Introduction

The objective of raising standards and improving the quality of publicly provided and purchased services crosses all aspects of public policy. This runs alongside continued emphasis on achieving or improving value for money. In 2004, and indeed during the past decade, there have been increased real levels of expenditure in areas such as criminal justice, health and social care, together with a plethora of performance indicators and targets associated with these objectives. To judge the success of such policies, we need to know whether these activities and expenditure are achieving benefits, both in terms of increased well-being and increased productivity of the resources used. This raises two questions – have such benefits been generated, and can we demonstrate that they have?

In the field of adult Personal Social Services (PSS), these are particularly difficult questions to answer. The overarching aims of PSS for adults are expressed in terms such as choice and independence, user-led and tailored services, and so on. Such global concepts do not lend themselves easily to measurement. Nevertheless, public funding of PSS in pursuit of these objectives continued to increase above the rate of inflation in 2004, and is planned to continue to increase at 6% above inflation until 2008 (DH, 2002a). If we are to assess the impact and improve targeting of such spend, there is a need to identify the benefits both at the macro level for evaluating progress and at the micro level to assist in service provision and performance measurement. There is increasing emphasis on using outcomes in setting targets and monitoring progress, but we need to be clear what we mean by outcomes and how they relate to other aspects of service quality that affect service users’ lives.

The chapter starts by identifying what we mean by ‘social care’, using a theoretical framework, the social production of welfare, which draws on economic theory and puts individuals and their carers at the centre of the process. This allows us to consider what it is that we mean by outcome in social care and the implications for quality. It also allows us to identify whether trends in PSS policies and practice in recent years have the potential for delivering improved well-being and efficiency.