Overall, the number of people using the internet continues to increase: 85% of all adults had used the internet in the last three months (to March 2015), an increase of 1% since last quarter.
Some 11% of adults (5.9m people) have never used the internet (to March 2015). This is a reduction of 6% since March 2011, which remains encouraging.
Of these 5.9 million adults who had never used the internet, 3.0 million were aged 75 years and over. This represents 33% of people aged over 75. Similarly, 3.3 million disabled adults had never used the internet, which represents 27% of disabled adults.
In June 2012, 34% of people over 75 and 34% of disabled adults hadn’t used the internet. Thus, there has been a 4% and 7% increase in the number of people over 75 and disabled people using the internet respectively. Nevertheless, it remains the case that over half of all the people who have never used the internet are disabled people.
This is made clear in graph at the top of this post, which shows the proportion of non-internet users depending on whether they’re a disabled person or not over the last two years. Thus, whilst things are moving in the right direction, and consistently with, say, people aged over 75, disabled people are still disproportionately failing to reap the benefits of the internet, even in 2015.
or How I learnt to love statistics and be an Honest Consultant
Chris Dillow at Stumbling and Mumbling often notes how remarkable it is that so few people know or understand Bayes’ Theorem. C.P. Snow wrote his famous “Two Cultures” essay drawing on his observation of how few people know about something as fundamentally important as the Second Law of Thermodynamics, and that this is the equivalent of not having heard about the works of Shakespeare.
I’ve often thought the same about the Normal Distribution, often called the Bell Curve after its distinctive shape.
The Normal Distribution is a result of probability theory that we all learnt in secondary school maths, and shows how we would expect a random range of related variables to be distributed.
The Normal Distribution
In the Normal Distribution illustrated above, the average of all of the values of a given set of numbers (for example, people’s height) is in the middle. In any distribution, over 68% of all of these values will fall within one standard deviation – the amount of variation from the average. Over 95% of all values will be within two standard deviations of the average.
(Applying this example to women’s height, we find that the average height for women is 5ft4in with a standard deviation of 3in. Thus, 68% of women’s height will fall between 5ft1in and 5ft7in, and 95% of all women’s height will be between 4ft10in and 5ft10in.)
The Normal Distribution is a really useful way of thinking about where single instances fit into an overall picture.
How could we apply the Normal Distribution to the idea of people’s experiences of public services? Let’s think of the horizontal (x) axis as a quality continuum, with the very worst experience on the left, through the average in the middle, to the very best on the right; and let’s think of the vertical (y) axis as a frequency continuum, from the very rare at the bottom to the very often at the top.
Thinking in this way, what we see is that people’s experiences of public services follow a Normal Distribution. The vast majority of people’s experiences are average or thereabouts; only very rarely (i.e., more than two standard deviations away from the average, or around 0.1% of the time) do people have either the very best or the very worst experience of public services.
Applying the Normal Distribution to people’s experiences of public services
I think this observation is important for two main reasons.
The first is about how politics, policy and campaigning is conducted. Although most people’s experiences are average or thereabouts, the experiences and examples we hear most about are, almost by definition, unusual. They exist at either end of the Normal Distribution. So politicians often talk about the very best case scenario in the new idea they’re introducing or in the White Paper case studies that are cited. Similarly, organisations present the best examples of the work they’ve done, promoting these through various communications channels or capturing them in funding bids or contract tenders.
In the above diagram, politicians and organisations operate mainly at point P on the Normal Distribution.
At the other end, we hear of nightmare stories of people’s experiences of services in the headlines of newspapers, or of scare stories from campaigners which highlight the very worst impact of this or that policy change. Newspapers and campaigners operate at point N on the Normal Distribution.
(Of course, each respective group can swap which end of the Normal Distribution they operate at depending on what purpose they are seeking to serve; think of politicians talking about “Broken Britain”, for example.)
The second reason it’s important to think about the Normal Distribution of people’s experiences of public services is to note that, most often, the very rare is what drives most activity. Trying to prevent or minimise the very worst in public services is the realm of regulators, legal teams and complaints procedures; trying to promote the very best is the business of funding bids, think tank proposals, job applications etc.
And it’s this difference between the ends and the middle of the Normal Distribution that creates the problem in the space of people’s expectations of public services. The gap between what the Normal Distribution says our experience is most likely to be (95% of people will be within two standard deviations of average) and what we think our experience will be – the space of N and P represented by newspaper headlines and political rhetoric – leads to expectations that, in reality, can very rarely be met.
A politician gives a speech in the space of P in which they say how things are going to be much better for us all. But, across a whole population, only 0.13% are likely to feel that full impact; the rest will have average experiences whilst some will have terrible experiences, so that both groups feel the promise of the politician hasn’t been delivered.
A newspaper reports in the space of N of an appalling case that occurred because of this or that change. Many will think that this is more than typical than it is, despite only 0.13% of the relevant population having that experience and the vast majority having an average or thereabout experience.
A commissioner commissions a new service from a provider based on the promises in the space of P the provider gave in its funding proposal. The reality is that the service provided is average, with some great outcomes and some very poor ones. This is exactly what the Normal Distribution could have told the commissioner, but they remain disappointed because of their original expectations.
Where does this leave us? I think that understanding and using the Normal Distribution could help us have a more honest approach to what people can expect from public services.
In an area that is “good” at what is does, what we’re really saying is that people’s experiences are generally slightly better than average; the Normal Distribution of such a place would like this (blue line) compared to the normal Normal Distribution (black line).
The Normal Distribution in a “good” area
In this area, slightly more people have a better experience, slightly fewer people have a poor experience, and a very small proportion of people still have extremely good or bad experiences. The net effect is that the average experience of all people in the area is slightly better than normal; effectively, the Normal Distribution has been slightly shifted to the right.
In an area that is “poor” at what it does, the Normal Distribution would look like this (blue line) compared to the normal Normal Distribution (black line):
The Normal Distribution in a “poor” area
In such a “poor” area, slightly more people have a poor experience, slightly fewer people have a good experience, and a very small proportion of people still have extremely good or bad experiences. The average experience of all people in the area is slightly worse than normal; effectively, the Normal Distribution has been slightly shifted to the left.
The subtitle of this post comes from my personal feeling that an Honest Consultant is one whose pitch to a potential client would entail a discussion about the Normal Distribution and how the results of their work will make things a little bit better than average for most people in an area.
Such a consultant is unlikely to be successful in their work. But, in understanding and using the Normal Distribution and what it tells us about people’s experiences of public services, the Honest Consultant is at least managing the expectations of the potential client and the public they represent. If in doing so this reduces the gap between what people expect and what they experience, and so increases people’s trust and understanding of what public services can or can’t do, then the Honest Consultant’s use of the Normal Distribution will have been worthwhile.
A Technical Annex (pdf) to go with CQC’s State of Care 2012/13 report, you say? How could I possibly resist?!
Below are some highlights from the annex looking specifically at the funding of adult social care. (These figures will be familiar to folks who pore over the HSCIC releases every quarter, but I take the view you can never get enough of info like this.)
Total and type of spend on adult social care:
Spend on adult social care has risen in cash terms – from £16.8bn in 2009/10 to £17.2bn in 2012/13, but there has been a real terms decline. Adults under 65 with a learning disability where the only major user group to see a real terms rise in expenditure from 2009/10 to 2011/12.
The following proportions were spent on the following client groups in 2011/12(figures include Supporting People monies, which was presumably found down the back of the sofa in the last year or so
53% of spend was on older people
31% on adults under 65 with learning disabilities
9% on adults under 65 with physical/sensory impairments
7% on adults under 65 with mental health problems
Direct Payments expenditure:
Expenditure on direct payments for adults increased in both cash and real terms. £360m was spend on Direct Payments in 2006/07 and reached £1.1bn in 2011/12
This is a real terms increase of 175% and is 6% of all gross adult social care spend.
Unit costs of different types of social care are fascinating. Really.
The average cost per adult supported in residential care, nursing care or intensively in their own home was £608 per person per week in 2011/12 – a 5% real terms cut
The average cost of providing day care for adults (including older people) was £213 per person per week
The cost of home care per person per week for all adults was £206.
Top-ups
This one surprised me: the overall proportion of people who indicated that they (or their family) ‘top up’ their care has increased from 38.1% in 2010/11 to 38.8% in 2012/13. This probably isn’t as much as I thought it would be.
To summarise, there’s less money in real terms, no matter what anyone else tells you.
For those folks who want extra geek points – and, frankly, who doesn’t? – it’s well worth reading CQC’s technical funding annex in conjunction with the King’s Fund’s submission (pdf) to the Health Select Committee’s Inquiry into public expenditure on health on social care. In social care, it notes:
The number of older people receiving publicly funded services has fallen by 26 per cent since 2009/10, with an equivalent reduction of 21 per cent among working age adults over the same period. Given the overriding imperative to provide care closer to home and reduce the need for residential care and hospital admissions, it is particularly worrying that the largest reduction has been in the use of community-based services such as home care (down 25 per cent) compared to nursing home care (down 4 per cent) and residential care (down 1.7 per cent).
Their numbers on the NHS are just as frightening.
So, to summarise again:
There’s less money in adult social care
There are less people getting adult social care
The number of people getting fewer services is rising quicker than the rate at which money is being taken out of the social care system
Money is being cut from services which cost less and people prefer quicker than it is being cut from services which cost more and people prefer less
The NHS is fairly buggered, or at least faces the biggest financial challenge it has ever faced.
As such, identified Direct Payments fraud made up the positively DWP-levels (see point 10 here) of 0.2% of all expenditure on Direct Payments.
In the same way people rightly ask for evidence to make the case for this, that or the other, we should also ask people who prefer things as they are what their evidence is against.
Here are some of the findings that stood out for me from this year’s report, roughly themed by some (hopefully useful) headings. Comments in (brackets) are my own observations on the preceding point.
Useful statistics
There are 53.1m people in England, of which 8.7m were 65+ and 1.2m were 85+
There are estimated to be 800,000 living with dementia across the UK, and it is forecast that one in three people over 65 will develop dementia. (The current number seemed very low to me, especially since the latter figure suggests nearly 3 million people living with dementia in the future – a huge leap. This is further exacerbated by the statement on p39 that “over the next 30 years the number of people with dementia is expected to double”, which would still only get us to 1.6m people. Can anyone shed any light on these stats?)
1.35m people work in the NHS workforce in England. This compares to 1.63m who work in social care
The majority of the increase in social care jobs came from Direct Payments (i.e. Direct Payments are good for the economy!)
In September 2011, there were 8,316 GP practices in England, with 35,319 FTE GPs. The number of patients per practice has grown and stands at 6,651 per practice
Social care
Only one third of men (33%) and one in six women (33%) will never need social care
83% of councils set their FACS eligibility as “substantial” in 2011/12 (this is a rise from 78% in 2010/11 and from 70% in 2009/10)
45% of care home places are occupied by self funders. A further quarter are topped-up by people or their families to make up for the gap between what the local council will pay and what the residential care costs
Around 220,000 of the 1.1m people who receive domiciliary care are self funders (this is likely to be a significant under-representation of people who pay for their own care, since it will only include those who have made contact with their local council)
The number of people with a Personal Budgets in 2011/12 was 527,000 – a growth of 40% from 2010/11. Of these, 139,000 receive a Direct Payment – a growth of 11% from 2010/11
Expenditure on Direct Payments has increased 15% in real terms, to £960m
25% of people referred themselves to social care
22% were referred from secondary health source (e.g. hospital)
14% were referred from primary health sources (e.g. GP)
14% were referred by family, friends of neighbours
It was interesting to note from the table on p.29 that social care providers are much less geographically dispersed than health providers
Poor care and user involvement
There are three considerable factors which underpin poor quality care: cultures where unacceptable care becomes the norm, an attitude to care that is “task-based” and not person-centre, and managing high staff vacancy or turnover rates
A recurring issue, particularly for people in learning disability or mental health services, is a lack of involvement in their care plans or having the chance to share their views on how their care is delivered
More work is felt to be required by commissioners and providers to ensure person-centred planning is embedded into all care for people who use services
In hospital wards that performed well on people’s quality of care there was strong consistency in the involvement of people in decisions about their care. In those hospital wards that performed poorly on quality of care, a common complaint was that people received little or no information about their care and what to expect
In social care, problems often arose in people’s quality of care where there had been a lack of person-centred planning, with little information about people’s individual preferences
No current, detailed full analysis of the DPULO sector currently exists.
Initial information on the DPULO sector was developed through mapping work in 2007 done by the Department of Health and last updated in 2009 by the (then) National Centre for Independent Living. However, this mapping work focused on identifying what user-led organisations exist and in what area. It didn’t necessarily tell us much about DPULOs – their size, work, robustness etc.
The Strengthening DPULOs Programme has built on this mapping work over the last 15 months. It has a database of over 320 DPULOs, and includes the following data for around 2/3 of the DPULOs on that list:
I’ve been thinking about what we might want in any full analysis of the DPULO sector. Below is the list so far.:
General information
DPULO name
DPULO postcode
Contact (CEO) first name
Contact (CEO) surname
Contact email address
Business information
Impairment groups covered – LD / LTHC / MH / PI / PSI
Number of FT staff = number
Number of PT staff = number
Financial information
Income and expenditure 2009/10 = number
Income and expenditure 2010/11 = number
Income and expenditure 2011/12 = number
For 2011/12
Total contract income
Total grants income
Total “other” income
Communications information
Number of members
Website address
Website = yes / no
Twitter account = yes / no
Facebook account = yes / no
Other useful suggestions for information to add include:
What assets each DPULO has
What membership / supporter numbers they have
What data they hold
If the analysis was going to be done, it should be as good as possible (notwithstanding all the usual problems with mapping, gapping and quality of data). I’d be really interested if people have any other things they think it would be useful to find out about. If there are, let me know in the comments below, or on Twitter using @rich_w.
(Aside: the Office for National Statistics really should be congratulated for publishing such useful stats and breakdowns each quarter.)
Overall, they show the total number of people using the internet is increasing: it’s 4% more than to March this year and 10% higher than this time last year. This is great news, and testament to the great work organisations like Go On UK are doing.
The focus on who isn’t using the internet tends to be on older people. Though understandable, my focus is always on disabled people, and the figures show why:
To June 2012, there were 3.91 million disabled adults who had never used the internet
This 3.91m disabled adults represents around 34% of all disabled adults, i.e. 1 in 3 disabled adults has never used the internet
The equivalent figure for non-disabled people is around 10%, i.e. 1 in 10 non-disabled adults has never used the internet
Thus, disabled people are three times more likely never to have used the internet than non-disabled people
The 3.91m disabled adults who have never used the internet represents just under half of the 7.82m adults who had never used the internet, i.e. nearly 1 in 2 of all people who have never used the internet are disabled people.
By way of comparison: 38% of adults aged 65 years and over had never used the Internet, representing 2.12m people, i.e. 2 in 5.
Thus, in relative terms, older people and disabled people’s use of the internet is about the same (38% to 34% respectively). In absolute terms, there are around 1.8m more disabled people who have never used the internet than people over 65.
Useful to keep in mind, especially if we’re moving towards Digital by Default and online information directories in social care…
Being a bit of a geek, I always look forward to the publication of the Personal Social Services Adult Social Care Survey.
This year’s (2010/11) provisional report was published in September, and the final report will be available next month.
Here are some of the findings I found most interesting. (Read the full report for comprehensive methodology statement, including sample size and a return rate – get this – of 40%!)
Satisfaction with care and support services
62% of service users who responded said that they were extremely or very satisfied with the care and support services they receive
28% said they were quite satisfied
7% said they were neither satisfied nor dissatisfied
3% said they were dissatisfied
Control
30% reported they have as much control as they want over their daily life
45% reported they have adequate control
20% reported they have some control but not enough
5% reported they had no control
Quality of life
26% of respondents reported their quality of life was so good it could not be better, or very good
31% reported it was good
33% reported it was alright
7% reported their quality of life was bad
3% reported their quality of their life was very bad, or so bad it could not be worse
Safety
62% of respondents felt as safe as they wanted
30% felt adequately safe, but not as safe as they would like
I was taken with Save the Children’s excellent report on UK poverty rip-off. In their continually good work on the poverty premium, Save the Children has shown that the typical low income family paid an extra £1,280 in 2010 than wealthier families.
In particular, low income families pay:
£598 a year for car insurance, compared to £310 average for wealthier families
£99 for home insurance, compared to £67
£1,134 for gas and electricity, compared to £881
£670 for a basic household cooker, compared to £239.
These differences arise mainly because lower income families do not have access to the best deals, or information about them.
There are significant echoes here with Contact A Family’s survey last year on the costs families with disabled children face. As I blogged here, they found that:
23% of families had to turn off their heating to save money
14% go without food
73% said they had to forego leisure activities and days out
68% are not taking any holidays
It is a well-established fact that families with disabled people disproportionately live in poverty. For example, 29% of families live in poverty when at least one family member is disabled, compared with 20% of families with no disabled people. Furthermore, disabled people are more likely to live in persistent poverty compared to non-disabled people (11% compared to 5%).
Behind these numbers are stories of the significant hardship that a considerable number of disabled people, be they adults or young people, and their families encounter.
We are about to live in “austere” times. These figures for me are a reminder that, for some, times already are – and have been for as long as they can remember – “austere”, and will only get worse over the next few years.
The purpose of the survey is to compare how disabled and non-disabled people participate in a number of areas, including work, education, transport and use of public services.
There is a huge amount of incredibly valuable information in this survey across a very wide range of areas. I don’t think I could do it justice without a week in a quiet room and no distractions, so here are just a few employment “highlights”.
Half of disabled adults of working age were in work, compared to 76% of non-disabled adults of working age. This gap (26%) actually represents the smallest gap there has been for some time, mainly on account of the fact it represents the lowest employment rate for non-disabled people for some time (and certainly since 2002)
56% of disabled people experienced restrictions in the type of amount of paid work they do, compared to 26% of non-disabled people
29% of disabled adults identified family responsibilities as a reason for being economically inactive (compared to 42% for non-disabled adults). Lack of confidence accounted for 19%, transport difficulties for 11% and employer attituides for 6%
19% of disabled people said some sort of equipment or adaptation would be an enabler of work
For those interested, here are the employment rates for disabled and non-disabled people since 2002 (plus the employment gap):
For anyone with any interest in disability, equality or research/stats, you could do much worse than check out the full research report on the ONS website. It’s 269 pages, but nearly every page is a treasure trove of information.
arbitrary constant 