Evaluation in Health and Social Care

Abstract

Political disillusionment in the ability of the UK welfare state to impact significantly upon disadvantage and poverty has led to a shift in focus away from achieving positive change and towards the maintenance of social problems at manageable levels. The issue this shift has raised is the level at which disadvantage and other social problems should be maintained. This change of emphasis has indicated a move away from the realization of service goals and towards the use of economy and efficiency as main evaluation criteria. This has been assisted by the introduction of quasi- market reforms and the weakening of the influence of professionals over quality issues in service delivery. The paper argues that differences exist between the key stakeholders in both health and social services but that 'traditional' evaluation has served to mask these differences. This is assisted by a lack of publicly declared service aims and the management capture of definitions of service issues such as quality. Evaluation in health and social care is increasingly focused on outcomes and performance indicators. This approach treats the service as a separate variable which can be separated out for study and consequently ignores the key factor of context. The context of evaluation is important in services which aim to create change in society. Inclusion of context also has the potential of placing a regulatory framework on the pursuit of economy, efficiency and effectiveness.