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 promising capacity for improvement and describes the Performance Assessment Framework (PAF) processes used by the Commission for Social Care Inspection (CSCI). The CSCI operates on behalf of the Department of Health (DoH) for adult and older persons services, and the Department for Education and Skills (DfES) for children's services. They measure national and local performance against key targets the government set, monitor progress towards national objectives and act as an external inspector for residential homes. Annually CSCI report on every authority's results and highlight key achievements and areas for improvement. This report covers the CSCI 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 Delivery and Improvement 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 against indicators has improved, with some variations between client groups. The county was awarded the maximum classification for 11 of the 48 indicators graded; 6 for child care and 5 for adults and older people. The minimum classification was awarded for only one indicator this year, in 2002/3 three indicators had this banding.

1.3 Although this paper is presented for information rather than decision, the report shows the progress in Social Services towards the corporate aims 1 Maximising life opportunities, 5 Improving Services and 6 Developing councillors and staff.

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, and includes the following elements:

2.2 Performance data. There are currently 51 high level performance indicators associated with the Performance Assessment Framework. Three 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 CSCI. 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 CSCI reviews for specific services. These are increasingly being linked to proactive work within councils on Service Reviews and Inspections of Health or Education. Historically CSCI/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 CSCI 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 2003-4

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 Progress is being made in closing the gap between young people leaving care and young people in general.

3.3 Most cost indicators increased at a rate above inflation, with those relating to children's services rising most. Nationally the unit cost of children's residential care rose by 6% and that for foster care by 8%. Costs in London and the South East are often higher than elsewhere, due to high labour costs.

3.4 The timeliness of reviews in child protection cases continues to be a problem, nationally only 43% of councils reviewed all their cases on time.

3.5 Relative spend on family support remained constant, indicating that expenditure on children in need but not looked after is increasing in line with expenditure on children looked after.

3.6 Emergency admissions to hospital increased nationally, probably reflecting a change in responses within hospital R&A teams.

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

3.8 The number of adults receiving Direct Payments increased from 23 per 100,000 population to 36. There was still a large variation between councils.

3.9 The results for London often appear to be different to those for Shire counties and Unitary councils with, for example, better performance on Intensive Home Care; the results for Metropolitan districts tends to lie between.

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 CSCI website at http://www.csci.org.uk/council_performance/paf .

4.2 Adult & Older Person's Services

Assessment: Serving most people well with promising 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 2003-4 by indicators across all adults show:

4.2.3 Hampshire's performance for adults overall was good; although further improvement in activities linked to intensive care, assessments and process/information collection activities would be helpful.

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 Historically Hampshire recorded delivery performance for items of equipment as 91% delivered within 3 weeks. The indicator has now been changed to D54 and monitors equipment delivered within 7 days, where the Integrated Community Equipment Stores achieved 73%. This is just below the national average, but is probably impacted by Hampshire not providing unassessed "cheap" equipment, which can distort the indicator. Most routine equipment is now delivered within 5 working days. Further improvement are planned for the timely supply of minor adaptations, which currently detract overall performance levels .

4.2.6 Hampshire is investing, jointly with Health partners, in activities to improve the interface indicators for emergency admissions and delayed transfers of care. This issue has been the subject of many reports to members, so will not be addressed in this report. It should be remembered that Social Services are monitored on all delayed transfers, not just those attributable to Social Services through the "fee" regime. Currently only around 15% of delays are attributable to Social Services.

4.2.7 Hampshire was awarded 3 blobs for the indicator measuring direct payments against the population aged over 18. This reflects the government's policy that Direct Payments should be a significant method of provision of services to older people; consequently setting very high thresholds for performance bandings. Our relative performance has slipped from 3rd to 12th nationwide as other authorities amend their policies in line with national priorities; since 1 April 2004 it has been a requirement to offer users Direct Payments when preparing assessments.

4.2.8 D59 Practice Learning is a new indicator which measures the amount of practice learning days provided to Social Work students (assessed as part of their course) per qualified social worker employed by Hampshire County Council. For 2003/4 we were 8th nationally, reflecting the strong links with local universities being built on through our recruitment and retention policies. This indicator also assists the Corporate Aim 6 "Developing councillors and staff".

4.2.9 A5 Emergency admissions to hospital is an interface indicator shared with Health. Originally it was seen as a focus for work with Health colleagues on proactive care; such as the Innovations Project in SE Hampshire, case management and falls services. CSCI now accept that this indicator has been devalued as nationally it shows significant increases in admissions "partly attributable to changes in the response of NHS Trusts to patients needing A&E services".

4.3 Older peoples services

4.3.1 These indicators supplement those for all adults.

4.3.2 A summary of results for 2003-4 of indicators specific to older person's services shows:

4.3.3 The range of indicators specific to older people has changed significantly for 2003/4, with 2 user satisfaction ones being cancelled and two new "process" indicators being added. Accordingly the performance for older people appears low; but it must be remembered that many indicators covering all adult services are improved and the combined set is what impacts on performance as perceived by older service users.

4.3.4 Performance appears low for supplying services to clients who remain in their own homes (C32). The counting mechanisms are being adjusted by the DoH for 2004/5; it is expected that this will ensure all authorities are counting the same types of activity. Hampshire's performance is similar to other authorities in the CSCI peer group (SE rural). Performance shows a slight rise from the previous year, despite a tightening of the definition by the DoH.

4.3.5 Hampshire is considered "ask questions" for the proportion of older people in the community receiving an assessment (E61) and for the assessments of older people from minority ethnic groups (E47). These were both new indicators for 2003/4; understanding of the guidance varied significantly between councils, reflected in the wide range of results submitted. Nationally E48 on ethnicity of older people receiving a package of care was not graded as results were too suspect. These indicators are being kept under close scrutiny by the DoH as new definitions were applied for 2003/4 and the variations were so significant they are about to publish further changes for 2004/5.

4.3.6 Two new indicators have been published which look at waiting times. D55 measures the acceptable waiting time between contacting Social Services and having a completed assessment; this is split into two parts: (i) From contact to start of assessment and (ii) from contact to completion of assessment. Overall Hampshire was awarded 2 blobs - but the first part of the indicator (i) was considered so flawed, through varied interpretation of guidance between authorities, that the CSCI did not consider this when assessing for star ratings. This impacted significantly on our assessed performance as we had used a tight interpretation when submitting data. For E56 measuring time from completed assessment to provision of all services Hampshire was awarded 4 blobs.

4.4 Learning Disabilities

4.4.1 These indicators supplement those for all adults.

4.4.2 A summary of results for 2003-4 by indicators specific to users with a learning disability shows:

4.4.3 As with other unit costs Hampshire's are higher than many Shire or Band 2 authorities. The grading still does not reflect the cost structure locally, or 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. The development of supported living options as "move-on" opportunities for people in registered accommodation, are concentrating on individuals with less complex needs. This affects the `user mix' and a further 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 C30. 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 2003-4 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 above 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 C29. No reduction in actual services provided occurred.

4.5.5 There was a user survey conducted for community users of services for people with a physical disability. The whole survey is being analysed within the Department, but two questions are included in the PAF set. D57 measures the percentage of users who felt that their opinions and preferences were always taken into account; Hampshire was in the top quartile for this indicator. D58 asked whether they could contact Social Services easily; although only given 2 blobs Hampshire's performance was consistent with most other authorities.

4.6 Mental Health

4.6.1 These indicators supplement those for all adults.

4.6.2 A summary of results for 2003-4 by indicators specific to mental health show:

4.6.3 The performance of services to people with a mental health problem is good. The Department is working with health colleagues under integrated management structures to implement the Mental Health National Service Framework. Accordingly most Mental Health indicators are collected through NHS assessment frameworks.

4.7 Children's Services

Assessment: Serving some children well with Promising prospects

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

4.7.2 A summary of results for 2003-4 by indicator shows:

4.7.3 Overall the performance of children's services is improving, with only one indicator having one blob (Last year similar performance merited two, bandings have been tightened). The government has provided money for children's services through various initiatives, helping maintain performance against many indicators, but much of this money has been needed to meet stricter requirements placing pressure on existing services.

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 Supporting People monies.

4.7.5 During 2004-5 district reviewing teams have been moved to "arms length" management by the Performance Management Unit; in line with government requirements. Since their creation as an independent service in 2002 they have improved review quality; improving services provided for children and the flow of information (C19) on the children concerned. For C19 performance has improved significantly - although only 2 blobs for 2003/4, the 2004/5 return submitted recently should attract 4 blobs. 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; facilitating children to remain with their parents whilst having the safety of legal looked after status, 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 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. Nationally around 30% of looked after children have a statement of special educational needs (SEN). The corporate team have introduced innovations include bursaries for children performing above expectations, personal education plans and improved contact with educational support workers. It will be several years before this good practice is shown in the indicators, which look at educational qualifications on leaving care; frequently at age 18.

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 provided extra money for intensive care in 2003-4, and this has resulted in an 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 CSCI. 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 2004-5 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, personnel data many other issues. It is also used as a way of monitoring regional trends; such as 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 December.

6 ANNUAL REVIEW LETTER & STARS

6.1 The Annual Review Letter from the CSCI is attached as Appendix 2. This reflects the Annual Review Meeting process where CSCI 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 18th November. Hampshire retained its 2 star status. Children's services were assessed as serving some children well with promising prospects for improvement. Adult and Older Person's services were assessed as serving most people well with promising prospects for improvement.

7 PERFORMANCE ACTION GROUPS

7.1 During the last year, the department has rolled out a hierarchy of Performance Action Groups (PAGs) to drive the performance agenda forward. These groups cover all levels in the organisation, from the Departmental Management Team to front line managers

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 PAF Performance Indicators are now a small subset of those collected in the Delivery and Improvement Statement, and used when assessing Hampshires performance. Appendix 3 contains detailed information on the indicators felt to be of significance in awarding the performance rating.

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. Cognisance of the relative levels of FSS settlements between authorities must be considered; which is not allowed for in many PAF bandings.

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, detailing improvements on many indicators considered of high importance by the CSCI, are agreed with senior managers and monitored monthly through the Performance Action Groups (PAGs). This process sets Departmental priorities and assists front line managers to be proactive when considering performance improvements; delivering an across the board improvement programme.

8.7 Joint working with Health, Education and other partners will continue to focus on longer term, responsible projects which offer opportunities for synergy between organisations to the benefit of users and carers. Current examples of this work include the ENHANCE Nursing Homes S31 agreement, the Innovations project and other managed care pilots, the Child & Adolescent Mental Health Trust and frontline co-operative working such as that leading to benefits for the health of children looked after by the authority.

9 RECOMMENDATIONS

9.1 That this report be accepted.

9.2 That the Social Care Policy Review Committee advise the Executive Member for Social Care 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.

Race Relations (Amendment) Act

The Government Regulations and Inspection arrangements specify requirements concerning racial (and other forms of) discrimination.

Compliance with the Act in terms of carrying out an Impact Assessment is confirmed, forming part of the programme of work relating to the Department's Service Plans.