Dear Director,

SUMMARY REPORT of 2006-07 ANNUAL PERFORMANCE ASSESSMENT OF SOCIAL CARE SERVICES FOR ADULTS SERVICES FOR HAMPSHIRE

Introduction

This report summarises the findings of the 2007 annual performance assessment (APA) process for your council. Thank you for the information you provided to support this process, and for the time made available by yourself and your colleagues to discuss relevant issues.

Attached is a revised copy of the performance assessment notebook which provides a record of the process of consideration by CSCI, leading to an overall performance rating. You will have had a previous opportunity to comment on the factual accuracy of the evidence notebook following the Annual Review Meeting.

The judgements outlined in this report support the performance rating notified in the performance rating letter. The judgements are

· Delivering 'good' outcomes (formerly Serving People Well) using the LSIF rating scale

And

· Capacity for Improvement is `excellent' (a combined judgement from the leadership and the commissioning and use of resources evidence domains)

The judgement on Delivering Outcomes will contribute to the Audit Commission's CPA rating for the council.

The council is expected to take this report to a meeting of the council within two months of the publication of the ratings (i.e. by 31^st January 2008) and to make available to the public, preferably with an easy read format available.

ADULT SOCIAL CARE PERFORMANCE JUDGEMENTS FOR 2006/07

Areas for judgement	Grade awarded
Delivering Outcomes	Good
Improved health and emotional well-being	Good
Improved quality of life	Good
Making a positive contribution	Good
Increased choice and control	Good
Freedom from discrimination or harassment	Good
Economic well-being	Good
Maintaining personal dignity and respect	Good
Capacity to Improve (Combined judgement)	Excellent
Leadership
Commissioning and use of resources
Star Rating	3

The report sets out the high level messages about areas of good performance, areas of improvement over the last year, areas which are priorities for improvement and where appropriate identifies any follow up action CSCI will take.

KEY STRENGTHS AND AREAS FOR IMPROVEMENT BY PEOPLE USING SERVICES

Key strengths	Key areas for improvement
All people using services
· Almost all people who use services and their carers are helped to understand how to stay healthy and maintain their emotional behaviour. · The council has retained its good performance in ensuring people receive an annual review of their care needs. · There is good integrated working between health and social care in the delivery of intermediate care services which has reduced the number of delayed discharge of care, prevented admissions to hospitals and improved services to enable people to live independently. · The council support most people to improve their quality of life by accessing leisure, social activities, learning and employment. · The council have in place a multi agency falls prevention strategy and service provision. · The council promote self directed care through a range of services · The council is committed to maintaining and enabling people to be involved in local activities and in policy development and decision-making. · Most people who use services and their carers are supported in developing confidence in their ability to convey their opinions, gain skills and qualifications and contribute to the wider community. · A range of mechanisms exists for people to access care managed support services to address their specific needs and access non-care managed services. · The council have a community wide group of adults and older people who contribute to the development of services through participation and consultations processes. · Engagement with users and carers is at the core of the council's modernisation programme. The council is able to demonstrate improved services through direct involvement of users and carers and provide evidence of action taken following feedback. · From the first point of contact most referrals, assessments, care planning and reviews are undertaken with respect for the person and in a timely manner, performance is very good. · The council has an effective complaints procedure in place, which is easily accessible to individuals who wish to use it. · A cross the county there are six advocacy agencies run by the voluntary and independent sector providing a comprehensive service across all client groups. · The council aim to deliver services that offer equality of access and prevent abuse taking place. · Clear eligibility criteria are published for all services and the substantial level remains following a recent review. · The council take a lead on adult protection in Hampshire and there is positive engagement with Police. · The number of people referred to the safeguarding teams is increasing and the council monitor progress of investigations and resulting action. · The adult safeguarding procedures are published and supported by information leaflets for staff and the public in various formats.	· An integrated single assessment process has yet to be fully implemented due to complex linking of IT systems. However, the council has agreed protocols with health colleagues to share information and avoid the need for repeated assessments. · The council's performance in the provision of direct payments is adequate having deteriorated from good. This is an area that needs addressing. · The provision of telecare equipment provided directly by the council and in partnership with others is comparatively low. The council are aware that they need to develop a partnership approach to the delivery of telecare services and significantly increase the availability.
Older people
· The council has published a Code of Good Practice for Volunteering. It is pump-priming a number of projects with the voluntary sector. Who engage volunteers to support older people in maintaining their independence and improving their quality of life.
People with learning disabilities
· The council run a respite care facility for people with profound learning disabilities. · The council focuses on the transition arrangements for people with leaning disabilities to ensure equality.	· The council still have a high number of people with learning disabilities receiving care in NHS accommodation. Re-provisioning arrangements in partnership with the PCT and Hampshire Partnership Trust are in place to undertake care assessments, support person centred planning and provide appropriate residential services or supported accommodation for individuals. · Despite reducing levels there are still high numbers of people with learning disabilities living in residential care
People with mental health problems
· Services for people with alcohol and drug related problems have benefited from additional investment. · The council continue to demonstrate good performance in ensuring people with mental health problems assisted to live at home. · The council provide support services to encourage individuals with physical and sensory disabilities to access employment opportunities. · The council has been successful in supporting people with mental health problems to access employment, voluntary work, and commence education training programmes. · The council have taken their responsibilities under the Mental Health Capacity Act seriously and in partnership with the Hampshire PCT recruited and trained 20 IMCA advocates to provide a service.
People with physical and sensory disabilities
· The council continue to demonstrate good performance in assisting young adults with a physical disability to live at home. · The council have specialist services for people with sensory disabilities and all staff attend national qualifying courses on deaf blind support work and communication guides. · The council's sensory impairment team were one of four finalists for the Health and Social Care Awards for its Sensory Early Intervention Service. · The council have two visual impairment action groups and four `Edge of Change' service user groups that enable people with physical and sensory disability and their carers to engage in service delivery. · The council has completed a local needs analysis in respect of services required by people with HIV / AIDS and have responded to a gap in the service for black Africans by establishing a specific service. · A user and carer empowerment officer has been appointed to lead the development of drug treatment systems in the county, services users and carers attend the strategic joint commissioning group.
Carers
· The council supports carers to access assessment and, has made good use of the carers grant and services to carers has improved significantly with performance now very good. · There is a specific focus on supporting carers from black and minority ethnic communities. · The council have been proactive in developing services for carers, which includes a carers 24/7 support and information line.	· The Council does not systematically collate data on the number of carers who are helped to remain in employment, although carer's are supported to access employment.

KEY STRENGTHS AND AREAS FOR IMPROVEMENT BY OUTCOME

Improved health and emotional well-being

The council makes a `good' contribution to improving people's health and emotional well-being.

Almost all people who use services and their carers are helped to understand how to stay healthy and maintain their emotional behaviour. Recent initiatives are focussing on engaging with older people from BME communities to assist their management of diabetes and coronary heart disease. The council has well developed, and consistent joint working arrangements with health partners and other relevant agencies. Services for people with alcohol and drug related problems have benefited from additional investment. There is good integrated working between health and social care in the delivery of intermediate care services which has reduced the number of delayed discharges of care, prevented admissions to hospitals and improved services to enable people to live independently. The council have a high number of people with learning disabilities receiving care in NHS accommodation. Re-provisioning arrangements in partnership with the PCT and the Hampshire Partnership Trust are in place to undertake care assessments, support person centred planning and provide appropriate residential services or supported accommodation for the individuals concerned.

Key strengths

· Almost all people who use services and their carers are helped to understand how to stay healthy and maintain their emotional behaviour. · A Guide to Care at Home provides information to help prevent isolation and encourage people to lead active lives. · Initiatives are focussing on engaging with older people from BME communities to assist their management of diabetes and coronary heart disease. · The council has well developed, and consistent joint working arrangements with health partners and other relevant agencies. · The use of residential services is steadily declining. · The council has retained its good performance in ensuring people receive an annual review of their care needs. · Services for people with alcohol and drug related problems have benefited from additional investment. · There is good integrated working between health and social care in the delivery of intermediate care services which has reduced the number of delayed discharge of care, prevented admissions to hospitals and improved services to enable people to live independently.

Key areas for improvement

· The council still have a high number of people with learning disabilities receiving care in NHS accommodation. Re-provisioning arrangements in partnership with the PCT and the Hampshire Partnership Trust are in place to undertake care assessments, support person centred planning and provide appropriate residential services or supported accommodation for the individuals concerned.

Improved quality of life

The council makes a `good' contribution to improving people's quality of life.

The council support most people to improve their quality of life by accessing leisure, social activities, learning and employment. The council are aware that they need to develop a partnership approach to the delivery of telecare services and significantly increase availability. The council continue to demonstrate good performance in assisting young adults with a physical disability and those with mental health needs to live at home. Delivery of items of equipment and minor adaptations to support independent living is very good. The support offered to carers is very good and there is a specific focus on supporting carers from black and minority ethnic communities. The council have in place a multi agency falls prevention strategy and service provision. The provision of additional extra care housing places is better than the comparator average. The council promote self directed care through a range of services and individuals are directed towards non care managed services when assessments identify individuals not eligible for council funded provision. The council run a respite care facility for people with profound learning disabilities and provide specialist services for people with sensory disabilities.

Key strengths

· The council support most people to improve their quality of life by accessing leisure, social activities, learning and employment. · The council continue to demonstrate good performance assisting young adults with a physical disability and those with mental health needs to live at home. · Delivery of items of equipment and minor adaptations to support independent living is very good. · The council supports carers to access assessment and, has made good use of the carers grant and services to carers has improved significantly with performance now very good. · There is a specific focus on supporting carers from black and minority ethnic communities. · The council have in place a multi agency falls prevention strategy and service provision. · The council promote self directed care through a range of services. · Individuals are directed towards non care managed services when assessments identify individuals not being eligible for council funded provision. · Specialist provision for small numbers of individuals with highly complex care needs is available. · The council have transition plans well established collecting data on profound and multiple disabilities. · Health care assessments help to identify gaps in service provision, and this information is used to inform the overall strategy which is developed in partnership with users. · The council run a respite care facility for people with profound learning disabilities. · The council have specialist services for people with sensory disabilities and all staff attend national qualifying courses on deaf blind support work and communication guides.

Key areas for improvement

· The provision of telecare equipment provided directly by the council and in partnership with others is comparatively low. The council are aware that they need to develop a partnership approach to the delivery of telecare services and significantly increase the availability. · Data collection on delivery of major adaptations needs improvement. · The council provide good information and support people to access a range of mechanisms to support self-referral and assessment, though this is an area for further work as part of service modernisation.

Making a positive contribution

The council is `good' at enabling people to make a positive contribution.

The council is committed to maintaining and enabling people to be involved in local activities and in policy development and decision-making. A range of mechanisms exists for people to select non-care managed services and access care managed support services to address their specific needs. Engagement with users and carers is at the core of the councils modernisation programme. The council have been proactive in developing services for carers, which includes a carers 24/7 support and information line. The council has published a Code of Good Practice for Volunteering and is pump-priming and piloting a number of projects in conjunction with the voluntary sector to support older people to maintain their independence and improve their quality of life. The council have developed a variety of mechanisms to ensure people are engaged in the design and delivery of local services and are able to provide evidence of action following feedback.

Key strengths

· The council is committed to maintaining and enabling people to be involved in local activities and in policy development and decision-making. Most people who use services and their carers are supported in developing confidence in their ability to communicate and convey what they really think, to gain skills and qualifications and contribute to the wider community. · A range of mechanisms exists for people to select non-care managed services and access care managed support services to address their specific needs. · The council have a community wide group of adults and older people who contribute to the development of services through participation and consultations processes. · Engagement with users and carers is at the core of the council's modernisation programme. The council is able to demonstrate improved services through direct involvement of users and carers. · The council have two visual impairment action groups and four `Edge of Change' service user groups that enable people with physical and sensory disability and their carers to engage in service delivery. · The council has completed a local needs analysis in respect of services required by people with HIV / AIDS and have responded to a gap in the service for black Africans by establishing a specific service. · Services also provide information, support on debt management and housing welfare benefits, sexual health and emotional and practical support in the form of counselling and advocacy. Many of these services are provided through joint initiatives. · A user and carer empowerment officer has been appointed to lead the development of drug treatment systems in the county, services users and carers attend the strategic joint commissioning group. · The council have been proactive in developing services for carers, which includes a carers 24/7 support and information line. · The council has published a Code of Good Practice for Volunteering and is pump-priming and piloting a number of projects in conjunction with the voluntary sector that use volunteers to support older people to maintain their independence and improve their quality of life. · The council have developed a variety of mechanisms to gather users views and are able to provide evidence of action taken following feedback.

Key areas for improvement

·

Increased choice and control

The council is `good' at enabling people choice and control.

The council assist individual's to exercise their preferred choice and control by providing pertinent information about eligibility criteria, availability of local services, and by providing timely assessments and reviews. The council has an effective complaints procedure in place. An integrated single assessment process has yet to be fully implemented due to complex linking of IT systems. However, there are agreed protocols with health colleagues to share information and avoid the need for repeated assessments. Comprehensive advocacy services are provided across all client groups. The council provides a range of care services which support the council's strategy to assist individuals in independent living, early intervention to prevent reliance on residential care and support service to carers. Despite reducing levels there are still high numbers of people with learning disabilities living in residential care. The council's performance in the provision of direct payment is adequate and this is an area that needs to be addressed. The council is an `In-Control' pilot authority.

Key strengths

· From the first point of contact most referrals, assessments, care planning and reviews are undertaken with respect for the person and in a timely manner, performance is very good. · The council has an effective complaints procedure in place, which is easily accessible to individuals who wish in to make a complaint or comment. · The council have developed an IMCA service which will provide specific advocacy services for people with a mental illness. · A cross the county there are six advocacy agencies run by the voluntary independent sector providing a comprehensive service across all client groups. · The council hold various events to gather service user feedback and users are supported to participate. · The council's performance in providing individuals with a statement of their needs is good. · The council have in place access to records, policies and procedures that provide users and carer with good information and give clear guidance to staff that are also supported with training events. · The council provides a range care services which support the council's strategy to support individuals in independent living, early intervention to prevent reliance on residential care and support service to carers

Key areas for improvement

· An integrated single assessment process has yet to be fully implemented due to complex linking of IT systems. However, the council has agreed protocols with health colleagues to share information and avoid the need for repeated assessments. · Despite reducing levels there are still high numbers of people with learning disabilities living in residential care. · The council's performance in the provision of direct payment is adequate having deteriorated from good. This is an area that needs addressing.

Freedom from discrimination or harassment

The council is `good' at promoting freedom from discrimination or harassment.

The council aim to deliver services that offer equality of access and prevent abuse taking place. Clear eligibility criteria are published for all services and the substantial level remains following a recent review. The council provide access for most people through initial assessment to determine the needs, regardless whether a person intends to self-fund or whether they eligible for council service provision. Most people are able to access assessment services easily. The council has published a Race Equality Scheme, so far the council have only achieved standards one and two. The council has improved its performance in collecting data regarding the ethnicity of individuals accessing services. The take up of direct payment by users from BME communities has improved. The council have published a Disability Equality scheme. Through needs analysis and user feedback the council is able to specifically target underrepresented groups to improve service delivery and engagement with hard to reach groups. The council have dedicated services specifically for people with profound and multiple learning disabilities. Equality Impact Assessments are conducted on any policies, procedure, service plan, and new developments.

Key strengths

· The council provide access for most people through initial assessment to determine their needs, regardless whether a person intends to self-fund or whether they eligible for council service provision. · Clear eligibility criteria are published for all services and the substantial level remains following a recent review. · Most people are able to access assessment services easily. · The council has improved its performance in collecting data regarding the ethnicity of individuals accessing services and performance in relation to providing older people from the BME communities following assessment. · Through needs analysis and user feedback the council is able to specifically target underrepresented groups to improve service delivery and engagement with hard to reach groups. · The council have published a Disability Equality scheme, which is part of a wider equality, and diversity strategy, which has been fully consulted on. · Equality Impact Assessments are conducted on all policies, procedures, service plan, and new developments.

Key areas for improvement

· The council has published a Race Equality Scheme, so far the council have only achieved standards one and two.

Economic well being

The council is `good' at promoting economic well-being.

The council has developed a joint process for dispute resolution with the PCT, which is aligned, to the national framework and Department of Health guidance regarding continuing care. A number of initiatives are in place to help improve employment opportunities for people with learning disabilities. The outturn figures are lower than the average of similar councils, due to a failure to fully capture all positive outcomes. The council provide support services to encourage individuals with physical and sensory disabilities to access employment opportunities. The Council does not systematically collate data on the number of carers who are helped to remain in employment, although carer's are supported to access employment. The council are keeping their charging policy under review, in particular to ensure it meets the requirements of self directed care. The council have a good partnership with the Directorate of Work and Pensions who will carry out financial assessments on behalf of the council in order to maximise resources. This service enables people to gain benefits they are entitled to, which in a number of cases, will result in reduced personal costs.

Key strengths

· The council has developed a joint process for dispute resolution with the PCT, which is aligned, to the national framework and Department of Health guidance regarding continuing care. · The council has a robust training programme to equip staff with the skills to identify and complete referrals to the continuing health care team. · The council has a focus on the transition and learning disability clients so they are treated equitably. · The council provide support services to encourage individuals with physical and sensory disabilities to access employment opportunities. This has been successful in promoting mental health awareness and supporting people with mental health needs to access employment, voluntary work, and commence education training programmes. · The council have a good partnership with the DWP who will carry out financial assessments on behalf to the council. This service enables people to maximise benefits they are entitled to, which in a number of cases will result in reduced personal costs.

Key areas for improvement

· The Council does not systematically collate data on the number of carers who are helped to remain in employment, although carer's are supported to access employment. · A number of initiatives are in place help improve employment opportunities for people with learning disabilities, although the outturn figures are lower than the comparator average, which is due to a misinterpretation of the definition and failure to fully capture successful activity. The council has taken action to ensure local organisations, under contract, are in a better position to improve employment and voluntary opportunities. However, plans for 2007/8 forecast minimal improvement.

Maintaining personal dignity and respect

The council is `good' at promoting personal dignity and respect.

The council take a lead on adult protection in Hampshire and there is positive engagement with Police. The number of people referred to the safeguarding teams is increasing and the council monitor progress of investigations and keep records of types of referral, action taken and outcomes. The adult safeguarding procedures are published and supported by information leaflets. The council ensure most adult social care staff are trained to understand and implement the safeguarding policy and recognise abusive situations and the number of staff trained is significantly better than the comparator average. Most people using care homes or supported living settings in Hampshire have access to single rooms if that is their preference. The council recently launched guidance on Sex, Sexuality and Personal Relationships to its entire staff. The guidance sets out the requirements and expectations in working with and supporting people in the area of sex, sexuality and personal relationships. The council has an effective records management team, which actively promotes good practice on record management, data protection and Caldicott compliance.

Key strengths

· The council take a lead on adult protection in Hampshire and there is positive engagement with Police. · The number of people referred to the safeguarding teams is increasing and the council monitor progress of investigations and keep records of types of referral action taken and outcomes. · The adult safeguarding procedures are published and supported by information leaflets for staff and the public in various formats. · The council have taken their responsibilities under the Mental Health Capacity Act seriously and in partnership with the Hampshire PCT have recruited and trained 20 IMCA advocates to provide a service. · The council ensure that most adult social care staff are trained to understand and implement the safeguarding policy and recognise abusive situations. The council's performance is significantly better than the comparator average. · Most workers are aware of and routinely use a wide-range of good quality preventative services and this has led to an increase the reporting of incidences of abuse and neglect. Most cases are satisfactorily investigated. · The council launched guidance on Sex, Sexuality and Personal Relationships to all staff. The guidance sets out the requirements and expectations in working with and supporting people in the area of sex, sexuality and personal relationships.

Key areas for improvement

·

Capacity to improve

The council's capacity to improve is `excellent'.

The council's challenges for 2006/7 were to achieve financial recovery and put in an effective modernisation strategy linked to organisational reconfiguration to address an over commitment of £19 million, such plans have included taking steps to address demographic changes, health service reforms, increasing levels of dependency with an ageing population, establish and implement a new pay structure for staff, develop performance expectations and management processes and consolidate corporate working, integrated services and joint commissioning. Through competent, ambitious and determined leadership skills of senior officers and commitment from elected members the council have been highly successful in delivering on the mentioned objectives. There is a transformation programme in place and this is focusing on maximising independence but also providing care and support when needed. The council ensure that people who use services, carers and staff are consulted on and take part in strategic planning and improvement processes. In 2006/7 the council together with its partners received an inspection of its Supporting People programme, which was judged to be `excellent' with `excellent' prospects for improvement. Partnership working enhances the council's capacity to meet its objectives but this could be further developed and additional assistance could be given to the voluntary sector to build capacity of local preventative services. The council have effective performance management processes in place. The council together with the Director of Public Health and the PCT have embarked on a joint strategic needs assessment, which will be completed by March 2008. The council continues to perform well in achieving and improving value for money and ensures that its resources are used cost effectively. The council clearly understands its communities and uses good analysis of needs and communicates well to users and other stakeholders and there is effective communication with diverse communities. Issues identified from the Race equality impact assessments have been reflected in the commissioning framework for the council and this has triggered a review at corporate level to look at procurement.

Key strengths

Leadership

· There is a transformation programme in place and this is focusing on maximising independence but also providing care and support when needed. · Most people who use services and carers are provided with responsive services and a competent workforce. · The council ensure that people who use services, carers and staff are consulted on and take part in strategic planning and improvement processes. · In most areas of service delivery the council have in place staff that are skilled and capable of delivering service priorities and maintaining high quality core services. · The council's performance in supporting practice learning is very good. · The council have effective performance management processes in place and weekly and monthly management reports provide accurate information on care management activity, enabling management action and financial planning to be taken promptly. · Use of resources clearly reflects the council's ambition to ensure that national and local priorities are addressed and resources are fairly allocated and meet the needs of almost all users. · The council's focus is to promote independence, choice, quality and well being and their business transformation plans robustly give this steer.

Commissioning and use of resources

· The council together with the Director of Public Health and the PCT have embarked on a joint strategic needs assessment, which will be completed by March 2008. The information gathered will provide the framework analysing current provision and gap analysis in meeting the needs of local people and form the basis of effective joint commissioning. · The council has responded rigorously to the significant financial over commitment in its adult social care budget, 2005/6. It has reduced from £19 million to £7.5 million and during 2007/8 is predicted to reduce to under £2 million. · Financial reporting and management is robust and financial management reports are provided to front line and operational managers, senior management team, Chief Executive and Elected Members on a weekly and monthly basis to ensure expenditure is kept on target and resources re-allocated as necessary. · The council works closely with health partners to avoid unnecessary duplication of costs. · The council clearly understands its communities and uses good analysis of needs and communicates well to users and other stakeholders. · The council is playing a leading role with partners in shaping ambitions through the Hampshire Strategic Partnership (HSP) and delivering agreed, challenging and realistic targets through the Local Area Agreement (LAA). · The Council continues to perform well in achieving and improving value for money and ensures that its resources are used cost effectively. · The council effectively engages, on a regular and continuous basis with most people and partners in a variety of ways and effective communication is made with diverse communities. · Through engagement and consultation users and stakeholders contribute to strategic planning, service delivery and quality monitoring. · The council has a clear understanding of the local social care market and had taken innovative measures jointly with provides to meet the needs of publicly funded and self funded individuals.

Key areas for improvement

Leadership

· There is a need to ensure that the arrangements in place to deliver an operational electronic social care record during 2007/8. This system will link health and social care records, enabling relevant data to be held centrally.

Commissioning and use of resources

· Some joint budgets exist specifically in the integrated equipment store and learning disability service provision. There is scope for expansion in this area provided outcomes for users of services are beneficial. · The council work well with the voluntary sector but additional engagement would be beneficial to enable it to build further capacity and to deliver on the well-being and independence agenda.

Follow up action in 2007-08

CSCI require by 1 December 2007, an action plan outlining how the council intends to deliver against the areas for improvement outlined within the body of this summary report. Progress will be monitored and evaluated through the 2007/8 routine business meetings.

Yours sincerely



Amanda Sherlock

South East Regional Director

Commission for Social Care Inspection

Copied to: Peter Robertson, Chief Executive of Hampshire County Council