Contact: John Clifton, ext. 7283; Barbara Sorkin ext. 5985

1 Executive Summary

1.1 This report follows the recent announcement that Hampshire County Council has retained its two stars for Social Services with excellent capacity for improvement and describes the Performance Assessment Framework (PAF) processes used by the Department of Health to measure national and local performance. It reports on Hampshire's results for 2002-3 and highlights key achievements and areas for improvement. The report covers the Annual Review Letter, the results for individual performance indicators, the 2 star rating awarded to Hampshire Social Services and how this fits in to both the national PAF for social care and the Corporate Comprehensive Performance Assessment. Finally it identifies major themes from the Autumn Position Statement, recently reported to the Department of Health, which includes County targets for use in local and national monitoring.

1.2 Overall Hampshire's performance has improved, with some variations between client groups. The county was awarded the maximum classification for 13 of the 49 indicators published so far; 6 for child care and 7 for adults and older people. The minimum classification was awarded for 3 indicators (Employment, education and training of care leavers, Health care for looked after children and Provision of a statement of needs to adult service users); as in 2001-2. Although acknowledging further scope for improvement in these areas, difficulties in collecting information have contributed to the classification.

1.3 Although recent government cabinet changes have transferred responsibility for children's social care from the Department of Health to the Department for Education and Skills, all 2002-3 evaluation remains with the DoH team in the Social Services Inspectorate (SSI).

2 Introduction

2.1 The White Paper "Modernising Social Services" sets out the arrangements for assessing the performance of each Council with Social Services Responsibilities (CSSR). This assessment process pulls together information from a range of sources to provide a comprehensive overview of the social care performance of each council. This process includes the following elements:

2.2 Performance data. There are currently 51 high level performance indicators associated with the Performance Assessment Framework. Four of these indicators relate to health authorities and their interface with social care. The range of PAF indicators available facilitates direct comparison between councils, helps in the identification of regional and/or service trends whilst also allowing realistic targets to be agreed and monitored. They are underpinned by many indicators specific to the national agenda for social care; being derived from Quality Protects, National Service Frameworks, White Papers etc.

Each PAF indicator is awarded a `blob' rating by the Department of Health. These are:

●●●●● Very good

●●●● Good

●●● Acceptable, but possible to do better

●● Ask questions about performance

● Investigate urgently; may be linked to incorrect return or very

poor performance.

2.3 Evaluation. There are in-depth Social Services Inspectorate (SSI) reviews for specific services. These are increasingly being linked to proactive work within councils on Best Value, replacing their historic role of auditing after the BV review is finalised. During 2002-3 Hampshire was reviewed for children's services and for a self audit in response to the Climbie judgement. Both of these reviews have been taken through the committee process, so will not be covered in this report. Historically SSI/Audit Commission Joint Reviews have looked at how well the council discharges its social services responsibilities every five years. This function has been replaced by the Comprehensive Performance Assessment evaluation which looks at corporate health and the inter-relationships between departments in implementing corporate strategies.

2.4 Monitoring. The SSI are in frequent contact with councils and regularly monitor progress in achieving national targets. The main vehicles for this are the Spring and Autumn Delivery and Improvement Statements which contain performance data, strategies, action plans and risk analysis. They also follow up concerns arising from statistical information, inspections, Reviews or health partners and liaise with District Auditors and the Commission for Health Improvement in evaluating performance.

2.5 The Best Value Performance Plan, published annually by the council, contains a specified subset of the PAF indicators which are used to assess the 'corporate health' of the county council. Forecasts for current year performance and targets for the following year are published here, highlighting the need for targets to be robust and in line with national and Public Service Agreement targets.

3 KEY NATIONAL MESSAGES 2002-3

3.1 The national picture emerging from last year's PAF indicators is that there has been an overall improvement in performance within personal social services, with variations between councils narrowing.

3.2 National targets for the following childrens services were not met: Educational qualifications of care leavers; Re-registrations on the child protection register; Stability of placements for looked after children; Care leavers in education, training or employment on their 19^th birthday.

3.3 Most cost indicators increased at a rate above inflation, with those relating to children's services rising most.

3.4 The timeliness of reviews in child protection cases improved, but nationally only 51% of councils reviewed all their cases. This may overstate performance and the indicator has been tightened for 2003-4.

3.5 Relative spend on family support increased slightly, indicating that expenditure on children in need but not looked after is increasing faster than expenditure on children looked after.

3.6 The balance between care at home and in a residential setting is improving, but there is scope for further improvement.

3.7 29% of new users did not get their first service until more than 6 weeks after their initial contact with social services, but this is an improvement on last year. The definition of this indicator is being tightened for 2003-4.

3.8 Nationally 7% of adults and older people who wished for a single room on entering permanent residential care were not allocated one. This is an improvement on preceding years.

4 HAMPSHIRE'S PERFORMANCE

4.1 Hampshire's performance is reported on by client group. Detailed PSS PAF results are given in Appendix 1, with full details available from the Department of Health website at http://www.doh.gov.uk/paf .

4.2 Adult & Older Person's Services

Assessment: Serving most people well with excellent prospects

4.2.1 These indicators cover all people over 18; thus they include people with a physical disability, learning disability, mental health problems and all older people.

4.2.2 A summary of results for 2002-3 by indicators across all adults show:

4.2.3 Hampshire's performance for adults overall was good, with further improvement needed in activities linked to intensive care and process/information collection activities.

4.2.4 The Department has been in dialogue with the Department of Health about the definitions that should be applied to "intensive" care in B11 and C28, as these indicators do not reflect day care, luncheon clubs, meals on wheels or Direct Payments. Were such services to be included our recorded performance would certainly improve, but it is likely this would apply to other authorities too; leading to revised banding of performance.

4.2.5 The disappointing performance under D39, statement of needs, reflects the inclusion of clients who only receive extremely limited services such as meals on wheels and the provision of simple equipment where the issuing of statements had been considered by the department as an unnecessary bureaucratic activity. However, we are implementing measures to address this problem and, although not showing in the classification awarded, Hampshire's performance has improved again this year; rising from 70% to 75% of users receiving a statement of needs.

4.2.6 Hampshire has improved performance under D38, items of equipment delivered within 3 weeks, from 88% to 91%. Most routine equipment is now delivered within 5 working days, with further improvement expected in the timely supply of minor adaptations. For 2003-4 the expectation is that services will be delivered within 7 working days, according to the new definition for this indicator. Hampshire is currently working through a modernisation programme with its Joint Equipment Stores to support this improvement.

4.2.7 Hampshire is investing, jointly with Health partners, in activities to improve the interface indicators for emergency admissions and delayed transfers of care. Although emergency admissions can only be collated through health systems, delayed discharges are agreed locally on a weekly basis and will form the basis of the "reimbursement" (Fine) payable by the authority for Hampshire clients occupying acute beds when this is no longer required for medical reasons. This issue has been the subject of many reports to members, so will not be addressed in this report.

4.2.8 A new indicator has been collected for the first time this year, measuring direct payments against the population aged over 18. Although one of the best authorities in the country, Hampshire has only been awarded 3 blobs for this indicator. This reflects the government's belief that Direct Payments should be a significant method of provision of services to older people; consequently setting very high thresholds for higher performance bandings.

4.3 Older peoples services

4.3.1 These indicators supplement those for all adults.

4.3.2 A summary of results for 2002-3 of indicators specific to older person's services shows:

4.3.3 Performance in specific indicators for older people are good, although as many indicators covering all adult services are more modest, this impacts on performance as perceived by some service users.

4.3.4 Historically performance has not appeared acceptable when supplying low level services to clients who remained in their own homes (C32). The counting mechanisms have now been corrected and show that Hampshire's performance is similar to other authorities in the relevant peer group (SE rural). Performance shows a dip from 2001-2, this is due to a tightening of the definition by the DoH rather than a reduction in help provided.

4.3.5 Hampshire is considered 'very good' for the proportion of older people in the community receiving an assessment and acceptable for assessments of older people from minority ethnic groups. These indicators are being kept under close scrutiny and monitored against forecast demographic changes.

4.3.6 Two new indicators have been published, based on a user survey amongst users of domiciliary care in the county. These questions, to a large extent, mirror staff perceptions. They show that users are very satisfied with Hampshire social services, but that we are unable to `personalise' packages as much as users would like due to market capacity. Results are in line with neighbouring shire authorities. Although only 2 questions are published as PAF indicators, many were asked. These supplementary questions are currently being analysed by the University of Kent on behalf of participating authorities, and the research is due for publication in early 2004. This user group will be surveyed again in 3 years time; the 2003-4 user survey will involved younger physically disabled and sensory impaired users of community packages.

4.4 Learning Disabilities

4.4.1 These indicators supplement those for all adults.

4.4.2 A summary of results for 2002-3 by indicators specific to users with a learning disability shows:

4.4.3 As with many other unit costs, performance has improved slightly due to the DoH's inclusion of a "cost factor". Although Hampshire's factor is higher than many Shire counties, it still does not reflect that of many neighbouring authorities in the South East. Additionally, Hampshire is pursuing the objectives of the High Needs Strategy through work with partner organisations, developing support services and accommodation which will enable people to remain in their family homes or move-on to homes of their own. Early stages of the development of supported living options as "move-on" opportunities for people in registered accommodation, are initially concentrating on individuals with less complex needs. This affects the `user mix' and a rise in the average cost of residential and nursing home care (B14) can be predicted; with the majority of placements in such homes relating to people with higher needs.

4.4.4 As with older people helped to live at home, a tightening of the definition caused a reduction in the services we were allowed to count against this indicator. No reduction in actual services provided occurred.

4.5 Physical Disabilities

4.5.1 These indicators supplement those for all adults.

4.5.2 A summary of results for 2002-3 by indicators specific to physical disabilities shows:

4.5.3 Performance of services, as measured through PAF, to people with a physical disability or sensory impairment is average.

4.5.4 As with older people helped to live at home, a tightening of the definition caused a reduction in the services we were allowed to count against this indicator. No reduction in actual services provided occurred.

4.6 Mental Health

4.6.1 These indicators supplement those for all adults.

4.6.2 A summary of results for 2002-3 by indicators specific to mental health show:

4.6.3 The performance of services to people with a mental health problem is good. Many of the historic problems around poor recording by social and health care workers in the integrated Community Mental Health Teams have been solved. The Department is working with health colleagues to develop a joint mental health information system needed to facilitate the implementation of the Mental Health National Service Framework.

4.7 Children's Services

Assessment: Serving some children well with excellent prospects

4.7.1 In general performance is good against children's PAF indicators.

4.7.2 A summary of results for 2002-3 by indicator shows:

4.7.3 Overall the performance of children's services is acceptable. The government has provided money for children's services through Quality Protects and other initiatives, helping maintain performance against many indicators, but much of this money has been ring fenced to new activities which have placed pressure on existing services. This pressure is two fold; limited resources have been stretched and management time has been diverted from core activities.

4.7.4 Several indicators are affected by the age profile of Hampshire's looked after children population. For adolescents who have been in care for a long period of time, who are looking to move into their own accommodation in the medium term, a change to a family based placement would be inappropriate (B7). Similarly, on initially moving into their own accommodation, they can affect D35 (stability of long term placements) adversely. It is expected that this demographic "blip" will be reduced as adolescent and care leaver services within the county, aimed at supporting these children in their family homes or independently, are expanded using Quality Protects and Supporting People monies.

4.7.5 During 2001-2 children's services were re-modelled. It was expected that the creation of the district reviewing teams would have improved review quality; improving services provided for children and the flow of information (C19) on the children concerned. The new arrangements were not in place long enough to settled down and impact on performance in 2002-3, but routine monitoring is showing significant improvements for 2003-4. In a similar way, the creation of the care leavers service is now helping educational attainment (A2) and increasing contact with care leavers (A4) in the role of corporate parent; which remains until care leavers are in their early twenties.

4.7.6 A significant difficulty in the children's sector is recruitment and retention, of both staff and foster carers. The centralisation of the family placement team is assisting improved "matching" of foster carers and children which has helped placement availability for younger children (C22).

4.7.7 The long term stability for looked after children (D35) remains poor. It is important to note the negative impact on this indicator of what are, in fact, positive policies including returning children placed outside county borders to Hampshire, so they can be closer to relatives, and older children preparing to leave care and moving into hostels. However, the shortage of suitable foster carers also affects this indicator.

4.7.8 The basis of the unit cost calculation has changed to include respite care, hiding a real increase in the unit costs for residential and foster care; reflecting the national trend. This is linked to changes in in-house residential provision where Hampshire has opted for the early implementation of the improved standards recommended by the National Care Standards Commission. These have resulted in a maximum size for children's residential homes of 6 children, reducing placements available in Hampshire by 16 and costing an extra £1 million.

4.7.9 Hampshire has a good reputation for the educational attainment of children in residential homes, being considered amongst the best nationally. The PAF indicator (A2) reflects this. As might be expected, the ability mix of children varies between years and has a noticeable impact on academic achievement and Hampshire's performance indicators. The new team, specialising in links with education, has introduced innovations include bursaries for children performing above expectations, personal education plans and improved contact with educational support workers.

4.8 Value for Money

4.8.1 Overall, Hampshire is providing services efficiently, at an acceptable cost. Although unit costs seem high against national comparators, they are typical of neighbouring authorities and reflect local market capacity problems.

4.8.2 It should be recognised that as the policy to support more people at home gains momentum, the purchase of high dependency care will increase as a proportion of the total, causing Hampshire's unit costs to rise across all client groups.

4.8.3 Departmental priorities were confirmed last year as remaining with services targeted at people assessed as being in greatest need; whilst managing steadily increasing demands within cash limited budgets. These imperatives impact upon both Hampshire's ability to provide a high volume of services to meet lower level needs and in the provision of increasing numbers of intensive care packages. Hampshire has provided extra money for intensive care in 2003-4, and this has (so far) resulted in a 20% increase in the number of households supported with an intensive care package.

5 AUTUMN DELIVERY AND IMPROVEMENT STATEMENT

5.1 The Autumn Delivery and Improvement Statement is part of the six-monthly monitoring between the department and the DoH. Traditionally, the Autumn return concentrates on efficiency and effectiveness measures, children's services and progress towards targets set through National Service Frameworks and White Papers.

5.2 As part of this process revised forecasts for 2003-4 are provided for many PAF indicators to help monitor improvement, and contingency plans shared where action plans are not on target.

5.3 The Autumn return examines local authorities intentions regarding Care Trusts, Training, Climbie action plans, personnel data many other issues. It is also used as a way of monitoring regional trends; such as the shortage of independent residential and nursing home places and the difficulties in attracting staff to social care.

5.4 A copy of the Autumn Delivery and Improvement Statement will be made available in the member's room in late November.

6 ANNUAL REVIEW LETTER & STARS

6.1 The Annual Review Letter from the SSI is attached as Appendix 2. This reflects the Annual Review Meeting process where SSI Inspectors met with senior managers in the authority to discuss evidence of performance improvement, progress on the modernisation agenda and the effectiveness of our working arrangements with other social care stakeholders.

6.2 The Annual Review Letter, coupled with performance indicators, formed the basis of the stars awarded on 13th November. Hampshire retained its 2 star status. Children's services were assessed as serving some children well with excellent prospects for improvement. Adult and Older Person's services were assessed as serving most people well with excellent prospects for improvement.

7 PERFORMANCE ACTION GROUPS

7.1 During the last year, the department has created a hierarchy of Performance Action Groups (PAGs) to drive the performance agenda forward. At present these groups cover 2 levels in the organisation; one for the Departmental Management Team and one between Assistant Directors and County Managers. They are planned to be rolled out to service and team managers, across all sectors, over the coming year.

7.2 Performance Action Groups are evolving to look at all aspects of performance; the quantitative aspects of services for users and carers, the financial position, impacts arising from human resource issues, quality and outcomes. This represents a significant cultural change within the department, but one that should be beneficial to users and staff alike.

8 CONCLUSIONS

8.1 The Performance Assessment Framework provides a very helpful comparative picture of overall performance, and highlights areas where further emphasis is required if Hampshire is to continue to improve.

8.2 Whenever performance indicators are examined it is tempting to challenge whether the correct measures are being applied and whether all that should be counted, is indeed being counted. As the range of performance against PAF indicators is narrowing, it suggests that authorities are now counting similar activities against indicators.

8.3 Where it is felt that indicators do not provide an adequate picture of local performance, it is important to identify more relevant local measures. These are used for internal management processes and have been a feature of several Best Value reviews over the last few years.

8.4 It is not realistic to achieve top performance across the whole range of indicators in the framework, and it is important that Members identify priority areas for improvement in their consideration of the Department's core business and future budgetary position.

8.5 PAF largely provides a picture of inputs and outputs, rather than outcomes. Although this year's PAF contains some indicators concentrating more upon qualitative aspects of social care - such as user satisfaction and ethnicity - these are still in the minority. It is very important that issues of quality and effectiveness are examined in a way that balances the more quantitative approach taken by the PAF range of indicators when making planning decisions.

8.6 Action plans (Appendix 3), detailing proposed improvements on one and two blob indicators and those considered of high importance by the DoH, are taken to senior managers monthly through the Performance Action Groups (PAGs). Staff to support this agenda started work with Hampshire in mid November and PAGs will be rolled out in all client groups as soon as possible, assisting front line managers to be proactive when considering performance improvements.

9 RECOMMENDATIONS

9.1 That this report be accepted.

9.2 That the Executive member for social care requests that the Social Care Policy Review Committee advise on any matters of policy that require specific attention and any actions required, subject to available resources.

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.

None

NB the list excludes:

1. Published works

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