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Surveying older service users' opinions of the services they receive, as demanded in a recent White Paper, presents particular difficulties.

Charles Patmore, Hazel Qureshi and Elinor Nicholas look at different ways of consulting them

From April 2000, according to the White Paper Modernising Social Services, social services departments must conduct surveys of satisfaction among service users and family carers. A particular challenge will be to consult frail older people who receive home care, since many of them have infirmities which make common survey methods difficult.

We have gained insights into how older home care clients can comment on their services during a current research project, funded by the Department of Health. Our research interviews included questions to 88 older community care clients about how they would like their views on services to be obtained. We used one-to-one interviews, questionnaires, focus groups and some phone conference with housebound clients.

While many older people find one-to-one phone interviews fully acceptable, many others dislike phone interviews strongly. Dislikes reflected problems in hearing or in holding telephones, and the ease with which a phone interview could be sprung on you without preparation. Thus phone interviews should not be the sole channel for a consultation. But they can be usefully offered as an option alongside individual interview at home.

Family carers for older people were notably positive about consultation in groups. This would combine communicating their views with meeting other family carers. Also they wished to be interviewed apart from the person they cared for, something which a home interview would not necessarily provide. Family carers were also more positive about questionnaires than older service users.

Many older service users voiced similar suggestions about their ideal interviewer. They wanted to be interviewed at home by a senior manager of their own services - someone clearly senior to the manager immediately responsible for their care. They believed that senior managers needed direct, eyewitness education in older people's everyday realities to be able to influence and act on policy. Also, our interviewees felt that senior managers had a moral obligation, if they cared about older people, to investigate first-hand the results of the services which they headed. We found this preference for interview by senior managers only among older people, not among family carers or younger social services clients. Social services staff, in contrast, often believed older people would prefer an interviewer who was independent from social services.

Other aspects which our interviewees said mattered included an interview process which gave them control over the interview. They wanted space to deliver their own considered message. They preferred questions to be mailed in advance so they could prepare their responses, not have topics sprung on them. They wanted clear pledges that they could decline any topic without further enquiry. Women should be offered women interviewers, some felt. Feedback on the practical consequences of consultations was also named as very important. To date we have tried their suggestions about giving feedback on results and mailing interview questions in advance. Both were much appreciated.

What could these findings mean for next April's satisfaction surveys? Arguably, written self-completion questionnaires should not be used. Their use was widely criticised, sometimes very forcefully, for excluding people for whom reading or writing had become difficult. Questionnaires were also disliked because they are impersonal, often of wearisome volume, and have ready-supplied answers.

Instead some sort of interview is needed and this, inevitably, would mean using a small enough sample for interviews to be practicable. A solution may be to offer a choice of home interview or phone interview to a carefully selected sample of service users.

Modernising Social Services states that a few standard questions will be supplied nationally for the satisfaction surveys, otherwise they will be designed locally. We have found it perfectly possible to incorporate some structured satisfaction ratings within oral interviews with older home care clients. Indeed, oral interviews can obtain full explanations for each question and thus the reasons behind a particular score can be brought out. We interviewed local social services managers, who compared favourably the quality of guidance from in-depth interviews with small samples of service users to outputs from written questionnaires involving much larger numbers.

Individual interviews, face-to-face or by phone, are better suited to the assessment of satisfaction than focus groups. We compared results from groups and from individual interviews and, post-research, re-interviewed some group members on their own. Sometimes group members had hidden their views during a group consultation. Also, groups can present a misleadingly uniform picture of sources of satisfaction among home care clients. For instance, groups can present punctuality or relationships with staff as commonly valued, whereas individual interviews show great differences between individuals on such counts. A survey which seeks to understand and improve satisfaction without investigating each individual's priorities will often miss the point.

If only small samples can be interviewed, those samples need to be selected so that they are representative. We recruited home care interviewees via an administrative database and could thus separately consult people who received different intensities of service. Thus a satisfaction survey could represent separately people receiving more than ten hours home care per week and people receiving less, following definitions for the proposed social services performance indicators¬ . We found social services staff valued such separate feedback. We selected names from the database, then checked with home care organisers whether these clients were well enough before asking them for an interview.

Approaches are needed which maximise participation in interviews. In our research, illness, dementia and speech or hearing problems were common reasons why home care organisers excluded people. We noted how communications on tape or in Braille could assist participation by blind people. People from ethnic minority groups may need interviewing in their own language - we found Asian people much preferred an interview to translations of written questionnaires. Agreement to participate in interviews should increase if professionals follow the preferences named by our interviewees, such as the advance mailing of questions or, very importantly, getting feedback on results of the survey. The latter means social services should plan uses for the satisfaction surveys other than simply reporting them.

What, then, about our interviewees' top-ranking preference: the challenging idea that senior managers should interview them? We have begun a practical trial of its usefulness within a social services department. Watch this space.

¬ Department of Health A New Approach to Social Services Performance, DoH, 1999

Charles Patmore, Hazel Qureshi and Elinor Nicholas are researchers on the Outcomes Programme, Social Policy Research Unit. For information contact Social Policy Research Unit, University of York, York YO1 5DD

Gathering opinion from older people

· Offer a choice of an individual home interview or a phone interview.

· Check how well interviewees represent clients in age, gender, ethnicity and disability.

· Mail them the questions in advance.

· Consider social services managers as interviewers - people more senior than the line manager to the client's service providers.

· Offer women interviewers to women.

· Plan uses for the information collected and feed back the results to interviewees.

Method of research

Our research interviews included questions to 88 older community care clients about how they would like their views on services to be obtained. Nine different sets of older social services clients were interviewed, including housebound people receiving high levels of home care and ethnic minority groups. Interview methods included focus groups, individual interviews and telephone conferences.

Having a personal interview at home was their first choice because it could reach a wider range of people with health, mobility or vision problems.

Written self-completion questionnaires were widely criticised, sometimes very forcefully, for excluding people for whom reading or writing had become difficult. These questionnaires were also disliked because they are impersonal, often of wearisome volume, and have ready-supplied answers. In contrast, a personal interview let clients put their views in their own words. While we never directly tested self-completion questionnaires, the widespread opposition to the very idea cast doubt on their viability.

We conducted focus groups and asked about their usefulness. On the positive side, focus groups could certainly be run successfully with older community care clients. Indeed, group consultation was often the runner-up to home interviews in popularity. But, among people picked from home care lists and invited to a group, there was vastly higher agreement to participate among people aged 65-79 than among those aged 80 and more. The latter were the clear majority on these home care lists yet, had our consultation used only groups, they would have been barely represented.

All the people invited had been rated able to travel by their home care organisers and were offered free transport to the groups. Nevertheless, people more than 80 years old would often turn down focus groups but agree to an interview at home. They were happy to be in focus groups if they were held at day centres or clubs where they were already present, but the latter approach cannot represent the many home care clients who do not use day centres - around 85 per cent of the city-wide home care list in our study.

It is necessary to check how well the age range of participants in a consultation matches that of the people whom this sample should represent. Appropriate proportions of people aged more than 80 and 85 are needed and we found they could best be reached through home interviews. Our study also included some telephone conferences for house-bound people receiving intensive home care. These worked well but, like groups, seemed more likely to recruit people from the 65-79 age range.