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Examines the relationships between policy, practice and research in social care and health services for older people in Great Britain. Factors influencing the political prominence of the issue of services for older people and the level and type of resources available to tackle problems; Policy goals conveyed by community care; Standards that the National Service Framework for Older People want to achieve.

In the UK there is currently a new focus on the basic purpose and objectives of services, not on organizational structure or the efficiency of the systems alone, but on the outcome of services for people who receive them. The Labour government has defined the promotion of independence as a priority for health and social services, but this outcome can be interpreted in a variety of ways which may not be compatible. As part of a programme of research into identifying ways of measuring the outcomes of community care, views about outcomes have been gathered from a number of stakeholders—disabled and older service users, family members and social service staff. This article outlines the views of disabled service users collected from both in-depth interviews and focus groups in a northern city. The article focuses on outcomes of services which they identified as important and considers the meaning of independence and the wider implications for clarifying objectives and defining service quality. [ABSTRACT FROM AUTHOR]

This paper describes one part of a feasibility study carried out in England which examined the costs, quality and effectiveness of continence services in areas with different approaches to provision. It involved the design of instruments to collect the views and perceptions of patients and an investigation of ways to develop a methodology to implement comparative studies. It is the design and piloting of the questionnaires and the way patients responded that forms the focus of this paper. The main sample group recruited for the study were women who had recently sought formal help with urinary incontinence and were likely to receive conservative treatment or management in the community. They were interviewed and asked to complete four questionnaires at two points in time. A smaller sub-group of disabled women, interviewed only once, were included to compare cost profiles for different client groups. The questionnaires which were developed address the impact of urinary incontinence (using a standard scale), the effectiveness of service provision in terms of patients’ clinical history, expectations and hoped-for outcomes, service receipt and its cost, and patients’ satisfaction with several aspects of service provision. In total 118 women were interviewed, including 28 disabled women. The study generated a set of survey instruments which might be used for a variety of purposes including audit and future research and which could inform purchaser and provider decisions by using patients’ perspectives of quality of life outcomes to enhance service development. [ABSTRACT FROM AUTHOR]