Archived decisions

        CSCI

        33 Greycoat Street

        London

      SWSW1P 2QF

        Mr Nick Georgiou

        Director of Adult Social Services

        Hampshire County Council

        The Castle

        Winchester

        SO23 8UQ

        27 October 2008

        JD/WC/2008 APA/HCC

      Dear Mr Georgiou

      PERFORMANCE SUMMARY REPORT of 2007-08 ANNUAL PERFORMANCE ASSESSMENT OF SOCIAL CARE SERVICES FOR ADULTS SERVICES FOR HAMPSHIRE COUNTY COUNCIL

      Introduction

      This performance summary report summarises the findings of the 2008 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 the final copy of the performance assessment notebook (PAN), which provides a record of the process of consideration by CSCI and from which this summary report is derived. You will have had a previous opportunity to comment on the factual accuracy of the PAN following the Annual Review Meeting.

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

        · Delivering outcomes: GOOD

        And

        · Capacity for improvement: EXCELLENT

      The judgment 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 January 2009) and to make available to the public, preferably with an easy read format available.

      ADULT SOCIAL CARE PERFORMANCE JUDGMENTS FOR 2007/08

      Areas for judgment

      Grade awarded

      Delivering Outcomes

      GOOD

          Improved health and emotional well-being

      Good

          Improved quality of life

      Good

          Making a positive contribution

      Excellent

          Increased choice and control

      Good

          Freedom from discrimination and harassment

      Good

          Economic well-being

      Good

          Maintaining personal dignity and respect

      Good

      Capacity to Improve (Combined judgment)

      EXCELLENT

          Leadership

      Excellent

          Commissioning and use of resources

      Excellent

      Performance Rating

      3 STAR

      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 development and where appropriate identifies any follow up action CSCI will take.

      KEY STRENGTHS AND AREAS FOR DEVELOPMENT BY PEOPLE USING SERVICES

      Key strengths

      Key areas for development

      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 well-being.

      · Community Development workers offer a countywide focus on improving access to hard to reach communities.

      · The Community Innovations Team has a key role in signposting those with low and moderate needs to services and support.

      · A number of complex care services are delivered jointly, specifically for people with alcohol related health needs.

      · Improvements have been made to the availability of residential treatment programmes for people with drug related care needs.

      · The council have dedicated services to support people with HIV / AIDS.

      · The council are funding a range of organisations to promote independence and wellbeing for people with specific and specialist needs in the community.

      · The council commissions a range of care services, which do not require formal assessment and people using these services are satisfied with the level and quality of service offered.

      · Where there are small numbers of people who need a specialist service the council ensures most are given a choice of specialist support to promote independence.

      · Through client surveys the council report that most people who use services feel safe because their homes are safe and secure.

      · Most people who use services and their carers are supported in developing their confidence to contribute their own views and develop confidence in their own abilities, skills and qualifications and broaden their opportunity to engage in community life.

      · Service users across all care groups were involved in the review of adult safeguarding processes.

      · The councils grant aid programme supports organisations that promote volunteering. It supports through the umbrella body 112 organisations of more than 3,000 volunteers providing 330,000 hours of voluntary care and support.

      · The council effectively seeks ongoing engagement and feedback from most people who use services and carers, as well as the wider community, using a range of initiatives that enables most people to participate and feedback to bring about improvement in service delivery.

      · The council continue to maximise an individual's ability to exercise choice and control by providing pertinent information about eligibility criteria, availability about local services, timely assessments and reviews.

      · The effectiveness of signposting services in Hampshire ensures people receive information and advice promptly, without the need for a full care management assessment.

      · Most people who use adult social care and their carers and potential users of services are well informed and receive information, which is accurate, accessible and appropriate in terms of their needs.

      · Through understanding the needs and choice of the community the council is aware of the services that need to be available out of working hours and what responses are required for urgent and unpredictable support.

      · The council is giving people across the county the opportunity to give their views and opinions on the future of services for adults in need of support and care. A `Commission of Inquiry' has been set up by the council to hear the views of individuals on changing the way services are delivered and funded.

        · The council has continued to develop strategic actions to help improve performance in relation to early intervention and prevention and to support the development of the personalisation agenda.

        · The council has a commitment through it's quality and diversity scheme to provide services for people with any disability of sexual orientation and from any culture, ethnic group or religion which are free from discrimination and harassment.

        · 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.

        · Equality Impact Assessments are conducted on any policy, procedure, service plan, and new developments.

        · There is an increasing choice of pathways available to meet economic and employment need. A corporate employment strategy was published in October as a response to the LAA flagship initiative to up-skill people in Hampshire.

        · People who use services are supported to maximise benefits they receive as a result of the financial assessments and benefits team who carry out financial assessments for vulnerable people to determine the amount they should contribute to their care.

      · There are systems in place to ensure those who choose to fund their own care have equal access to safeguarding procedures and this is demonstrated by the increasing rate of referrals linked to self-funders, which is higher than the average of similar councils.

      · Adult safeguarding procedures are published and supported by information leaflets for staff and the public in a variety of formats.

      · The council continues to ensure that most adult social care staff are trained to understand and implement the adult safeguarding policy and recognise abusive situations, performance is significantly better than the average of similar councils.

      · The council is committed to working with the independent sector to provide the necessary adult safeguarding training and support to help drive up standards and protect vulnerable adults.

      · Almost all people admitted to care homes or supported living settings in Hampshire have access to single rooms if they choose and performance is now very good.

      · Inter-personal relationships are innovatively and actively encouraged and most people are able to express their sexual preferences and are free to form relationships in safe, non-judgemental environments.

      · A multi-agency board is in place with representation from key partner agencies. The PCT appointed a Safeguarding lead, which will help promote further engagement and joint working between the council and Health colleagues.

      · Performance in providing individuals with a statement of their need remains good.

      · Although the council has in place agreed protocols with health colleagues to share information and avoid the need for repeated assessments it has yet to implement an integrated single assessment process. The council is exploring with the PCT, options for a single assessment process.

      · The council acknowledge the need to improve accessibility to advocacy services, particularly for black and minority ethnic groups and those with complex needs.

      · Performance in the provision of direct payments remains adequate and below the average of similar councils. This is despite the council undertaking a major review of the scheme to encourage people to use direct payments. Overall the provision of direct payments needs to improve in order to match the performance of similar councils.

      · The provision of direct payments to black and minority ethnic groups reduced during the year and performance is lower than the comparator average.

      · The council need to improve their collection and recording of data in relation to the ethnicity of adults in receipt of services.

        · The council ensures that individuals who are eligible for continuing health care are assessed appropriately and in a timely manner. Although, there remain some issues about capacity and consistency in the PCT, which the council are seeking to address with them.

      · Although the number of referrals reported to the council's adult safeguarding teams continues to increase, the council acknowledge further work is required to bring activity in line with the average of similar council's.

      · The council acknowledge the need to review membership arrangements of the Safeguarding Board to ensure that political members are represented.

      Older people

      · A joint commissioning strategy has been completed in partnership with the PCT, NHS Trusts and the Alzheimers Society, which involved high levels of engagement with stakeholders. This has led to a range of new or revamped services for older people with mental health needs living in the community.

      · The council's strategy to make best use of intermediate care services to support people to live independently, reduce hospital admissions and stays in residential care is highly effective.

      · The council's strategy to reduce the number of hospital admissions through early intervention and community support is effective, similarly their performance in reducing delays in discharge from hospital is continuing to improve.

      · The number of older people permanently admitted to residential or nursing care continues to reduce and performance is very good for both older people and adults.

      · This year, despite the council having in place plans to independently distribute telecare items they did not meet their target. However, the council has built a solid partnership with district councils and jointly commissioned telecare providers for each district. This initiative together with committed funding has enabled the distribution of telecare services across the county to substantially improve from what was previously a low base with patchy distribution. Although improving, this is still an area that needs further development.

      · Improvements to reduce waiting times for minor adaptations is still required, as performance is not as good as the average of similar councils.

      · In comparison with similar councils the level of extra care housing options is low. However, in partnership with district councils the council have approved an Extra Care Strategy, which provides a commitment to developing at least 400 units of extra care housing. This will be fully delivered by 2010/11 utilising new build schemes and the enhancement of existing sheltered housing, 200 of these beds will be available during 2008/09.

      · Although there has been a significant improvement in the number of older people accessing direct payments, the overall value of each package predominantly falls into a one off low value offer to promote well being to individuals aged 85+. Over two thirds of direct payments offered by similar councils, to older people, were of a significant value.

      People with learning disabilities

      · The council continue to provide a range of short term breaks for people with a learning disability and performance is significantly better than the average of similar councils.

      · People with profound learning disabilities and multiple sensory disabilities benefit from integral person centred planning and newly commissioned supported living schemes.

      · The autism diagnostic centre was launched early 2008 providing a multi disciplinary service to support people to live in the community.

      · Targeted information for young people with long term conditions and their families is made available on transition from Children's Services and further information is available to them via the Person Centred Planning Website.

      · The council's performance in helping adults with a learning disability to live independently is good.

      · There remain a significantly higher numbers of people with a learning disability living in NHS campus accommodation. In partnership with health agencies the council has developed a strategy and action plan, which has involved input from users of services and their carers and are on target to ensure that everybody is re-housed by 2010. In South West Hampshire a reprovision project for over 50 people has already taken place and cited by the Department of Health as best practice.

      · Although the number of people with a learning disability helped into paid work significantly increased during the year performance remains below the average of similar councils and remains an area of work requiring further improvement.

      People with mental health problems

        · The council's performance in helping adults with a mental health problem to live independently is very good.

      People with physical and sensory disabilities

        · The council's performance in helping adults with a physical disability to live independently is very good.

      Carers

      · The council provides very good services for carers, including those from black and minority ethnic groups.

      · The council revised their care management system to include employment questions specifically relating to carers as part of the carers assessment module.

      · All carers are encouraged to work if that is their choice and the availability of flexible breaks schemes have increased to support carers with work.

    KEY STRENGTHS AND AREAS FOR DEVELOPMENT BY OUTCOME

    Improved health and emotional well-being

      The contribution that the council makes to this outcome is `GOOD'

      Key strengths

      · Almost all people who use services and their carers are helped to understand how to stay healthy and maintain their emotional well-being.

      · Community Development workers offer a countywide focus on improving access to hard to reach communities.

      · The Community Innovations Team has a key role in signposting those with low and moderate needs to services and support.

      · A number of complex care services are delivered jointly, specifically for people with alcohol related health needs.

      · The council have dedicated services to support people with HIV / AIDS.

      · Improvements have been made to the availability of residential treatment programmes for people with drug related care needs.

      · A joint commissioning strategy has been completed in partnership with the PCT, NHS Trusts and the Alzheimers Society, which involved high levels of engagement with stakeholders. This has led to a range of new or revamped services for older people with mental health needs living in the community.

      · The council's strategy to make best use of intermediate care services to support people to live independently, reduce hospital admissions and stays in residential care is highly effective.

      · The council's strategy to reduce the number of hospital admissions through early intervention and community support is effective, similarly their performance in reducing delays in discharge from hospital is continuing to improve.

      Key areas for development

      · There remain a significantly higher numbers of people with a learning disability living in NHS campus accommodation. In partnership with health agencies the council has developed a strategy and action plan, which has involved input from users of services and their carers and are on target to ensure that everybody is re-housed by 2010. In South West Hampshire a reprovision project for over 50 people has already taken place and cited by the Department of Health as best practice.

      Improved quality of life

      The contribution that the council makes to this outcome is `GOOD'

      Key strengths

      · The council's performance in helping adults with a physical disability to live independently is very good.

      · The council's performance in helping adults with a mental health problem to live independently is very good.

      · The council's performance in helping adults with a learning disability to live independently is good.

      · The council continue to provide a range of short term breaks for people with a learning disability and performance is significantly better than the average of similar councils.

      · The council provides very good services for carers, including those from black and minority ethnic groups.

      · The council are funding a range of organisations to promote independence and wellbeing for people with specific and specialist needs in the community.

      · The council commissions a range of care services, which do not require formal assessment and people using these services are satisfied with the level and quality of service offered.

      · Where there are small numbers of people who need a specialist service the council ensures most are given a choice of specialist support to promote independence.

      · People with profound learning disabilities and multiple sensory disabilities benefit from integral person centred planning and newly commissioned supported living schemes.

      · The autism diagnostic centre was launched early 2008 providing a multi disciplinary service to support people to live in the community.

      · Through client surveys the council report that most people who use services feel safe because their homes are safe and secure.

      Key areas for development

      · This year, despite the council having in place plans to independently distribute telecare items they did not meet their target. However, the council has built a solid partnership with district councils and jointly commissioned telecare providers for each district. This initiative together with committed funding has enabled the distribution of telecare services across the county to substantially improve from what was previously a low base with patchy distribution. Although improving, this is still an area that needs further development.

      · Improvements to reduce waiting times for minor adaptations is still required, as performance is not as good as the average of similar councils.

      · In comparison with similar councils the level of extra care housing options is low. However, in partnership with district councils the council have approved an Extra Care Strategy, which provides a commitment to developing at least 400 units of extra care housing. This will be fully delivered by 2010/11 utilising new build schemes and the enhancement of existing sheltered housing, 200 of these beds will be available during 2008/09.

      Making a positive contribution

      The contribution that the council makes to this outcome is `EXCELLENT'

      Key strengths

      · Most people who use services and their carers are supported in developing their confidence to contribute their own views and develop confidence in their own abilities, skills and qualifications and broaden their opportunity to engage in community life.

      · Service users across all care groups were involved in the review of adult safeguarding processes.

      · The councils grant aid programme supports organisations that promote volunteering. It supports through the umbrella body 112 organisations of more than 3,000 volunteers providing 330,000 hours of voluntary care and support.

      · The council effectively seeks ongoing engagement and feedback from most people who use services and carers, as well as the wider community, using a range of initiatives that enables most people to participate and feedback to bring about improvement in service delivery.

      Key areas for development

      Not applicable

      Increased choice and control

      The contribution that the council makes to this outcome is `GOOD'

      Key strengths

      · The council continue to maximise an individual's ability to exercise choice and control by providing pertinent information about eligibility criteria, availability about local services, timely assessments and reviews.

      · The effectiveness of signposting services in Hampshire ensures people receive information and advice promptly, without the need for a full care management assessment.

      · Most people who use adult social care and their carers and potential users of services are well informed and receive information, which is accurate, accessible and appropriate in terms of their needs.

      · Targeted information for young people with long term conditions and their families is made available on transition from Children's Services and further information is available to them via the Person Centred Planning Website.

      · Through understanding the needs and choice of the community the council is aware of the services that need to be available out of working hours and what responses are required for urgent and unpredictable support.

      · Performance in providing individuals with a statement of their need remains good.

      · The number of older people permanently admitted to residential or nursing care continues to reduce and performance is very good for both older people and adults.

      Key areas for development

      · Although the council has in place agreed protocols with health colleagues to share information and avoid the need for repeated assessments it has yet to implement an integrated single assessment process. The council is exploring with the PCT, options for a single assessment process.

      · The council acknowledge the need to improve accessibility to advocacy services, particularly for black and minority ethnic groups and those with complex needs.

      · Performance in the provision of direct payments remains adequate and below the average of similar councils. This is despite the council undertaking a major review of the scheme to encourage people to use direct payments. Overall the provision of direct payments needs to improve in order to match the performance of similar councils.

      · Although there has been a significant improvement in the number of older people accessing direct payments, the overall value of each package predominantly falls into a one off low value offer to promote well being to individuals aged 85+. Over two thirds of direct payments offered by similar councils, to older people, were of a significant value.

      · The provision of direct payments to black and minority ethnic groups reduced during the year and performance is lower than the comparator average.

      Freedom from discrimination and harassment

      The contribution that the council makes to this outcome is `GOOD'

      Key strengths

        · The council is giving people across the county the opportunity to give their views and opinions on the future of services for adults in need of support and care. A `Commission of Inquiry' has been set up by the council to hear the views of individuals on changing the way services are delivered and funded.

        · The council has continued to develop strategic actions to help improve performance in relation to early intervention and prevention and to support the development of the personalisation agenda.

        · The council has a commitment through it's quality and diversity scheme to provide services for people with any disability of sexual orientation and from any culture, ethnic group or religion which are free from discrimination and harassment.

        · 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.

        · Equality Impact Assessments are conducted on any policy, procedure, service plan, and new developments.

      Key areas for development

      · The council need to improve their collection and recording of data in relation to the ethnicity of adults in receipt of services.

      Economic well being

      The contribution that the council makes to this outcome is `GOOD'

      Key strengths

      · The council revised their care management system to include employment questions specifically relating to carers as part of the carers assessment module.

      · All carers are encouraged to work if that is their choice and the availability of flexible breaks schemes have increased to support carers with work.

        · There is an increasing choice of pathways available to meet economic and employment need. A corporate employment strategy was published in October as a response to the LAA flagship initiative to up-skill people in Hampshire.

        · People who use services are supported to maximise benefits they receive as a result of the financial assessments and benefits team who carry out financial assessments for vulnerable people to determine the amount they should contribute to their care.

      Key areas for development

        · The council ensures that individuals who are eligible for continuing health care are assessed appropriately and in a timely manner. Although, there remain some issues about capacity and consistency in the PCT, which the council are seeking to address with them.

        · Although the number of people with a learning disability helped into paid work significantly increased during the year performance remains below the average of similar councils and remains an area of work requiring further improvement.

      Maintaining personal dignity and respect

      The contribution that the council makes to this outcome is `GOOD'

      Key strengths

      · There are systems in place to ensure those who choose to fund their own care have equal access to safeguarding procedures and this is demonstrated by the increasing rate of referrals linked to self-funders, which is higher than the average of similar councils.

      · Adult safeguarding procedures are published and supported by information leaflets for staff and the public in a variety of formats.

      · The council continues to ensure that most adult social care staff are trained to understand and implement the adult safeguarding policy and recognise abusive situations, performance is significantly better than the average of similar councils.

      · The council is committed to working with the independent sector to provide the necessary adult safeguarding training and support to help drive up standards and protect vulnerable adults.

      · Almost all people admitted to care homes or supported living settings in Hampshire have access to single rooms if they choose and performance is now very good.

      · Inter-personal relationships are innovatively and actively encouraged and most people are able to express their sexual preferences and are free to form relationships in safe, non-judgemental environments.

      · A multi-agency board is in place with representation from key partner agencies. The PCT appointed a Safeguarding lead, which will help promote further engagement and joint working between the council and Health colleagues.

      Key areas for development

      · Although the number of referrals reported to the council's adult safeguarding teams continues to increase, the council acknowledge further work is required to bring activity in line with the average of similar council's.

      · The council acknowledge the need to review membership arrangements of the Safeguarding Board to ensure that political members are represented.

      Capacity to improve

      The council's capacity to improve services further is 'EXCELLENT'

      Key strengths

      Leadership

      · Through competent, ambitious and the determined leadership skills of senior officers and commitment from elected members the council have been highly successful in delivering set objectives within budget.

      · Adult social care works closely with corporate partners, health colleagues and other agencies in understanding and planning for effective and sustained delivery of well-crafted services that meet local need.

      · The council is engaged in discussion with the PCT about priorities to further develop joint countywide working and consider pooling resources where there is overall benefit to individuals using services.

      · Through its systematic long term forward planning the council have ensured there are the people, skills and capacity in place at almost all levels to deliver services priorities and maintain high quality core services.

      · The council have reduced levels of staff absence, which is now lower than the average of similar councils.

      · Performance in practice learning remains at a very good level.

      · The council have a good history of partnership working with the independent sector through the PaCT programme and as a consequence a comprehensive training and development programme is in place.

      · This year 21% of independent sector managers received training in leadership and development and the council, through its evaluation processes, identified 90% of employers can demonstrate direct improvement in service quality as a result of the training programme.

      · Performance management is well embedded and fully understood by all staff and the council continues to have effective performance management arrangements in place and remain confident of their ability to collect and use data effectively.

      Commissioning and use of resources

        · The council has in place systems to analyse information from the joint strategic needs assessment to ensure commissioning plans can be reviewed to reflect identified needs.

        · Use of resources clearly reflects the council's ambition to ensure that national and local priorities are met.

        · In recognition of the need to target support towards self-funders seeking residential or nursing care the council has embarked on a range of projects including the development of the award winning `CareChoices' website, which enables potential individuals and their carers to access up to date information on care services.

      · Total cashable efficiency gains achieved during the year were significantly higher than the comparator average.

      · The council have developed contacts and infrastructure with the voluntary sector to ensure that capacity in this sector is addressing the agenda around self-directed support. A commissioning manager with lead responsibility for developing relationships with the voluntary sector has been appointed.

      · The council has a clear understanding of the local social care market and there are some innovative measures taken jointly with providers to meet the needs of both publicly funded and self funded individuals.

      · The council make good use of information on local regulated care services and have in place effective joint plans to deal with failing and closing services.

      · Commissioning arrangements are considerate of safeguarding issues, complaints, critical incidents, risk analysis and user feedback.

      · The council have a workforce and development function that is an integral component of the quality framework which delivers a targeted service to care providers in the independent sector, specifically to services who are assessed as being poor or where there is concern about capacity to deliver safe and effective services.

      Key areas for development

      Leadership

      · The council remain unable to deliver a fully operational electronic social care record linking health and social care records, to enable relevant data to be held centrally, despite plans for delivery during the year. This remains an area for improvement that requires full resolution.

      · To enhance and support the developing personalisation agenda the council must continue to embed county-wide, successfully trialled local services, for example the personal assistant scheme provided in south east Hampshire and the Basingstoke self directed support project.

      Commissioning and use of resources

      · The council continue to engage in discussion with the local PCT about priorities for joint working and acknowledge there is a need to further develop joint working countywide before extending any further pooled budgets.

      Yours sincerely

      Amanda Sherlock

      South East Regional Director

      Commission for Social Care Inspection