Contact: Carole Bennett 01962 833 005 carole.bennett@hants.gov.uk

1. Summary

2. Recommendation

That the Committee note the performance improvements in the Adult Services Department and the action being taken to maintain and improve performance in 2008.

3. Background

3.1 The Select Committee has requested the Director of Adult Services to provide 6 monthly progress reports on the performance of the department in relation to the national performance framework for adult social care.

4. Introduction

4.1 This is the third Adult Services performance update report to the Committee and summarises improvements made during 2007 to bring the department to its current position; and outlines what is being done to maintain this position in 2008 and address key areas for improvement.

4.2 This report also provides, as Appendix 1, an update on the department's performance in delivering the national Performance Assessment Framework (PAF) indicators as at November 2008. It includes numbers of clients supported and benchmarks with comparator authorities 2007 performance, as previously requested by the Committee.

5. Performance Improvement 2007

5.1 The annual performance assessment rating for the Council's Adult Services Department was announced by CSCI on 29 November. It has been awarded 3 Stars - the highest rating, placing it in the top quartile of the 150 councils with adult services responsibilities. The CSCI report was presented by the Director of Adult Services to Cabinet on 17 December and is published on the County Council's website CSCI Performance Assessment Report 2007

5.2 The two judgments which led to the 3 Star rating are:

Delivering Outcomes: Good - a service that consistently delivers above minimum requirements for users. (The range is poor, adequate, good and excellent). This judgement contributes to the Audit Commission performance rating of the County Council to be announced in February 2008.

Capacity to Improve: Excellent - the Council has a clear vision and ambitious strategic direction, communicates this effectively and organises the necessary resources required for delivery and meets value for money requirements. (The range is poor, uncertain, promising, and excellent).

5.3 At the Annual Review Meeting and subsequent report, CSCI made it clear that they are impressed by the improvement in performance whilst tackling financial recovery, and the leadership shown by the County Council in tackling the overspend. This has lead to their confidence in the department's ability to deliver further performance improvement and service modernisation. These judgements support the Council's priorities to keep `Hampshire safer and more secure for all' and `Maximising wellbeing'. This performance rating is a testament not only to the staff of Adult Services, but also to the leadership and support of the whole Council to improve outcomes for vulnerable people in Hampshire and address a financial over-commitment.

5.4 Particular note was made that "Financial reporting and management is robust". At the end of 2005/06 financial year, the department's budget showed an over- commitment of £11.1m, with the full year impact predicted to be £19m. The leadership of Members, support from chief officers in the County Council and action taken by all staff in Adult Services has ensured the department is on track to reach financial recovery by the end of 2007/08.

6. Performance Assessment Framework (PAF) Indicators

6.1 In July 2007, the Committee received a report on the department's PAF indicator trends and 2006/07 results. Members requested a further update on this information, particularly in relation to comparator councils.

6.2 The 2006/07 results of all Councils have now been published and our comparator group performance has been added to the graphs shown in Appendix 1. An accompanying commentary sets out the key achievements for each indicator.

6.3 Performance against these indicators is one, albeit important, aspect of the national assessment. Through a process of aggregating the 24 individual PAF scores, CSCI rank Council's performance. This places Hampshire 64^th in 2007, compared to 2006 performance of 101^st out of 150 councils. This rate of improvement outstripped most other councils and was a significant factor in the 3 Star rating.

6.4 The new set of national indicators will not come into effect until April 2008, and for Adult Services, this means the department will need to continue to show significant improvement against the current 24 PAF performance indicators until that time. At the start of 2007/08, targets were agreed by the management team that:

(i) keep pace with population growth, for example an additional 260 older people need to be helped to live at home this year in order for performance to remain at last years level.

(ii) where `smarter' working is identified, for example ensuring best practice is shared between teams to help improve performance and outcomes for clients.

(iii) where advancement to the next performance `band' is affordable.

6.5 Appendix 1 shows that the department is on track to achieve or slightly exceed the majority of its targets for 2007/08. Current priorities are C51 Direct Payments (which is also a CSCI area for improvement) - with targets set at team level; and C72 The number of older people admitted into residential or nursing care - which has been rising but is improving as result of management action targeted towards hospital discharge. Action plans are in place and while developing other options for vulnerable people requires both careful strategic and individual care planning, the department is confident of improvement in performance in these areas by year end.

6.6 A particular challenge will be to repeat the rate of improvement from 2007, especially as the department is now performing in the top Band for 46% of the national indicators and where advancement in some indicators is not possible. For example C32 Older People Help to Live where progress to the next Banding (Good) would have a significant financial impact for the Department and has not been factored into the budget.

7. Maintaining 3 Stars

7.1 The national performance framework requires continuous improvement across all aspects of the service in order to deliver the seven outcomes in the Dept of Health White Paper 'Our health, Our care, Our say' (as set out in paragraph 4.5 below) and the two additional performance assessment areas for `Leadership' and `Commissioning/use of Resources'

7.2 Hampshire is rated `good' at delivering outcomes and `excellent' in commissioning and use of resources for it's adult services. CSCI's expectation is that high performing councils will need to build upon their excellent management ratings to achieve excellent levels of service delivery in order to retain the 3 Star rating. The department's modernisation plans are therefore key to improving performance in the seven outcomes and maintaining the star rating.

7.3 As part of the Council's 2007 performance assessment for Adult Services, CSCI identified the following areas of strength and improvement:

Delivering Outcomes

36 areas of strength

10 areas for improvement.

Leadership and Commissioning

41 areas of strength

3 areas for improvement

7.4 The Council's CSCI areas for improvement 2008 are to:

Outcome 1: Improved Health and Wellbeing

1. reduce the number of people with learning disabilities living in NHS accommodation

Outcome 2: Improved Quality of Life

2. increase the provision of telecare

3. improve the robustness of information from district councils on people waiting for home adaptations

4. develop self referral and self assessment as part of our modernisation plans

Outcome 3: Making a Positive Contribution

None

Outcome 4: Increased Choice and Control

5. have a single (health and social care) assessment process in place

6. reduce the number of people with learning disabilities living in residential care

7. increase the number of people using Direct Payments

Outcome 5: Freedom from Discrimination or Harassment

8. as part of the County Council, achieve Level 3 of the Equalities and Diversity Framework standards

Outcome 6: Economic Wellbeing

9. improve the quality of information on the number of carers supported to work

10. increase the number of people with learning disabilities supported into paid and unpaid work

Outcome 7: Maintaining Personal Dignity and Respect

None

Leadership

11. complete the development of an Electronic Social Care Record

Commissioning and Use of Resources

12. explore further opportunities for joint budgets with Health

13. increase engagement to build capacity in the voluntary sector

8. Action to address the Areas for Improvement

8.1 Action to inform the 2008 performance assessment was planned for at the start of the financial year. This is kept under continual review by the department's management team. Areas for improvement were also identified by the Department through its performance monitoring process; and the self assessment submitted to CSCI in May 2007. A performance improvement plan was developed in June 2007, and progress is reviewed monthly by the DMT Performance Management Board.

8.2 The areas for improvement in the CSCI report contained no surprises, though some are challenging, not only to Hampshire, but to councils across the country. For example, to have a single assessment process in place across Health and social care so that vulnerable people only need to `say it once'. In its overview of the 150 Council self assessments, CSCI have acknowledged that 2 out of 3 councils have not yet delivered this component of joint working. In Hampshire, we are exploring with the Primary Care Trust options for a single assessment process which will take into account new Dept of Health guidance on a Common Assessment Framework for Adults.

8.3 The Department's Performance Improvement Plan has recently been reviewed in the context of the CSCI areas for improvement and submitted to the Commission as required. A copy of the Improvement Plan is available on request and is a comprehensive 26 page document which sets out for each improvement area:

i Which of the seven social care outcomes/two management domains the improvement supports

ii The CSCI statement on the improvement required

iii The planned improvements with milestones and targets, for example number of clients supported. Capacity for these improvements is built into the budget.

iv Lead managers are identified - to provide clear accountability; and management action taken to date and planned is recorded.

8.4 The Improvement Plan will form the basis of discussions at the two business meetings with CSCI to be held in January and June 2008. The Annual Review Meeting 2008 will be held on 3 Sept 2008 at which our performance across the whole service, including the areas for improvement, will be reviewed

9. Conclusion

9.1 Maintaining our 3 Stars presents a real challenge given population growth, the need for significant change in order to modernise our services, keeping within budget and CSCI expectations of continual improvement across all aspects of our service. Nevertheless, Adult Services is well placed to meet this challenge through its excellent capacity for improvement.

10. Impact and Implications

10.1 Impact Assessment

10.1.1 National performance assessment is an inclusive process. The department's Improvement Plan will have a positive impact on fair and equal access to services.

Section 100 D - Local Government Act 1972 - background documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report.

NB: the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act.

NONE

Safe and Healthy People Select Committee

18 January 2008. Performance Improvement - six monthly update

APPENDIX 1

Comparison of PAF trends and performance 2003 - 2007

Hampshire's Improving Performance Framework (IPF) comparator group include the following Local Authorities:

Essex, Oxfordshire, Worcestershire, Bedfordshire, Warwickshire, Cambridgeshire, Cheshire, Leicestershire, Gloucestershire, Hertfordshire, Staffordshire, Kent, Northamptonshire, Buckinghamshire and Wiltshire.

Help to Live at Home

Performance improved in 2006/07 to 26.8%, from 25.4% in the previous year, retaining performance in band 2 (good). Performance was slightly below the comparator average, but has already achieved the end of year plan.

Annual C28 performance is based on activity delivered in a 2 week period in September. Performance in 2007/08 was just short of plan (9.5) with 9.2 households per 1,000 population aged 65 and over being in receipt of 10 or more hours of home care and six or more visits a week. Maintaining our performance in Band 3 `acceptable'.

In total 1,995 households received an intensive service, which is 44 fewer than last year (2,039). The modernisation of the home care service with the development of the Community Re-enablement Teams means the service now provides more hours of home care, 90,661 hours during the sample week, compared to 89,100 last year, but with the focus now on re-enablement fewer clients are receiving intensive packages of care.

C29 performance remains in the top Band 1 (very good) and is higher than our comparator authorities, though fell slightly in 2006/07, from 6.4 (4,947 clients) in 2005/06 to 5.9 (4,552 clients) per 1,000 population. This PI is includes people using Direct Payments and reflects the 2006/07 drop in performance of this PI.

Performance increased from 2.4 (1,797 clients) in 2005/06 to 2.7 in 2006/07 (2,072 clients), moving us into Band 2 (good), as the department helped an additional 275 people to remain in their own homes.

Whilst performance in 2006/07 was slightly below that of our comparators we are currently on track to achieve the end of year plan.

Performance improved from 8.5 (6,583 clients) in 2005/06 to 12.1 (9,317 clients) in 2006/07 maintaining our position in the top Band 1 (very good). The increase in the number of people being supported has been achieved by the extra capacity created in the Mental Health Teams in Hampshire as a result of Health Service changes.

In 2006/07 Hampshire had the highest outturn of all our comparator authorities and we are on target to achieve plan this year.

Performance increased in 2006/07 to 83.5 per 1,000 population aged 65+, from 82.5 in 2005/06. This represents a total of 17,861 older people supported at home (500 more than in 2005/06) through extra capacity created through the Home Care modernisation and extra investment in equipment services. This improvement meant performance kept pace with the population increase and maintained our performance in Band 3 (average)

Performance is significantly above that of our comparators and in 2006/07 we had the second highest outturn of our comparator group. Current performance is on target to achieve plan.

Direct Payments

Performance in 2006/07 fell, in part due to other options being available such as the carers respite voucher scheme, OT Direct, self directed care and re-enablement services. Charging policy changes also required all service users to be financially assessed, resulting in 150 DP users making their own care arrangements. In 2006/07 a total of 857 people were using Direct Payments.

The Department remains on trajectory to achieve its target year end performance of 96, but we do not expect significant growth until the implementation of the revised scheme in 2008.

% of Client s receiving services who are Carers

The number of services provided to carers in 2006/07 improved on the previous year with 13,529 carers receiving a service, making our outturn 15.5% and taking us into the top band (very good).

In relation to our comparators, performance is above the average of 12.25 and Hampshire had the third highest performance in our group.

Clients in care homes with Single Rooms

Performance in 2006/07 improved from 88% in 2005/06 to 90%, taking us into Band 2 (good), as 1,405 of the 1,557 people admitted into a permanent residential or nursing placement during the year where allocated a single room.

As all the Enhanced care homes are now open and only offer single room accommodation performance in this indicator is expected to improve this year and is on plan to be achieved.

Clients receiving a Care Plan

In 2006/07 96.4% of clients received a statement of need. This is an improvement on the previous year and took performance into band 2 (good), bringing it in line with our comparators.

Clients with an Annual Review

Performance improved by 12.1% in 2006/07 on the previous year increasing from 68.5% to 76.8%, exceeding plan and maintaining performance in Band 3 (average), the top banding available for this indicator. In total 71,945 clients received an annual review out of the 94,048 clients who received some form of service from Adult Services. This figure includes the 30,000 people who receive equipment and 17,000 people who access the mental health service provided jointly with Health.

In relation to our comparators, performance in 2006/07 was above the average of 72% and is currently already above the plan for the end of year at 82%.

Waiting Times for Services

In 2006/07 Hampshire reported 39 delayed transfers of care per 100,000 population, improving on the 43 reported in the previous year and taking us into Band 2 (good).

In relation to our comparator authorities performance was slightly higher than the average (39), but within the same banding as 60% of our comparators.

During the first half of 2007/08 delays have significantly improved on the end of year performance, reducing by a further 20% in November to 31 per 100,000 population aged 65 and over.

In 2006/07 performance in waiting times for equipment improved by 7.5% on the previous year to 91.3%, maintaining our performance in the top banding (very good). In total 51,027 of the 55,875 items of equipment issued during the year were delivered in 7 working days.

Performance is above that of our comparators and is currently on target to achieve plan.

Performance in 2006/07 improved by 4.5% to 93% moving us into Band 1 (very good). In total 12,199 new clients, aged 65 and over, of the 13,166 that requested an assessment during the year had their assessment completed in 4 weeks.

Our performance in this indicator is the second highest of all the comparators and 7% higher than the comparator average of 86.

The high performance of the previous year continues to be maintained in 2007/08 and is on course to achieve plan, with November's performance 92.3.

Performance in 2006/07 remained in band 2 (good) improving by 2% on the previous year to 89%. As 9,898 of the 11,150 older people that received a service during the year had their care packages in place within 4 weeks of their assessment being completed.

Performance is in line with the comparator average and only 1% short of the top banding.

Performance in 2007/08 has been maintained during the first half of the year and is on course to achieve plan.

Residential and nursing admissions

In 2006/07 1,681 older people were admitted into a nursing or residential home on a permanent basis, 189 fewer than in the previous year, improving our performance to 79 per 100,000 population aged 65 and over, and maintaining performance in the top banding (very good).

Performance in 2007/08 has remained fairly consistent with the end of year outturn with current performance at 79.8. The reductions experienced in the previous year have not continued but measures are in place to ensure that placements into permanent care are only made when no viable alternatives are available.

In 2006/07 126 people aged 18-64 were admitted into long term residential or nursing care, 39 fewer than in the previous year, improving our performance to 1.6 per 10,000 population aged 18-64, and maintaining band 2 (good).

Performance in 2006/07 was better than the comparator average of 1.7 and has continued to improve in 2007/08, with current performance already achieving plan.

Costs of Care

Weekly cost of intensive social care

The weekly cost of intensive home care in 2006/07 came in below plan at £582, (plan £596), increasing by only 1% on the previous years outturn of £575. Keeping performance in band 3 (ask questions)

The department are currently leading on a regional benchmarking project in relation to B12 and the first performance outturn for 2007/08 will be available in January 2008.

Hourly cost of home care

In 2006/07 unit costs for home care for adults and older people reduced from £16.60 in 2005/06 to £14.47, moving performance into the top CSCI banding.

The improved performance in 2006/07 means our hourly rate is lower than the comparator average of £15.03 and the eighth lowest of all our comparators.

The department are currently leading on a regional benchmarking project in relation to B17 and the first performance outturn for 2007/08 will be available in January 2008