Archived decisions

      Hampshire County Council

      Cabinet Item 7

      17 December 2007

      Adult Services Performance 2007

      Report of the Director of Adult Services

        Contact: Rea Mattocks, Ext (01962) 847200, email: [email protected]

        1. Executive Summary

        1.1 The 2007 performance rating for councils with Adult Services responsibilities was announced by the Council for Social Care Inspection (CSCI) and is requested to be taken to public committee within 2 months of publication. The formal publication date is 29th November 2007.

        1.2 The rating for Hampshire County Council Adult Services Department shows significant improvement on previous years.

        1.3 The County Council has been awarded 3 stars, the highest rating, placing it in the top quartile of the 150 councils with adult services responsibilities. The two judgments which lead to this rating are:

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

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

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

      1.5 In its annual performance assessment report of the Council, the Commission for Social Care Inspection have stated "Through competent, ambitious and determined leadership skills of senior officers and commitment from elected members, the council have been highly successful in delivering on [its] objectives". CSCI regard the Council as one where "Most people who use services and carers are provided with responsive services and a competent workforce" .

      1.6 Particular note was made that "Financial reporting and management is robust". At the end of 2005/06 financial year, the departments budget showed an over- commitment of £11.1m, with the full year impact predicted to be £19m. The Adult Services Department was set a two year financial recovery programme by Members to achieve a balanced budget by the end of the 2007/08 financial year. The leadership of Members, support from chief officers in the County Council and action taken by all staff in Adult Services has ensured the department is on track to reach financial recovery by the end of 2007/08, with an overachievement taking place in 2006/07. The assessment by CSCI for leadership and commissioning and use of resources (both areas being key for the County Council receiving 3 stars) specifically make reference to the positive relationship between the way in which the County Council has achieved financial recovery and modernisation as well as maintaining and improving performance.

      1.7 CSCI has asked Hampshire County Council whether it would be willing to share its expertise with other Local Authorities who are currently facing the issues that Hampshire County Council has already tackled.

      2. Recommendations

      2.1 The following decision is sought:

          That Cabinet note the performance improvements in its Adult Services Department and recognise that this has been achieved through the leadership of elected members, and the commitment and dedication of Chief officers and staff within Hampshire County Council.

      3. Background

      3.1 The new national performance assessment framework for adult social care was launched in 2006/07 and aligns with the seven outcomes in the Dept of Health White Paper 'Our health, Our care, Our say: a new direction for community services':

          1. Improved health and wellbeing

          2. Improved quality of life

          3. Making a positive contribution

          4. Increased choice and control

          5. Freedom from discrimination and harassment

          6. Economic wellbeing

          7. Maintaining personal dignity and respect

          There are two further areas on which the council is also assessed:

          8. Leadership

          9. Commissioning and use of resources

      3.2 The seven outcomes are scored to give the `current delivery' judgement and the two further areas give the `capacity to improve' judgement. As shown in Table 1 below, these determine the star rating for the Council. The `current delivery' judgement contributes to the Audit Commission performance rating of the County Council, to be announced in February 2008.

          Table 1 Star Ratings

         

         

        Capacity to improve

         

         

        Poor

        Uncertain

        Promising

        Excellent

        Current delivery of outcomes

        Poor

        -

        -

        -

        -

        Adequate

        -

        *

        *

        **

        Good

        *

        **

        **

        ***

        Excellent

        **

        ***

        ***

        ***

        4. CSCI Findings and Recommendations

        4.1 The Council is required to publish the findings and recommendations of CSCI's assessment through an open session of a Council meeting; and this is attached as Appendix 1. The CSCI summary report identifies 36 strengths and 6 areas for improvement. The areas of strength include:

          i Improving performance to ensure most clients have at least an annual review of their needs

          ii Good joint working with Health to reduce the number of people delayed in hospital

          iii Very good performance in ensuring assessments are carried out and services are received within national standards on timeliness

          iv An effective and accessible complaints procedure

          v Clear eligibility criteria, remaining at `substantial' following review

          vi Implementation of the Mental Capacity Act

          vii Supporting vulnerable younger adults, enabling them to remain living at home

          viii Specialist services for people with sensory impairment

          ix Carers 24/7 support and information service

      4.2 Action plans for the `areas for improvement' are being implemented for delivery, within budget, by March 2008. These include:

          i To further develop an integrated single assessment process with Health

          ii To increase the take up of Direct Payments

          iii To increase the supply of Telecare

          iv To reduce the number of people with learning disabilities living in NHS accommodation

          v To further reduce the number of people with learning disabilities living in residential care

          vi To collate data on carers who are helped to remain in work

      5 How performance was improved in 2006/07

      5.1 The council's challenges for 2006/7 were to achieve financial recovery and embark on a modernisation strategy to address an over commitment of £19 million. There was and remains, the need to respond to demographic changes, health service reforms, increasing levels of dependency, meet performance expectations and to implement the Council's new pay and benefits structure for staff.

      5.2 A significant part of the evidence that informed the judgement was the rate of the department's improved performance against the Performance Assessment Framework (PAF) national performance indicators. There are currently 24 indicators, banded on different scales ranging between 1 - 5. Appendix 2 shows the 2006/07 outturns. During 2006/07, the department achieved a performance of 92% being in Band 3 or above, with 46% in the maximum band. The England average is 88% and 48%. This performance places Hampshire 64th out of 150 councils. This compares to our 2005/06 performance of 101st out of 150 councils. This rate of improvement outstripped most other councils.

      5.3 Significant contributors to improvement against the national priorities and performance indicators for Adult social care include:

        i Strong leadership - member scrutiny and support, making difficult decisions for example not to raise the eligibility criteria and to write off an over commitment of £7.5m and increase the following year's budget by £6m.

        ii The support of all other Council departments - who took difficult decisions in order to make extra funding available to the department; and who worked hard to improve access to mainstream services and promote wellbeing for all vulnerable adults.

        iii The restructuring of the Adult Services department - which includes a new business and performance management function. This enabled the monthly monitoring of performance indicators and budget activity, better planning and a focus on the seven outcomes for adult social care.

        iv Reaping the benefits of the Council's earlier investments in:

        ENHANCE nursing homes, which has helped reduce the number of people delayed in hospital.

        SAP and SWIFT, information technology, to provide better care management and business management information

        v Using evidence from these systems - to take prompt action throughout the year to address performance issues. For example, The Leader agreed additional funding of £250k for equipment to improve the Help to live at home PI for older people.

    6. What is being done to improve performance in 2007/08

    6.1 The seven outcomes and two additional domains for `leadership' and `commissioning and use of resources' require continuous improvement across all aspects of the service. This includes continued progress on previous performance improvement areas such as D40 Delayed Transfers of Care, where joint Health and Adult Services investment and hard work by hospital teams has ensured performance is now in line with the comparator average, but must not be allowed to drop. Close partnership working with Health is vital to the performance of the department and regular joint management meetings tackle issues such as continuing healthcare and adult protection

    6.2 The 2007/08 year is approaching the final quarter and action to inform the 2008 performance assessment was planned for at the start of the financial year. As can be seen from Table 1 above, the department will need to maintain its `capacity to improve' judgement and/or improve the delivery of outcomes judgement in order to retain the 3 star rating for 2008.

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

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

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

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

    6.4 A particular challenge will be to repeat the rate of improvement from 2007, especially as the department is now performing in the top Band for 46% of the national indicators and where advancement in some indicators is not possible for example C32 Older People Help to Live where progress to the next Banding (Good) would have a significant financial impact for the Department and has not been factored into the 2008/09 budget.

      7. Performance in 2008/09 and beyond

      7.1 Continuous improvement by the Council and its partners will be evidenced through the new national performance indicators and stretched targets through the LAA. Adult Services will have a key role in contributing to the achievement of the Health and Wellbeing Partnership Board. As services for vulnerable adults are transformed through the modernisation, close attention will need to be made to delivering the seven outcomes and the standards that underpin them. CSCI will be replaced by a new joint health and social care inspectorate and a new joint performance assessment framework will be developed. Our plans and strategies will need to encompass the wellbeing of all vulnerable adults, not just those who meet eligibility criteria. Action taken to prepare for the future includes:

        · participation in national debate, including an invitation to inform the creation of a Green Paper on Social Care Funding.

        · additional funding for the Business and Performance Information Team to meet new statutory performance framework, including joint reporting with Health and contribution to new County Council business and performance management systems (CORVU, SAP Business Intelligence, Hampshire Observatory).

        · 08/09 budget bids prioritisation model includes contribution to the seven outcomes .

        8. Conclusion

      8.1 This performance rating is a testament not only to the staff of Adult Services, but also to the leadership and support of the whole Council to improve outcomes for vulnerable people in Hampshire and address a financial over-commitment.

      LINK(S) TO CORPORATE STRATEGY

       

      Yes

      No

      Hampshire safer and more secure for all

      Yes

      		  
           

      Maximising well-being

      Yes

      		  
           

      Enhancing our quality of place

      		  

      No

           

        Section 100 D - Local Government Act 1972 - background documents

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

        NB: the list excludes:

        1. Published works

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

        None.