ASCOT in SCIE's (October 2010) is shown in Finding
Excellence in Adult Social Care excellence definition
5.7 - Good
Life in Old Age? Monitoring and Improving Quality in Long-term Care
OECD report corroborating the increasing uptake of ASCOT in an
international context and notes that ASCOT is a `standardised instrument
widely accepted in health care'.
5.8 - Statement provided by ID 4 (Research Professor, National Institute
for Health and Welfare, Finland) corroborating international influence on
planning and management of social care services.
5.9 - See Rostgaard, T., Nøhr, R., Og, B., and Fridberg T. (2012) Omsorg
Og Livskvalitet I Plejeboligen, Sfi Rapport.
København: SFI, which used ASCOT to show that meeting `higher order'
patient needs requires higher levels of investment.
5.10 - The Austrian report on quality in home visits and care homes - Qualitätssicherung
in der häuslichen Pflege (Bmask, 2013) - demonstrates how
ASCOT can be adapted to different national and cultural contexts.
5.11 - Statement provided by ID 5 (Director of Myers-JDC-Brookdale
Institute, Habib), corroborating international influence on planning and
management of social care services.