Review

Aim for a good outcome

Outcomes of Community Care for Users and Carers
Nocon, A and Qureshi, H
Open University Press, 1996, £14.99

Community care now means many different things to different people. In the NHS maintenance of some of society’s most problematic patients and clients gave way to a new emphasis on enabling them to live so-called normal lives in that mythical entity, the community. Once out of institutions it is expensive and difficult to follow former patients’ progress. Individual monitoring is one way but is far from simple. For those who want to measure individual outcomes of professional interventions, the book will be useful. Its main strength is that it covers service outcomes for people with physical or mental disabilities, mental health problems and age-related frailty, all in one book.

But there are three major problems with measuring individual outcomes. First, professionals must now consider more than just the individual. It is no longer enough to see whether a service appears to make a difference to one user or carer, without taking wider resource considerations into account.

Second, the term ‘measurement’ implies standardisation. Managers need to know how to allocate resources efficiently and this means measurement — assuming that users and carers respond in predictable ways to measurable care interventions. Since users and carers are individuals, this will clash with the perceptions of many professionals and the majority of users and carers. The result is that staff and users may not see why they should co-operate with the extra bureaucracy involved in outcome measurement when it conflicts with their own values.

Third, there is the problem of the measuring instruments themselves. As the authors point out, very few standardised instruments were designed with any input from users or carers. Many measures now being used in community care originate in hospital.

It follows there are a number of contradictions inherent in a book on outcome measurement which does not begin and end with the needs of services. Any attempt to prioritise the needs and perceptions of users and carers (who frequently have conflicting views) is bound to be extremely difficult, given the current state of research. But difficulty is no reason not to try, and this book is a step in the right direction.