Social Care Data for Research
Individual-level data on the social care people receive has been collected by local authorities in Scotland for the last seven years. Apart from an annual aggregate social care survey collected and published by the Scottish Government, this data is seldom used. We now have a UBDC PhD project fully under way, with the support of the Scottish Government and Renfrewshire Council, to dig deeper into social care and health data and improve planning and services.
Why Look at Social Care Data: Planning for Scotland’s Health and Social Care
Co-funded by the Economic & Social Research Council (ESRC) and the Scottish Government, this research is exciting for a number of reasons. This will be the first time (other than pilot, proof-of-concept projects) that social care data will be linked to health data on such a large scale in Scotland. It will provide unique insights into the interaction of health and social care services. This is timely given that services across Scotland are being radically redesigned and integrated with the aim of reducing expensive unscheduled health care use. The research has, therefore, the potential to identify important areas for policy development. It is also the first time that an appraisal of social care services by socioeconomic position has been conducted, giving the first insight into whether inequalities in access to services exist. Given reduction in inequalities is one of the main priorities of the Scottish Government’s national outcomes - the importance of this analysis is obvious.
What We Currently Know
The Scottish Government have published anonymised social care data from the 2010, 2011, and 2012 social care surveys as open data. To ensure individuals cannot be identified the data has been banded and some statistical disclosure methods have been applied, however, there are still some interesting results to be derived from the released files.
Subsetting the data to include only over 65s and attaching population estimates from the National Records of Scotland shows there are marked variations in the proportions of older people receiving home care (e.g. help with washing and dressing) across the country as shown in Figure 1.
When we compare the difference between the amount of weekly hours home care clients receive, we again see wide variations in different local authority areas (Figure 2). In some areas over 60% of clients receive less than 4 hours of home care whilst in others the proportion is a little over 20%.
What causes these variations? Are there such large differences in social care need across differing local authority areas that account for the difference in provision? Or are there differences in local eligibility criteria? Are councils, under considerable budget pressures, responding in different ways? Or is this a problem with data collection and quality - are the numbers a true reflection of service delivery?
Finally, perhaps the most important question - does the inverse care law, already observed in primary care in Scotland 1, also exist in the social care sector? Is access to social care harder in areas where there is the most need?
The inverse care law: “The availability of good medical care tends to vary inversely with the need for it in the population served.” (Tudor-Hart, 1971)
These questions come at a significant time: health and social care services are integrating following legislation introduced by the Scottish Government in2016. The legislation acknowledges that multimorbidity, the presence of more than one long-term condition in an individual, is the norm for those over the age of 65 and that the current single-disease framework of medical care is no longer suitable. We believe those with multimorbidity also have significant non-medical needs (such as social care). Integrated care services should aim to improve the lives for these people but our knowledge of how individual’s health and social care needs overlap is limited.
These issues are at the heart of my PhD. Do levels of socioeconomic position or levels of multimorbidity within local authorities help explain the wide variations in levels of care shown above, or are there other factors at play? Only linked administrative data can help us answer this question
Getting Under Way with Renfrewshire Council
September 2017 has seen the transfer of individual-level social care data, spanning ten years, from Renfrewshire Council to the national safe haven as part of my UBDC-based PhD project. Facilitated by UBDC’s Controlled Data Service, this partnership with Renfrewshire Council aims to gain a deeper understanding of the provision of social care, and to assess the suitability of this type of data for both academic research and local planning purposes.
The safe transfer of the social care data has been the result of close working with partners at UBDC and the council. Initially, along with my supervision team, I approached the council about the type of social care data they held. Further discussions then took place to address the feasibility of answering my research questions with the available data. Once agreement had been reached that the project was feasible, a formal approach was made to UBDC to facilitate the project and the necessary approvals and ethical requirements completed. A data sharing agreement between the Council and the University of Glasgow was signed, which finally allowed the transfer of data to take place.
This phase also has benefits for the council. Danny McAllion, Data Analytics and Research Manager at the council, said, “This research will help move forward our understanding of how social care is currently delivered and assist us in improving the design and delivery of our services. Working with the UBDC has been a valuable experience and a good example of academia and Local Government sharing resources and expertise. We’ll look for opportunities to work with them again in the future.”
Progress and Plans
Work on the first (Renfrewshire data) phase has started and transfer of data for the main linkage project is expected before the end of 2017. Procuring and linking administrative data can be a long process with many approval and regulatory hoops to jump through to protect privacy and security (the process can take up to 12-18 months). However, as detailed above, the potential benefits of linking administrative data make this a worthwhile process and UBDC staff are really helpful in enabling this process. Watch this space for further news on the progress and impact of this work!
R code used to produce Figures 1 & 2 are available from David Henderson’s github repo.
This blog first appeared on the UBDC website here