Meeting documents

            Meeting: Communities Scrutiny Sub-Committee (County Hall, Durham - Committee Room 1a - 06/12/2004 10:00:00 AM)

                  Item: A4 Performance Management (a) Star Ratings (b) Report of Director Social Care and Health (c) Presentation by Corporate Policy Unit

         

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Report to Communities Scrutiny Sub-Committee 6 December 2004 Performance Ratings for Social Services

Report of Debbie Jones, Acting Director for Social Care & Health

Purpose of the Report

1 To provide information relating to the Commission for Social Care Inspection (CSCI) Annual Performance Rating Assessment for Durham County Council and for other Local Authority Social Services Departments.

Background

2 On 18 November 2004 CSCI announced it’s performance ratings to councils responsible for Social Services in England. Ratings have been produced since November 2002 and aim to improve public information about current performance and to promote improvement at local, regional and national levels.

3 Overall “star ratings” are awarded but separate judgements are given for children’s and adult’s services respectively.

4 Star Ratings are a product of a wider performance assessment process, bringing CSCI and the councils into continuous contact throughout the year. Assessment includes evidence from inspections and reviews, monitoring and performance indicators, to form an overall picture of performance over time of both qualitative and quantitative aspects of performance. The assessment culminates in an annual review meeting with each council.

Star Rating 2003/04

5 Durham County Council received a 2 Star rating on 18 November 2004. Judgements for services were as follows.

	Serving People Well	Capacity to Improve
Children	Most	Promising
Adults	Most	Excellent

6 The judgement of serving ‘most’ people well for Children’s Services was an improvement from 2003 and the judgement of ‘excellent’ in terms of capacity to improve was again, for adult services, an improvement from 2003.

7 Both judgements reflect the improvements made within the service during 2003/04 and place the service at the limit of a 2 Star rating. Any further improvement will move the service into 3 stars.

8 In their Annual Review of Performance Report CSCI commented upon the respective services as follows.

Children and Families General Assessment

“Good progress is being made overall, and the successful recruitment and retention strategy has ensured that vital social worker posts are now filled. The council recognised the need to improve structural arrangements for referral and initial assessment and is putting appropriate plans in place. There was a substantial increase in the number of younger children coming into the care system last year and the council needs to maintain its focus on preventative strategies this year. Performance monitoring and the engagement of young people remain strengths.”

Services for Adults and Older People General Assessment

“The council is increasingly working in partnership with other agencies to ensure that people benefit from “joined up” services. There has been a good improvement in the number of people receiving Direct Payments, and an excellent reduction in the number of people leaving hospital who experience delayed transfers of care. The SSI Inspection of services for people with learning disabilities concluded that most people are being well served, and that there is an excellent capacity for improvement. Areas needing further work include the development of commissioning strategies with partners; developing a better understanding of how to meet the needs of people from black and ethnic minority communities; and, together with partners, meeting a number of Government targets for mental health services.”

9 CSCI did identify a number of performance issues which need to be addressed as part of the Social Care and Health service improvement plan, they are:

a. Despite a reduction in the number of children over 12 being looked after, the overall number of looked after children has risen over the last two years. The council should continue its work to understand and reverse the trend of increasing numbers of younger children entering the care system.

b. The council should ensure that those children who are capable of academic success reach their full educational potential.

c. The council should improve the long terms stability of children’s foster placements, for those children who have been looked after for four years.

d. The council should demonstrate its ability to identify and meet the needs of children from black and ethnic minorities.

e. The council and its partners should continue with its approach to planning for continuous improvement, despite the uncertainties created by the forthcoming referendum on regional and local government.

f. The council should continue to develop its partnership working with health and other organisations in order to improve the experience of older people who use services. This will be assisted by experience gained from a pilot scheme in one area of the county.

g. The council should ensure that the needs of all adults and older people who receive services should be appropriately reviewed.

h. The council should demonstrate its ability to identify and meet the needs of people from black and ethnic minorities.

i. The council and its partners should continue with its approach to planning for continuous improvement despite the uncertainties created by the forthcoming referendum on regional and local government.

10 However, these performance issues were balance with numerous references to improved performance, recognising the significant achievements of the service during 2003/04. Some of the improvements include:

a. The implementation of Health Act flexibilities for Child and Adolescent Mental Health Services and for children with physical disabilities and learning disabilities.

b. Child performance indicators show good and excellent performance.

c. Progress made in all areas identified in the Victoria Climbie audit.

d. There have been successful discussions with health partners to resolve disagreements about continuing care.

e. Performance indicators show excellent performance in relation to the numbers of people helped to live at home.

f. Staff sickness, turnover and vacancy level have reduced and are now compatible with levels in similar councils.

g. On balance performance indicators have improved again when compared to 2002/03.

How well are councils performing overall

11 Since last year, the star rating has changed for 25% of councils. Of these, 71% have improved and 29% have decreased. In population terms this means that, in the last year, social care performance has improved for councils containing fourteen per cent of the population. For councils serving nearly eighty per cent of the population, performance ratings have stayed the same, and for councils serving eight per cent of the population, performance has deteriorated.


12 Children and Families
In judging the services against standards overall, using all the assessment evidence available, the ratings show the strongest gains in fair access to services, and in capacity to improve. The least improved aspects of service since last year are in effectiveness and quality.

Looking in more detail at the results, there is evidence that local service priorities are now better aligned with national priorities, and more effectively supported by the management of resources. Priorities for children’s services in 2003/04 included:

a. Greater stability in the placements of looked after children. Here there is a mixed picture of improved initial stability, but some reduced stability in the longer term.

b. Some further improvements in the educational attainment of looked after children. Performance has continued to increase in this area, but social services have failed to reach the national targets set out for previous years, and improvements are modest.

c. Increasing the number of care-leavers in education, training or employment. Performance also improved here, though only 30% of councils achieved the 2003-04 national target level.

13 The sensitivity of the services to racial and cultural diversity in the population shows some improvement from last year’s ratings. The availability of key services on a twenty-four hour basis was considered a strength. Complaints were also seen to be well handled in many areas, supported by good publicity and user-friendly information’. Linked with this, strong performance was observed in safeguarding children from poor treatment whilst using services.

14 The least-well achieved areas of performance were in efficiency and value for money of children’s services, which showed the smallest gains over the last year. Whereas high-level strategic partnership is reported as a strong feature of performance, the detailed reflection of this in joint financial arrangements with partners is judged still to be weak.

15 Services for Adults
The areas judged to be strongest were in aligning local and national priorities, such as:

a. Improving the level of intensive support to people in their own homes and reducing the rate of admissions to care homes; improvements in both these areas were achieved.

b. Increasing the level of direct payments, where the number of adults receiving direct payments to manage their own support services increased by 5,100 over the previous year.

c. Reducing delayed discharge from hospitals, where the rates have dropped significantly.

16 This evidence suggests good performance also in establishing effective working partnerships with other local agencies. Fair access to services was also well rated, including the availability of 24-hour services and the fairness of eligibility and charging policies.

17 The most significant improvements since the previous ratings were in improving access to services (including greater sensitivity to racial and cultural diversity), in establishing joint working and financial arrangements with partner organisations.

18 The least well-rated aspects included support services for carers, and this is reflected also in the indicator data on carers’ assessments. The ratings also show relatively poor levels of performance in managing services efficiently, as well as less confidence that the range of services is sufficiently broad to meet the cultural and racial diversity present in the local population. Changes in judgements since last year suggest a lack of progress in providing safeguards against poor treatment whilst using services.

How does performance compare across different parts of the country?

19 The strongest performance is evident in the North East, East Midlands and Yorkshire and Humber regions. The North East and London, followed by the Eastern region, have seen the strongest rate of improvement over the last year.




How does performance compare across different types of council?

20 Performance was strongest, on average, in the inner London councils and Metropolitan Districts. Improvement has taken place in most types of council since last year with only Shire Counties showing a small fall. Improvement has been most pronounced across the London authorities.

Conclusion

21 Elected members may recall that the County Council received a disappointing 1 Star rating in November 2002. The “service” embarked upon an ambitious improvement plan augmented by a robust performance monitoring programme. In November 2003 the service received recognition of its achievements in terms of improved outcomes for service users through

the award of a 2 star rating.

22 I am particularly pleased that not only have we consolidated our performance but improved both of our service judgements. Social Care & Health staff have achieved considerable success during 2003/04 in responding to higher quality standards, increased demand for services and the requirement to modernise services in line with service user expectations, government requirements and County Council objectives.

Recommendations

23 Members to receive the report.

Contact: Peter Appleton, Head of Quality & Performance

Appendix 1: Implications

Finance Social Care & Health services throughout the county continue to face significant pressures in balancing the increased demand for services against finite and limited resources

Staffing Effective Human Resource Management including recruiting and retaining high quality staff is a critical factor in consolidating and improving performance

Equal opportunities N/A

Accommodation N/A

Crime and disorder N/A

Sustainability N/A

Human rights N/A

Localities N/A

Young people N/A

Consultation N/A

Scrutiny Sub-Committee Promoting Strong, Healthy & Safe Communities 6 December 2004 Performance Management

Report of Performance Monitoring Manager, Social Care and Health

1. Purpose of the Report

To provide Scrutiny Sub-Committee with an update on performance information within the second quarter 2004/05 and up to date information on user feedback.

2. Background
Performance is measured using a variety of methods and tools such as Inspections and Spring and Autumn Delivery and Improvement Statements. Of universal relevance to this process are the 49 Performance Assessment Framework (PAF) indicators some of which are also Best Value indicators.

Performance for first and second quarters 2004/05 and the previous four years performance against PAF indicators can be found in Appendix A. Results are traffic lit and can range from dark green (‘very good’ performance) to red (‘investigate urgently’).

Second quarter information is available for 42 of the 49 performance indicators currently within the Performance Assessment Framework.

Current position
Adult Services: -

Adult Services performance indicators for which there is available data in the second quarter 2004/5 are grouped by banding as follows:

9 very good (dark green)
6 good (light green)
4 acceptable (yellow)
2 ask questions (orange)
2 not banded

Of the 21 Adult services indicators that are banded, 19 have stayed in the same banding while two have improved since the last time reported. Staying in the same banding represents a substantial achievement for 7 of these indicators as they were already in the top banding. The 2 improving indicators have both moved from the light green into the dark green banding.

Performance for adults and older clients receiving a review as a percentage of those receiving a service (PAF D40) remains static at 53.6% in the orange banding. This indicator includes people who received services towards the end of the period and who would therefore not receive an annual review within the period. Also, the denominator for this indicator includes some one-off services (such as major items of equipment) which are not normally reviewed. Our local indicator, which relates to clients in receipt of ongoing services for at least 1 year, shows considerably higher performance (79.1%).

The ratio of the percentage of older service users receiving an assessment or review that are from minority ethnic groups (PAF E47) has increased to 0.71:1 but remains within the orange banding. In 2003/04 22 older people from 'non-white' ethnic groups received an assessment, compared to over 13,100 for white ethnic groups. The low figure for this indicator may be due to the relatively low proportion of older people from ethnic minority groups (0.27%) in the Durham population. As the relevant population is so small, a small change in the number of people assessed can have a significant impact on the final value of this indicator.

The number of delayed transfers of care of all ages (PAF D41) has reduced in the second quarter to 5.6 per 100,000 over 65 population which has taken this indicator into the dark green banding.

The acceptable waiting times for care packages for new older clients (PAF D56) has also moved into the dark green banding with 85.3% of care packages being in place within 4 weeks of completion of the assessment.

Children’s Services:

Children’s Services performance indicators for which there is available data in the second quarter 2004/5 are grouped by banding as follows:

4 very good (dark green)
6 good (light green)
3 acceptable (yellow)
3 ask questions (orange)
3 not banded

Three of these Children’s Services indicators have reduced banding and three improved a banding from the last time they were reported.

Performance against PAF indicator D35 (percentage of children who have been looked after for at least 4 years who have been in their current placement for at least 2 years) has gone down from 50.6% in the first quarter to 48.9% in the second quarter. There is a certain inevitability about this reduced performance given the strategy, which is still being implemented and which involves moving looked after children away from expensive out of county placements. Over time performance against this indicator should start to improve.

PAF A4 (Percentage of young people who were looked after who are engaged in education, training and employment at the age of 19) has shown a reduction in performance to 40% (orange banding). However, this figure does not include the full cohort as many do not turn 19 until after 30 ^th September. Out-turn for 2004/5 is forecast at 55% which is in the dark green banding.

The percentage of children in need from minority ethnic groups as a ratio of the percentage of minority ethnic groups in the child population (PAF E45) remains at 0.54:1 and in the orange banding. For Children’s Services the proportion from minority ethnic groups in receipt of a service reflects almost exactly the incidence in the general population. Performance against PAF E45 counts only those receiving a service in a particular week and the forecast for 2004/05 is an improved ratio of 0.7:1. It has been agreed at Children’s Services Branch Performance Days that for PAF E45 Managers will raise this with their teams as ethnicity is not being recorded on all referrals.

The percentage of children looked after who are in foster placements or placed for adoption (PAF B7) has fallen slightly to 83.7% in the second quarter (light green banding). An increase of 1.3% will take this indicator back into the dark green banding.

Performance continues to improve on PAF C19 (percentage of looked after children who have had a dental check and health assessment) with the figure now 80% and in the dark green banding.

PAF B8 (average gross weekly expenditure per looked after child in foster care or in a children’s home) has moved from the yellow to the light green banding. This is a provisional banding based on the rate of inflation.

PAF E44 (percentage of children’s gross expenditure that was not spent on children looked after) has moved from the yellow to light green banding, the highest banding available.

4. Improvement Plans

Adult Services and Children’s Services PAF indicators, as well as results against other performance indicators, will be reported to the December round of Social Care and Health Performance Days. Attention will be drawn to those indicators against which improvements are most urgently needed and action plans will be developed. The success or otherwise of agreed actions will be closely monitored.

5. User Feedback

The Personal Social Services Physically Disabled and Sensory Impaired User Experience Survey 2003/04 provided data for PAF D57 - Users who said their opinions and preferences were taken into account, and PAF D58 - Users who said that they can contact Social Services easily. Durham’s performance, compared to the IPF Group Average, can be seen in the following table. This survey was part of the Department of Health/Department for Education and Skills’ rolling programme of user surveys. The 2004/05 survey will be for Children in Need aged 10 to 17.

Indicator	Durham 2003/04 Outturn	IPF Group 2003/04 Outturn Average
PAF D57: Users who said their opinions & preferences were taken into account	28.9%	29.6%
PAF D58: Users who said that they can contact Social Services easily	80.4%	80.8%

For the established user feedback surveys carried out within Adult Services satisfaction remains mostly high with only the annual Carers’ Survey recording poor performance. Action plans arising from the results are developed and agreed by the Adult Services Management Team and are used to address areas of low performance and drive improvement. The table below contains overall average satisfaction for the main user feedback surveys within Adult Services.

Survey	2000/01	2001/02	2002/03	2003/04	2004/05 Qtr 1-2
Assessment Exit	84.9%	86.8%	88.7%	89.3%	89.4%
Carers Assessment Exit			90.9%	90.0%	88.8%
Carers’ Survey				66.5%	Reported annually
Community Mental Health Assessment Exit			85.9%	86.3%	85.3%
Home Care Survey	94.3%	94.5%	94.3%	94.2%	Reported annually
Hospital Discharge	76.6%	76.7%	79.2%	81.5%	N/A*

*The Hospital Discharge Survey was re-designed for 2004/05 to reflect the revised procedure. We are therefore unable to compare 2004/05 data to previous years’ figures.

User experience surveys for initial and core assessments are currently under development for implementation within Children’s Services. These are to be implemented in December 2004.

6. Recommendations and reasons

You are recommended to:

Contact: Keith Newby Tel: 0191 383 4959

APPENDIX 1
SECTION 2

PROMOTING STRONG, HEALTHY AND SAFE COMMUNITIES

Strategic objectives:
· To enable all people to participate in community life, become active citizens and develop a sense of place and cultural identity
· To support and protect vulnerable adults, young people and children
· To help reduce crime and the fear of crime
· To improve the health of local people and to make County Durham a safer place
· To invest in our children and young people
Performance Indicators - progress against targets


This section summarises improving performance and those areas where improvement is most needed. Full details of progress at the half-year point for all relevant performance indicators is contained in Table 2.

Supporting this corporate objective, there are indicators that are reported 6 monthly or annually, and others that are not presently collected by the police. Performance against those indicators that can be reported at the half-year point is generally good and promising progress towards targets can be seen. Of particular attention is:

BV 53 Intensive home care per 1000 population aged 65 or over. Performance against this indicator this year is consistently impressive and exceeds the annual target. This is in part due to Extra Care provision across the county.

BV 56 % of items of equipment delivered within 7 working days. Good consistent performance of this indicator this year, at this point, above the annual target.

BV 126 Domestic burglaries per 1000 households & those detected. The half-year figures for this indicator show improvement. The rate of burglaries has fallen and at the same time, the rate of those detected has increased. The equivalent figures for violent and vehicle crimes have similarly improved.

BV 161 Employment, education and training for care leavers. Performance at the half-year point is 20% below the annual target for 2004/05. However looking at the cohort expected to reach the age of 19 in the next 6 months, it is estimated that outturn for this indicator will increase to 55% against a target of 60% by the year-end.

BV195 (ii) Acceptable waiting times for assessment - less than or equal to 4 weeks. Performance has improved this quarter but this indicator has not achieved last year’s level and currently is more than 4% below the annual target.

BV 201 The number of adults and older people receiving direct payments per 100,000 population. This is a new BVPI for 2004/05 although an equivalent PAF indicator has been collected since 2002/03. Performance has improved impressively and now exceeds the target for 2004/05.

TO VIEW TABLES PLEASE REFER TO HARD COPIES LOCATED IN CORPORATE SERVICES AND THE COUNTY RECORD OFFICE


Attachments

 2nd Quarter 04-05 SHSC.xls;
 appendix1.doc;
 Appendix A.xls;
 December 04 Scrutiny sub-committee.doc;
 Performance Ratings for Social Services - 6.12.04.doc