Prioritising home care needs: research with older people from three ethnic minority community groups.

This paper draws on research with three minority ethnic community groups in Manchester. The aim of the study was to examine and prioritise social care needs. Focus groups were chosen as a way of beginning discussion about these issues.

Using focus groups to seek the views of patients dying from cancer about the care they receive.

PURPOSE: The prime purpose of the study was to investigate whether focus groups were a practical way of seeking the views of dying people and whether the information collected added to that collected by more established methods. DESIGN: A sample frame of Macmillan nurse patients was collated from which three cluster samples were randomly selected to participate in focus groups. The focus groups were structured with an experienced facilitator and recorder to answer three key questions.

Setting standards.

A method of involving users and providers in residential care for older people was used to develop standards of care and outcome indicators. The standards were prioritized using the paired comparison technique. Describes the method and the outcomes of the processes.

A cost function analysis of residential services for adults with a learning disability.

Successive UK governments have pursued a policy of community care for people with learning disabilities which, in the past ten years, has led to a marked change in the nature of residential provision. Research evidence on the costs and quality of alternative forms of community provision is inconclusive and contradictory. It is therefore timely to consider whether or not community residential facilities have delivered the expected quality of service at appropriate cost.

The SSD's (social services department) management challenge.

Health services managers are used to organisational change, but social services departments have been addressing, and are still facing, major challenges associated with implementing the changes to community care provision. Norma Raynes gives a perspective on local authorities' culture and bureaucracy, which need to change if the community care revolution is to be sustained.

Providing a personal service in the Trent Region.

Reports evaluation of the Trent Regional Health Authority's "Providing a Personal Service" initiative, one of the first major quality management strategies in the NHS. The evaluation highlights the key elements which supported this initiative and suggests some ways in which its progress can be sustained. Many of the comments are applicable to other approaches to quality management.

Resource management in community residential facilities for adults with learning disabilities.

The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A sample of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided. There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care.

Attitudes to clients with mental handicap.

The increase in community care provision for people with a mental handicap makes an understanding of the attitudes and motivations of staff caring for them an urgent priority. Norma Raynes and colleagues describe a Department of Health-sponsored study which investigated the quality of care delivered in four key sectors of community residential care. Their findings reveal the positive attitudes of staff in all four settings and suggest that local authorities have a potential source of highly motivated recruits among those working in the health, voluntary and private sectors.

Differences in the quality of residential provision for mentally handicapped people.

This paper examines the quality of care in four types of residence for mentally handicapped adults in Britain. Data were gathered from 175 residents of 150 living units--mental handicap hospital wards, voluntary and private homes, local authority hostels and parental homes. Differences were apparent between the types of residence in terms of both residents' characteristics and care practices and routines.

Comparison of the daily lives of four young adults who are mentally retarded.

Least restrictive environments are assumed to be ones in which high-quality care is to be found. The quality of care provided for four adult males living in hospitals and hostels is described. The data indicate that there are not only differences in the quality of care provided between hospitals and hostels, but variation within both types of setting.

Factors contributing to the length of general practice consultations.

Ten general practitioners in a study of general practice consultations were shown to differ significantly in the time they spent in their consultations. Patient demographic characteristics contributed little to differences in consultation time. Consultations in which (a) there was a diagnosis of psychological disorder, (b) the practitioner and the patients focused attention on psychosocial matters, and (c) psychotropic drugs were prescribed, were found to be associated with increased length of consultation time.

A preliminary study of search procedures and patient management techniques in general practice.

A record of one in three consultations occurring in 10 general practice surgeries in two morning and two evening sessions was made by an observer. The results showed marked variation in the frequency of the general practitioners' use of different means of eliciting information about the patient and in forms of management. These activities were further analysed within subgroups of the patients' symptoms and some activities were shown to be influenced by patients' presenting symptoms whilst others were not.

Aides' involvement in decision-making and the quality of care in institutional settings.

Using two measures of the quality of care in institutional settings, we found much variance in the care provided within three institutional settings. Factors that might account for this variance were examined. Aides' perception of their involvement in certain areas of decision-making was shown to be of major importance in accounting for the variance in quality of care.

4. Isslues in the assessment of the health status, needs, and treatment of the mentally and physically handicapped.

The importance of information for evaluating the health status, needs, and progress of the mentally and physically handicapped has been consistently argued. However, the varied nature of handicapping conditions, often aggravated by the presence of multiple conditions, the extended periods of treatment, the diverse professional groups involved, and the multiple uses and users of data pose difficult problems for uniform data collection. For these heterogenously disabled populations whose conditions are generally not fully remediable, it is especially important to have 1) data on functional ability, both current and potential, and 2) information characterizing the nature of the care environment in terms of its social and educational stimulus, barriers to functional development, and availability of supportive services in the community.