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Many social services departments have successfully developed services which meet older people's physical survival needs so that they can continue living in their own homes despite serious disabilities. An emerging priority is to support the morale and quality of life of the same individuals.Assisted by the Social Policy Research Unit (SPRU), a team of social services managers conducted a programme of interviews designed to obtain the views of very old, frail home care clients about their services and their lives in general. A few interviewees expressed very low morale and this seemed to reduce substantially their ratings of satisfaction with the help they received. While it is well established that disability and isolation are linked to depression in older people, it is rare that service providers systematically address these problems. Some practical strategies for this purpose are proposed as a result of this survey.

Twenty‐three home care providers were interviewed concerning what promotes or impedes quality aspects of service giving, as defined by older customers ‐ like service from familiar staff or flexible help. The influence of Social Services purchasers and of structures for purchasing care proved notably important. Purchasers affected service quality through the amounts of time that they commissioned and through whether they would purchase help for customers' quality of life as well as for their physical survival. Quality was affected through whether care was purchased through fixed quantities of time or through the fulfilment of specified tasks. Some purchasers controlled details of everyday care giving, which other purchasers left to providers' discretion. Also influential was the attitude of providers themselves to giving miscellaneous occasional help like changing light bulbs, finding reliable private tradesmen or taking customers with them on shopping trips. Some providers readily gave such help and found it unproblematic to do so. Others prohibited it, although this seemed to not always be implemented earnestly. The most marked differences in willingness to give flexible help occurred between different independent sector providers, rather than between independent and Social Services in‐house providers. A third type of influence on quality of home care was ‘economic’ factors like the purchasing power of local home care pay rates within the local labour market, local geography and demography. Some questions are itemised which merit inclusion in any evaluation of the quality of a home care provider.

This article presents evidence for important individual differences between older people concerning what they value as high quality service from home care. A case is made for improving service quality through systematically consulting each service user about their own preferences and seeking to fulfil these requests on an individual basis. This contrasts with setting uniform quality standards for all older home care clients, based on their most commonly expressed preferences. Evidence is cited from individual interviews with older home care service users and from an experiment in modifying older people's services through briefing home care staff on the preferences of individual clients. Issues in developing this approach are discussed.

This article describes the test of a method for consulting frail older people about the quality of social services and their unmet needs. The method, home interviews by senior social services managers, was prompted by advice from older social services clients about how best to obtain their views. Results of the interview programme are presented, together with benefits arising specifically from using managers as interviewers and discussion of future application of this approach.

While the future funding of social care currently has perhaps the highest public profile in the need to reform social care, not far behind is the agenda to transform social care from its prevailing rigid and service‐centred culture to one that is personalised. The core driver used by the government to achieve personalisation is to give people ‘choice and control’ through the provision of personal budgets. This is the allocation of sums of money ‘up front’ to allow people to choose and commission their own support systems. The new coalition government has signalled its wish to not only endorse this approach, but to accelerate its implementation. However, there is growing evidence that while this will work very well for people and those around them with the will, the skills and the time to make a success of it, for most it will not result in real change. This is especially the case for older people. This article explores this issue, but carries the message that personalisation can and should be made a reality for all service users and all older people. However, it will require a commitment to a transformational change programme within councils that goes beyond simply achieving well against the former government's performance indicator of numbers with personal budgets.