Contact: John Clifton ext or Barbara Sorkin ext 5985

1 Introduction

1.1 This report has been written to update members on the Social Service Department's Action Plans to improve performance, and to inform them of the revised monitoring arrangements put in place. This report was requested at the January PRC when a report was presented informing members of the "PAF ratings and stars" awarded by the Social Services Inspectorate for 2001/2.

1.2 Results for the financial year 2002/3 are being prepared, with most being due at the Department Of Health by 30 May. Despite this, we will not know the results for other councils, or the performance bandings which will apply, until their publication in late autumn (normally November). As a consequence, this report has been written in the assumption that performance during 2002/3 is broadly similar to last year for most indicators.

2 New Performance Monitoring Arrangements

2.1 Following corporate work on the Comprehensive Performance Assessment, the requirement to achieve Public Service Agreement targets, the raised importance of PAF indicators in Best Value Performance Plans and Star ratings assessments; the decision has been taken to consolidate performance reporting within Social Services. The recent Climbie audit has provided another strand of work which is also being approached through this programme.

2.2 A Performance Action Group has been set up reporting to the Director of Social Services, which meets monthly. This group will monitor the agreed action plans for 3 sub-groups, one for each client group. Many performance indicators cover the two adult client groups, and these will be addressed in each sub-group as different issues tend to apply in each sector.

2.3 The sub-groups are operational and have drawn up specific action plans for each indicator where improvement is required. These are consolidated into Appendix 1.

3 Children's Indicators

3.1 There are two "investigate urgently" or "one blob" indicators for children's services:

3.2 Health of Looked After Children, C19. This indicator measures the average percentage of looked after children with an up-to-date immunisation record, a dental check within the last year and the regular medical checks required under LAC guidance. Hampshire had a very poor rating against this record as the information required had not been recorded in files, or in IT systems, in a routine way. This matter has been addressed through training, both of Social Workers and their clerical support teams. Social workers have been made aware of the need to collect and record this data, with clerical support being tasked with finding this information within files or from carers and entering it into IT systems. Although this work is ongoing, and generating significant improvements, the annual indicator is based on a return as at September 2002. Consequently performance has already been notified to the Department of Health for 2002/3; however we do have the ability to notify the Department of improvements by the end of March through the bi-annual Delivery & Improvement Statement. This Statement forms a substantial part of the evidence on which star ratings are based.

3.3 Education, Training and Employment for Care Leavers aged 19, A4. Under the previous organisational structure for children and family services in Hampshire, care leavers were frequently given a lower priority than younger children at risk. As part of the re-modelling a specialist team has been created to support care leavers. Resulting from this change, and the motivation of the staff involved, this indicator will improve significantly over the next two years. Unfortunately, many of the cohort of care leavers measured for 2002/3 performance indicators were no longer in contact with social services by the time this team was created. Improved performance will come through routine contact with young adults leaving care since its formation, thus impacting in significantly improved performance for 2004/5 onwards.

3.4 In addition to these indicators there are also several indicators awarded two "blobs" which require discussion.

3.5 Cost indicators, B8, B9, B10. These have been treated as one subject due to their definitional similarity and shared problems; most outside the influence of Hampshire County council. Hampshire is currently benchmarked against other Shire counties, rather than SE Region authorities experiencing similar market conditions. The Department of Health is reviewing the use of a "deflator" to be applied to SE Region authorities results before benchmarking against peer group authorities. This might resolve the issue, but a decision on this will not be made until the autumn. There are also further areas under investigation which might improve performance; the allocation methods applied to central overhead costs, improved recording of respite care programmes and the mix of foster and residential care utilised.

3.6 Long term stability of children looked after, D35. This measures the percentage of children in care for over 4 years who are in foster care for the last two years. Our performance against this has been below average, showing little fluctuation. A task group is being formed to look at the children involved in the 2002/3 figures, looking at their case histories to see whether there are any practice issue involved which need to be changed. This indicator might be influenced by children with disabilities who need to be in a residential care setting or by our policies around preparing care leavers for independence through moving them on from foster care into bedsits and hostels. Until the task group reports, and time has been allowed for this to influence practice, performance against this indicator is likely to remain stable.

3.7 Ethnicity of children in need in comparison to the background population, E45. The target is to have roughly a 1:1 ratio between the percentage of children from an ethnic minority in the community and the percentage of children in need receiving services. Hampshire appears to be providing too many services to children from a minority ethnic background - but this is probably linked to out of date population data based on the 1991 census. It is believed that when 2001 census data is used, for 2002/3, Hampshire should be broadly in line with government targets.

4 Adult Services

4.1 There are three "investigate urgently" or "one blob" indicators for adult services:

4.2 Percentage of adults and older people allocated single rooms on entering permanent residential or nursing care, D37. Like many SE Region authorities our results against this indicator are poor, predominantly due to market capacity. Our pricing structure means that homes tend to provide single rooms to private clients, those from London boroughs prepared to pay more and to users with relatives prepared to pay the "third party top up". We have approached the registration authorities to find out the number of single rooms available to purchase in Hampshire, to test if the government target is realistic locally. They do not currently record this information. Research is being done through older person's teams (which heavily influence this indicator) gathering hearsay evidence. Until this is analysed we cannot expect a significant improvement for this indicator, indeed it might worsen as market capacity reduces.

4.3 Percentage of people receiving a statement of needs, D39. All users of services funded through Social Services are expected to get a statement of needs. Traditionally Hampshire has only provided such a letter to users of fully care managed services, in the form of a care plan. To rectify this, simple statements of need have been generated for all users of specialised equipment and all non-residential users with services recorded in ACMS. New arrangements have also been put into place for OT assessments, which meet this requirement. These measures will improve Hampshire's performance, but it will remain poor (around 70-75%) as we have not yet agreed practical, cost effective ways of providing letters to meals on wheels and transport users, or small luncheon clubs and day services run by the voluntary sector which we grant aid.

4.4 Delayed discharges, D41. This indicator measures "bed blocking" in acute hospital beds by potential social care users for whom no community care package has been implemented, although they are fit for discharge. Results for 2002/3 remain poor, due to local market capacity problems. Longer term this problem is being addressed through joint work with Health in EMI and Nursing bed provision and through working with domicilary care providers to stimulate the market. Members have also provided extra funding to support work in facilitating prompt discharges. Recent legislation will implement a charging structure (fines) which local authorities must pay to Health for beds blocked for longer than 2 days after a patient is declared ready to leave hospital. This system is to be introduced in January 2004.

4.5 In addition to these indicators there are also several indicators awarded two "blobs" which require discussion.

4.6 Intensive Home Care, C28. This indicator measures the number of households (of all adults) receiving more than 10 hours care in the home and more than 6 visits during the week, against the population of people in Hampshire aged over 65. There are many problems with the indicator; especially that it makes no allowance for day care, meals on wheels or Direct Payments, and we continue to make representations to the Department of Health about this. With the extra funding recently agreed by members to facilitate discharges from hospital, this indicator should improve during 2003/4. However it will be difficult to improve sufficiently to meet our PSA target, so an action plan has been formulated to significantly boost performance over the next 18 months (the sample week on which the indicator is based happens during September).

4.7 Intensive Home Care as a percentage of Intensive Home and Residential/nursing care, B11. This indicator measures the ratio between provision of Intensive Care (as detailed above) and admissions to residential and nursing care. Our poor performance against this indicator is linked to our poor performance for C28' Hampshire is rated as "excellent" for the number of users supported in residential and nursing care. No actions are required for this indicator, improved performance will be a by product of work on C28.

4.8 Cost indicators, B12 and B14. The issues which impact on these closely mirror those described for children's services; SE Regional costs coupled with poor recording of activity for respite care and jointly provided services with Health. There are also issues around accounting practices appearing out of line with other authorities for S28a and some preserved rights users. The action plan is addressing these issues.

4.9 Percentage of clients receiving a review, D40. All users of services are expected to have at least an annual review to check that the services provided continue to meet their needs; with many users receiving more or less care as a result of that review. Historically Hampshire has only reviewed fully care managed users, so issues exist broadly similar to those raised when discussing statements of need (D39). We are investigation whether reviews should be "contracted out" to some voluntary organisation service providers. However the requirement to assess all users against the Government's new "Fair Access" eligibility criteria would make this a difficult task. Action plans have been drawn up to meet the Fair Access targets which will help improve performance against this indicator.

4.10 Ethnicity of older people receiving assessments, E47. As with the children's ethnicity indicator E45, poor performance is linked to the 1991 census being used as the base. No work is proposed on this indicator until the 2001 census has been used in the evaluation. Despite this Hampshire continues to work closely with ethnic minorities, trying to ensure the provision of suitable services.

4 Recommendations

5.1 Members note this report, informing the Director of Social Services of any changes they require making to the action plans contained in Appendix A.

5.2 Members receive a report early in 2004 detailing the Social Service Inspectorate's ranking of Hampshire's indicators and the star rating awarded for 2002/3 performance.

Section 100 D - Local Government Act 1972 - Background Documents

The Following documents disclose facts or matters on which this report, or an important part of it, is based and has 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 of confidential information as defined in the Act.