Dear Mr Butler

ANNUAL REVIEW OF PERFORMANCE

Thank you for arranging our recent annual review meeting. This letter and report set out the Commission for Social Care Inspection's (CSCI) view of the performance of social services in your area during the last year, and comment on improvements for the year ahead.

The report is intended to help the council improve outcomes and the quality of service to service users and carers. It is also intended to improve the prospects for improved performance ratings in the future.

In assessing performance, CSCI reaches judgements about performance against a set of standards and criteria, drawing on evidence from a number of standard sources. These include:

· the published PAF performance indicators and other statistical data up to 2003-04, plus data supporting planned targets for 2004-05;

· evidence agreed in the course of our monitoring meetings that have been formally recorded;

· monitoring information from the Delivery and Improvement Statements completed in October 2003 and May 2004.

Details of the standards and criteria have been published, and are available from CSCI, or may be seen on the CSCI's performance website. A summary of the evidence used has also been sent to you separately.

The report is in two parts. The first is a summary of improvement recommendations that highlights the strategic issues for the council. The second part summarises the strengths of performance over the last year, and the priorities for improvement in the year ahead. These are organised around 6 standards against which the council is assessed. The annual review does not attempt to review all aspects of performance, but focuses on the main performance issues for which CSCI has current information.

This report will form part of the performance record for the council, and will be published on the CSCI website in November. You are asked:

· to present it to an open meeting of the relevant executive committee of the council, within two months of the date of this letter, and to inform me of the date on which this will take place;

· to make the report available to members of the public at the same time; and

· to copy this letter and report to the council's appointed auditor, and to NHS and education partners.

Progress will continue to be monitored during the year through our usual processes, and a further Annual Review meeting will take place during 2005-06.

Performance (Star) Ratings will be confirmed in November, based on an assessment of overall performance using all admissible evidence. The evidence summarised in this letter will be used to help arrive at the rating, but may be updated where further evidence becomes available.

Yours sincerely

Sara Goodinge

Business Relationship Manager

Copy: Council Chief Executive

Auditors

Part 1

Overview: Performance Review Report for Hampshire

Social Services: 2004

Summary of improvement recommendations

The review of social and caring services in Hampshire has highlighted the following performance issues that need to be addressed over the next twelve months. Further information about the standards against which social and caring services are assessed is contained in the detailed report.

Services for children and families

· During 2004-05 the council has begun to more clearly demonstrate the effectiveness of its recent investment in children's services, and how this is helping to provide quality services that lead to better life chances for children. This improvement in outcomes needs to continue.

· The council needs to demonstrate further improvement in its care management processes for children's services: the re-referral rate; timescales for initial and core assessments; and timeliness' of reviews especially for children on the Child Protection Register.

· The benefits of recent changes to placement strategies- (recruitment and retention of carers, services for adopters and kinship care)- need to be evidenced through increased stability of placements and improved adoption services.

· Given the amount of corporate and multi-agency work being undertaken, it would be pleasing to see more improvement in the outcomes for children who are looked after. Recognising the time lag between changes and outcomes, benefits need to be demonstrated in the 2004/5 performance indicators.

· Some impact on the pattern of access to services and their provision should be seen as a result of the work currently being done to analyse and eliminate variations in services, including those to black and minority ethnic people across the county.

· The council needs to evidence that its recruitment and retention policy is effective in all areas in the county and build on the gains made in some districts.

Services for adults and older people

· Outcomes for service users should continue to demonstrate that the promotion of independence, choice, privacy and dignity are consistently central to service provision and commissioning strategies.

· Improvement is needed in the early stages of the care management process; too many service users are waiting more than 48 hours before their formal assessment starts and the percentage of assessments completed within 2 weeks is lower than the IPF group. The number of assessments for new clients aged 65 or over is higher than comparator authorities, reflecting activity in equipment provision.

· The council needs to continue to take actions in partnership with Health to minimise the number of whole system delayed transfers of care; building on recent reductions in those for which social care has responsibility.

· We note that discussions are underway on the concept of `managed care'. These require clarification as action plans are developed and we await further details on the expected outcomes, and monitoring arrangements.

Part 2

Performance Review Report 2004

Hampshire

SERVICES FOR CHILDREN AND FAMILIES

The council has a clear vision for children's services and they continue to receive unprecedented support from councillors and managers who are committed to improving social services. The councillors have shown their confidence by allocating significant new resources to children's services. During the year there have been staffing capacity problems that have impacted negatively, particularly in reviews of child protection cases and some other case management areas. The organisational and IT changes made in the last two years are beginning to have an encouraging result. While the positive changes did not demonstrate improved outcomes for children in all areas within 2003/04, in-house monitoring indicates that their effectiveness will be apparent in 2004/05 outcome data. Despite detailed arrangements, required due to Hampshire's complexity, the authority is working well with partner organisations to respond to the needs of children and other government priorities.

1. National priorities and strategic objectives

Improvements observed since the previous annual review

· A Pathfinder Children's Trust has been created for Children and Adolescent Mental Health Services, which will strengthen and take forward services.

· Productive corporate and multi-agency work is underway and some improvement in outcomes for care leavers and the health of children who are looked after have been realised.

· The Chief Officers' Board, established to lead the modernisation and development of children's services has also enabled councillors to develop their knowledge and understanding of the children's services agenda and has heightened corporate awareness of children's issues generally.

· Children and families' services have a clear vision of the culture it is trying to establish for its service users, which is one of empowering families in making their own decisions. It is anticipated that the work on the children's legislation will result in a structure of integrated teams building from the ground up from already established pockets of successful work. These are seen as major planks in its future work and we await further details on the expected outcomes and how they will be monitored.

Areas for improvement

· Some life chance indicators for children who are looked after have improved slowly and the council anticipates that their plans will allow this trend to continue. However, further work will be required to improve Hampshire's position in its IPF group e.g. education, health and training.

· Despite some improvement the health monitoring of looked after children still remains lower than comparable councils and plans to improve these outcomes should remain a priority.

2. Cost and efficiency

Improvements observed since the previous annual review

· During the period 1 April 2003 to 31 March 2004 there were significant budget increases, totalling £4.25m, in the council's children and families' services. However, the council still spends less than other councils in its IPF group - £202 per head of population aged under 18, against £227 for the average for councils within that group. This is linked to the FSS settlement, which is also lower than the IPF group averages.

· Human resources management throughout Hampshire County Council is undergoing a fundamental re-organisation to deliver improved and focused services to all departments. The council has reviewed its staff recruitment and retention strategy and has increased its investment in key staff, creating a contingency fund for pay and benefits for social services staff.

· Business case strategic planning has yielded benefits in relation to the ongoing work to secure a range of residential services concentrating on placing children both in county and in an appropriate setting.

· Hampshire has undertaken a major review of its in-house fostering services, completed in June 2004. To improve placement choice and improved placement stability, further attention should be given to improvements in the recruitment, retention and support of foster carers. It is recognised that a business case is currently being formulated for funding to ensure improvement.

· The council is also working to develop fostering services further and to strengthen partnership arrangements with independent fostering agencies (IFAs). Regular meetings with IFAs and Hampshire foster carers are informing the commissioning direction and scope. This has resulted in the use of IFA placements for remand foster care and consideration is being given to specialist IFA's catering for the needs of disabled children. Hampshire is also interested in expanding services through the Government foster care treatment programme if it is expanded to cover 8-12 year olds.

· SWIFT care management has been rolled out for children's assessments and care packages during 2004. It is anticipated that this will enable the council to be more confident in its data and to be able to interrogate it more effectively leading to improved information which will inform both operational and strategic decision making

Areas for improvement

· Hampshire still has a low proportion of foster carers who are paid on a fee or salary basis (33% as compared to an average of 51% in the IPF group) Changes proposed to the in house service including improving benefits and support, development of a more sophisticated commissioning strategy are designed to address these shortcomings. The development of placement choice and enhanced support to carers will be the key to improved quality and stability of placements. The council should continue with its development of an action plan to implement the strategy, with specific measurable targets related to expected outcomes.

· The introduction of the new SWIFT care management system should enable the council to monitor activity and drive improvements in all life chance indicators.

· Social services ability to manage and balance its budget has resulted in increased corporate confidence in the department's ability to prudently manage its resources, and hence it has been rewarded with additional investment. However the council will need to develop more robust planning and monitoring systems to ensure resources are targeted at service improvement and that they demonstrate value for money.

3. Effectiveness of service delivery and service outcomes

Improvements observed since the previous annual review

· There has been a significant increase in the number of social workers working with the CAHMS team (9.5 to 12.5 full-time equivalents). The CAHMS Children's Trust is prioritising children who are looked after as a `high need' group which should have a more positive effect on placement support and stability.

· There continues to be a good take up of Direct Payments to carers of disabled children (12) and to disabled children aged 16-17 years (37). This is more than three times the average number for the IPF group (4.7and 14.9 respectively).

Areas for improvement

· Hampshire has a good record in placing children in foster places and the percentage of young people looked after in foster places or placed for adoption has improved or remained at a good level (PAF B7 and C22). Nevertheless if quality, timeliness and choice are to be provided it has been recognised that further improvements are required. This requires a robust action plan to generate the necessary improvements, which we will monitor. Anticipated outcomes would include improved stability (D35), more robust permanence planning indicated through a measurable increase in the percentage of children placed in permanent placements without any apparent drift (adoption, kinship care and family and friends figures).

· Hampshire has made less progress on the implementation of an Adoption Support Service than some other authorities. Although showing poorer performance on adoption of looked after children than IPF group comparators, the council believes much of this is due to an active Kinship Care approach. A monitoring programme is needed to assess its impact and, if required, develop an action plan to address any shortcomings and improve performance in the coming year.

4. Quality of services for users and carers

Improvements observed since the previous annual review

· The council has confirmed that all of the recommendations from the Victoria Climbie self-audit have been implemented.

· The council recognised that its ability to improve the quality of its services was inhibited by its staffing difficulties. It has therefore been pro-active in looking at recruitment strategies and secondments and has invested in training. The initiatives taken included paying particular attention to `hot spots', bursaries, contacting ex-workers about vacancies, overseas recruitment and advertising campaigns. A further paper went to Council in July 2004 for approval of packages of measures aimed at helping to resolve recruitment issues (The paper covered more than just children and families services). By August 2004 there had been an additional 25 staff recruited to children and families services.

· The council has improved and increased its ability to monitor the consistency and quality of services. It has introduced more robust file auditing, and a process to learn from complaints. The introduction of the SWIFT computer system is leading to robust data being available making performance management more effective. It is anticipated that it will also improve recording and practice consistency, which will link to quality audit work.

Areas for improvement

· Having made major investments in staffing the council now needs to demonstrate improvement in its care management processes for children's services particularly to make sure that they are timely (assessments -although significantly improved by year end, only 43 per cent of initial and 48.8 per cent of core assessments were completed within the target times during 2003/4) and that the quality of the initial work is sufficiently good to ensure that a higher proportion of service users get the services they need when they first come to social services (the re-referral rate is 33.3 per cent in Hampshire and 18.3 in IPF; it is noted that the 33.3 per cent includes re-referrals for other reasons, which could not be quantified with historic recording systems, which overstates Hampshire's relative figure. )

· Similarly the lack of staff in 2003/04 (there was a net loss of 8 social workers during the year) impacted negatively on the life chances of children as statutory reviewing of the services that they and their families require have been delayed. During 2003/04 only 76.6 per cent of LAC reviews in the preceding six months were completed within the required timescales and only 91 per cent of the children on the child protection register were reviewed within the appropriate timescale, which is a particularly unsatisfactory level and potentially left these children at increased risk. This is a key threshold performance indicator. The council reports that there is improvement in all these areas and that there is now 100 per cent compliance to requirements. This needs to be sustained.

5. Fair access

Improvements observed since the previous annual review

· The council has further improved its out of hours services. There is effective 24 hour, 7 days a week access to services and advice. Further work could be done to monitor the use of these services with particular regard to what proportion of the take up is from black and minority ethnic people.

· The council has produced a pro-forma for impact assessments in accordance with the Race Relations (Amendment) Act and has commissioned training on carrying these out. It is anticipated that the impact assessment of service plans will be completed by October 2004; this will then be an ongoing part of service planning.

· The council has developed an audit tool kit (REMIT) as a diagnostic tool to facilitate the department in understanding how well it is doing in relation to equalities and to find ways of improving. It is designed to identify best practice and make a difference. Hampshire has adopted it as corporate tool and it is also being used by some primary care trusts.

Areas for improvement

· The council does not have a large number of people from black or ethnic minority backgrounds, (1.5 per cent compared to a national average of 7.8 per cent) but the challenge is to explore and ensure that the needs of people from minority backgrounds can be met effectively and promptly. Meaningful consultation is a challenge as there is limited local infrastructure.

· Some impact on the pattern of access to services and their provision should be seen as a result of the work being done to analyse and eliminate variations in services including those to black and minority ethnic people across the county.

6. Capacity for improvement

Improvements observed since the previous annual review

· As in previous years the department is experiencing high levels of corporate support, including both resources (a total cash increase of £20m of which £14m is growth) and strategic guidance.

· There has been an increase in the range and effectiveness of quality control mechanisms including the establishment of Performance Action Groups throughout the client groups, and restructuring of the communications team.

· Restructuring of the training team has had positive outcomes. Hampshire has, relative to their IPF group, a high percentage of social workers and residential managers working with children who have obtained the child care PQ1 award. (55per cent -IPF 30.7 per cent) Although the percentage of residential child care workers who have achieved level 3 NVQ has dropped marginally it is still considerably higher than the IPF group, (67 per cent - 39.6 per cent)

Areas for improvement

· Hampshire's ability to meet wider responsibilities continues to be restricted by a shortage of staff in some key areas despite its recruitment and retention strategy. It will need to continue to address these difficulties.

· There were data quality issues in the transition period to full implementation of SWIFT, these appear to have been resolved but close monitoring will remain necessary until all staff are effectively using the system.

SERVICES FOR ADULTS AND OLDER PEOPLE

The council is working well with its partners in a rapidly changing, very complex system of health service organisations and is responding to government priorities. It has consolidated its progress on services for adults and older people; this is reflected in an improved set of performance indicators. The council must continue to move forward in supporting more people at home and modernising its day care services. The council needs to implement the recommendations that have resulted from recent consultations with vulnerable adults and people from black and ethnic minorities and self-assessment work that has been undertaken.

1. National priorities and strategic objectives

Improvements observed since the previous annual review

· The focus for social services is consistent with the Government's agenda on promoting independence for vulnerable older people, people with mental health problems, disability and learning disabilities.

· The council has devised a commissioning strategy involving a range of partners, including the independent sector, based on clear strategies for services for all adult client groups. Outcomes from these are demonstrated by the improvements that have been made on a number of performance indicators such as helping physically disabled adults and adults with learning disabilities to live at home.

· The council has progressed on much strategic development work with health and is developing preventative strategies with Primary Care Trusts. There has been considerable progress from the first phase of `Enhance', the nursing home strategy, with the first beds due to open during 2004/5; and on the Innovations Project to develop intensive care and community management of patients identified by GPs as likely to require hospital care, with 4 primary care trusts. Most staff required were in post by April 2004.

· Work is also being undertaken, some with the assistance of the change agent team, on local plans to facilitate discharge of people from hospital and to prevent admission to hospital. There has been variable `buy in' by acute trusts to these schemes and we await further evidence of their positive impact on outcomes for service users.

· The council has continued to deliver on the Valuing People strategy and person centred planning is a main vehicle for improvement.

Areas for improvement

· Considerable work and financial resources (£2m in year investment) have been put into reducing the number of delayed transfers from hospital. An additional £3.5 m was invested in improving delayed discharge performance in 2003/04 and this commitment is ongoing into 2004/05. Although considerably reduced it is an area that continues to be a challenge.

· Choice and capacity have been the major factors in delays. The council has clear strategies, which include Enhance and rapid response teams, that should enable it to continue to make progress to minimise these delays and ensure people are cared for in the most appropriate setting. According to SITREPS data the rate of delayed transfer of care for which the council is responsible per 100,000 population over 65 years had fluctuated in 2004 between 17.7 and 12.4 per 100,000 as compared to an average figure of 7.8 to 10.9 in the IPF group. The outcomes from the various projects need close monitoring so that best practice can be replicated across Hampshire; although it is recognised that social care delays have considerable reduced, whilst whole system delays have remained problematic.

· The early thinking that is underway on the concept of `managed care' requires clarification and we await further details on the expected activities, outcomes, and how these will be effectively monitored.

· A report to the departmental management team in June 2004 highlighted areas of work that needed to be addressed in relation to EMI and proposed solutions. A robust action plan that gives clear measurable target outcomes for EMI people is under development, and will require monitoring. This will be facilitated when the SWIFT care management system is implemented for adult client groups in February 2005.

· Historically the balance of service provision has been insufficiently targeted at developing a full range of home care services to help older people live at home. The levels of intensive home care service (PAF C28) shows a modest improvement on previous years, help for older people to live at home (PAF C32) remains at a level where there is considerable room for improvement. These facts must however be seen against the relatively high numbers of people on direct payments and the number of service users who are receiving services in the community that support them in a manner which negates the need for intensive home care. Nevertheless the council must continue to focus on these targets if progress is to be achieved. There should be a clear action plan to generate improvements, consistent with the FSS funding given to Hampshire and the requirements/nature of Hampshire's residents.

2. Cost and efficiency

Improvements observed since the previous annual review

· The council is continuing to develop its commissioning strategies to ensure greater stability and capacity in the market. An element to increase capacity is a supplement payment for residential care of EMI people.

· The take-up of Direct Payments continues to increase successfully across care groups, with plans for further growth. A user led audit identified that 90 per cent of service users were happy with the scheme.

· Health Act flexibilities and other joint funding arrangements are used effectively. Combined working has been achieved across several areas using s28a pooled budgets and formal s31 flexibilities. Savings from integrated management have been re-invested in front line services. Hampshire managers also consider that this joint work has led to an increased capacity for all to understand the issues facing the various stakeholders which has led to better ways of resolving difficulties and more opportunities for joint working at a local level outside formal partnership working, such as social workers in GPs surgeries.

Areas for improvement

· Negotiations with acute trusts around the use of re-imbursement monies to fund alternative strategies are ongoing but are hindered by some trusts using the monies to reduce debt rather than re-investing in patient care. We will need to monitor progress in this area.

· Admissions of supported residents (PAF C26 and C27) to residential/nursing care are both at optimum levels. The effect of the Enhance project, the reshaping of its in-house provision (EMI strategy) and its in-house unit costs must all be monitored. The council must continue to work with residential service providers to ensure that there is a clear overall strategy for service development, with a range of providers who are able to respond to the changing demands of care, and that the market remains stable. This area will need to be monitored to identify any trends which might require action.

· Similarly the council will need to continue its work with domiciliary care providers and establish an action plan with measurable targets to ensure that they are more able to respond to the changing balance of care provision, particularly in relation to EMI people.

3. Effectiveness of service delivery and service outcomes

Improvements observed since the previous annual review

· The council is continuing to develop and improve its services and packages of care to enable people with mental health problems and people with physical disabilities to remain living in the community and is achieving very good results. This has been facilitated by developments such as OT Direct and its integrated community equipment stores for example by responding quickly effectively to delivering equipments and adaptations. There are further plans and work is underway to streamline services to make them increasingly service user friendly and cost effective.

· Similarly there is considerable emphasis on enabling people with learning disability to remain in the community and have more control over their own lives. There is a stress on promoting independence and choice through increased use of person centred planning, direct payments and supporting advocacy. As part of the overall service provision the council is in the process of modernising its day care provision. Advocacy has been available to support people involved in this and to support those attending the Partnership Board, local implementation groups and subgroups.

Area for improvement

· The council needs to demonstrate through both its own provision and its commissioning and contracting that it is promoting service user choice by working to ensure a higher percentage of single bedrooms in residential provision becomes available.

4. Quality of services for users and carers

Improvements observed since the previous annual review

· As part of the overall strategy to promote independence the council provides a range of services to carers. There has been an increase in carer support workers to 2 in each of the community mental health teams. There is a flexible breaks service (voucher scheme), which is well used and 2 new carers' cafes were developed during the year.

· The majority of the elements in the care management process are working effectively, there has been a significant increase in the number of service users who receive a statement of what services they can expect and they receive them in a timely manner.

· The service user satisfaction indicator demonstrates a high rate of satisfaction for services and this has been confirmed by the council's own efforts to assess the user perspective.

Areas for improvement

· Contacting social services for some service users (PAF D58) is not a very positive experience and needs attention. It is possible that this could be linked to the new access systems or the fact that through the self-advocacy groups service users expectations are increasing. Some further analysis of this should be undertaken so that access can be improved through the lessons learnt.

· Despite the user satisfaction ratings and the generally positive impact of care direct and OT direct there are care management processes that need to be improved upon: waiting time times for assessments (PAF D55) are not at an acceptable level. If Hampshire is to meet the December 2004 national target for assessments for older people the council will need to develop a work programme which facilitates the improve progress on completion times.

· Services for carers from black and minority ethnic backgrounds are under developed. The council recognises that it had not achieved effective communication with these communities and has now appointed community development workers to establish community networks. It is anticipated that this will facilitate both the provision of appropriate services and provide carers with information and advice about them resulting in a greater up-take of services to black and minority ethnic carers.

5. Fair access

Improvement observed since the previous annual review

· The council had published the information on monitoring of ethnicity in accordance with the Race Relations (Amendment) Act.

Area for improvement

· Work being done to analyse and eliminate variations in services across the county needs to continue. This should be facilitated once SWIFT is fully implemented in adults' services. The council needs to demonstrate that its services are equally accessible to all vulnerable groups of adults including people from black and minority ethnic backgrounds. Currently the indicator for the ethnicity of older people receiving a service following assessment (PAF E47) is low, as is the proportion receiving a service following assessment.

6. Capacity for improvement

Improvements observed since the previous annual review

· Social Services has a strong position in the council and receives excellent support from the Chief Executive and Cabinet Members. There has been £7m investment in 2003-04 to enable existing services to be sustained and new services to be developed in response to national priorities and local strategic objectives.

· The council has a clear vision of how it sees joint working developing and this enables it to work positively with its partners.

· There have been a number of new developments that promote people's ability to live at home such as the Innovations project a whole systems approach to older persons care designed to prevent hospital admissions alongside this good progress on more established projects such as Enhance.

· Hampshire has attracted some European funding for promoting development in partnership with other regions within the European Community. They are looking at empowerment of older people and at ways to exploit assistive technology. It is a three-year project but there should be outcomes in the first year.

· The council has recognised that recruitment and retention is a constant challenge, and is investing in this area. Training to all staff, including support staff, is given a high priority.

Area for improvement

· Whilst the council has reviewed its staff position, it reports that challenges remain in recruiting sufficient staff to a greater or lesser extent in all fields of activity.

Sara Goodinge

Business Relationship Manager

06 October 2004