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Making delivery count: Developing performance indicators for adult social care

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Title: Making delivery count: Developing performance indicators for adult social care


1
Making delivery countDeveloping performance
indicatorsfor adult social care
Social Services Research Group Conference 27
November 2008
Simon Medcalf Social Care Performance Strategy, DH
2
The importance of PIs
  • Performance indicators form the building blocks
    of the local performance framework.
  • They describe shared national and local
    priorities, provide the focus of attention on
    specific areas and policies, and set out how data
    will be collected to support and evidence
    delivery.

Policy priorities
National Indicator Set
Policy development
Improvement efficiency
Local Area Agreements
Performance assessment
Operational planning management
3
The issue
  • For adult social care, the representation amongst
    the national list of priorities set out in the
    NIS is poor only 8 of the 189 national measures
    are solely attributable to adult social care.
  • Their quality is more of a concern than the
    quantity, and relation to policy direction is
    variable.
  • Few of the measures display the outcomes focus
    which is intrinsic to the new local performance
    framework, and fewer still display a coherent
    link to Putting People First and the
    transformational agenda.

189 National Indicators
32 health and wellbeing
8 adult social care
4
The project
  • Responding to this situation, this new project
    aims to
  • Deliver a suite of PIs from which the next
    iteration of the NIS (and PSAs, LAAs) will be
    drawn,
  • Develop PIs which sit in the context of policy
    priorities, evidence real outcomes and are of
    genuine use to Councils and regulators,
  • Review the current NIS to determine which
    measures should be retained and which deleted,
  • Change the terms of the conversation around
    performance this is about supporting service
    improvement not feeding the beast!

5
Setting our objectives
  • The performance framework should support our
    priorities by
  • Showing how outcome-focused PIs link to strategic
    objectives
  • Evidencing achievement of the outcomes central to
    the themes
  • Acting to promote a focus on particular areas in
    keeping with the overall policy direction

We need to set the NIS in the context of our
high-level ambitions for adult social care. What
are the relevant strategies, objectives and
aspirations and how do they relate to each other?
6
Mapping the aspirations of key Government
strategies
Stay healthy and recover quickly from illness
Exercise maximum control over their own life
and/or lives of family members
Participate as active and equal citizens,
economically and socially
Live independently
Have the benefit of the best possible quality of
life, irrespective of illness or disability
Sustain a family unit which avoids children
taking on inappropriate caring role
Retain maximum dignity and respect
Putting People First
Focussing on prevention, early intervention and
enablement, rather than crisis management, to
bring long-term benefits to individuals health
and wellbeing
Supporting people to maintain or improve their
well-being and independence within their own
homes and local communities and through
avoiding unnecessary admission to hospital
Ensuring information is Available and
accessible for all to support decision-making
and access to care services, irrespective of
peoples social circumstances and eligibility
for statutory services
Improving peoples health and emotional
well-being by enabling them to live as
independently as suits them
Enabling people to make choices and be in
control of their own care to deliver successful
outcomes first time. Promoting shared decision
making to encourage ownership
LAC 2008(1) Transforming Social Care
Designing systems that build on the capacity of
individuals and their communities to manage
their own lives, confident that they have access
to the right information and interventions at
the right time should they need more support
Strategic working with NHS partners to enable
people with long term conditions to manage their
health and wellbeing more effectively
Providing quality care that promotes dignity,
and is safe, effective and available when and
where people need it
Our Health, Our Care, Our Say
Improved quality of life
Economic wellbeing
Exercise choice and control
Improved health and wellbeing
Maintaining personal dignity and respect
Freedom from discrimination and harassment
Making a positive contribution
Our NHS Our Future
Fair treating people with equity and dignity
at all times
Safe making sure people are not put at risk
of harm
Effective improving people's health, wellbeing
and quality of life
Personalised responding to individual needs
and preferences
Every Child Matters
Make a positive contribution
Achieve economic wellbeing
Enjoy and achieve
Stay safe
Be healthy
Supporting People
Carers will have access to integrated and
personalised services to support them in their
caring role
Carers will be able to have a life of their own
alongside their caring role
Carers will be supported so that they are not
forced into financial hardship
Carers will be supported to stay mentally and
physically well and treated with dignity
Carers Strategy
Disabled people who need support to go about
their daily lives will have greater choice and
control over how support is provided
Disabled people will have greater access to
housing, transport, health, employment,
education and leisure opportunities and to
participation in family and community life.
Independent Living Strategy
Choice - A real say in where they live, what
work they should do and who looks after them.
Inclusion enabling people to do
ordinary things, make use of mainstream services
and be fully included in the local community.
Legal and civil rights Treat people as
individuals with respect for their dignity, and
challenge discrimination on all ground.
Independence Services provide the support to
maximise independence
Valuing People
Performance Assessment Outcomes (OHOCOS)
Leadership
National Minimum Standards
Commissioning and Use of resources
CSCI
7
Looking for common themes
Stay healthy and recover quickly from illness
Exercise maximum control over their own life
and/or lives of family members
Participate as active and equal citizens,
economically and socially
Live independently
Have the benefit of the best possible quality of
life, irrespective of illness or disability
Sustain a family unit which avoids children
taking on inappropriate caring role
Retain maximum dignity and respect
Putting People First
Quality of life
Choice and control
Health and wellbeing
Focussing on prevention, early intervention and
enablement, rather than crisis management, to
bring long-term benefits to individuals health
and wellbeing
Supporting people to maintain or improve their
well-being and independence within their own
homes and local communities and through
avoiding unnecessary admission to hospital
Ensuring information is Available and
accessible for all to support decision-making
and access to care services, irrespective of
peoples social circumstances and eligibility
for statutory services
Improving peoples health and emotional
well-being by enabling them to live as
independently as suits them
Enabling people to make choices and be in
control of their own care to deliver successful
outcomes first time. Promoting shared decision
making to encourage ownership
LAC 2008(1) Transforming Social Care
Designing systems that build on the capacity of
individuals and their communities to manage
their own lives, confident that they have access
to the right information and interventions at
the right time should they need more support
Strategic working with NHS partners to enable
people with long term conditions to manage their
health and wellbeing more effectively
Providing quality care that promotes dignity,
and is safe, effective and available when and
where people need it
Our Health, Our Care, Our Say
Improved quality of life
Economic wellbeing
Exercise choice and control
Improved health and wellbeing
Maintaining personal dignity and respect
Freedom from discrimination and harassment
Making a positive contribution
Inclusion and contribution
Dignity and safety
Our NHS Our Future
Fair treating people with equity and dignity
at all times
Safe making sure people are not put at risk
of harm
Effective improving people's health, wellbeing
and quality of life
Personalised responding to individual needs
and preferences
Every Child Matters
Make a positive contribution
Achieve economic wellbeing
Enjoy and achieve
Stay safe
Be healthy
Supporting People
Carers will have access to integrated and
personalised services to support them in their
caring role
Carers will be able to have a life of their own
alongside their caring role
Carers will be supported so that they are not
forced into financial hardship
Carers will be supported to stay mentally and
physically well and treated with dignity
Carers Strategy
Disabled people who need support to go about
their daily lives will have greater choice and
control over how support is provided
Disabled people will have greater access to
housing, transport, health, employment,
education and leisure opportunities and to
participation in family and community life.
Independent Living Strategy
Choice - A real say in where they live, what
work they should do and who looks after them.
Inclusion enabling people to do
ordinary things, make use of mainstream services
and be fully included in the local community.
Legal and civil rights Treat people as
individuals with respect for their dignity, and
challenge discrimination on all ground.
Independence Services provide the support to
maximise independence
Valuing People
Organisational outcomes
Performance Assessment Outcomes (OHOCOS)
Leadership
National Minimum Standards
Commissioning and Use of resources
CSCI
8
Building a strategic framework
  • What should be the role of the local performance
    framework?
  • To support service delivery and improvement
  • To articulate shared national and local
    priorities
  • To demonstrate what the service is achieving for
    individuals and communities
  • To promote the direction of travel towards
    future aspirations
  • To account for the contribution of adult social
    care as a partner in the local community
  • To do this we need a balance

Individual outcomes
Population outcomes
What the service is contributing with partners to
wider objectives for the whole community
What the service is achieving for individual
citizens, users and carers
9
Towards a strategic framework
Quality of life
Choice and control
Inclusion and contribution
Health and wellbeing
Dignity and safety
Organisational outcomes

Live independently
Stay healthy and recover quickly from illness
Exercise maximum control over their own life
and/or lives of family members
Sustain a family unit which avoids people taking
on inappropriate caring roles
Participate as active and equal citizens,
economically and socially
Have the benefit of the best possible quality of
life, irrespective of illness or disability
Retain maximum dignity and respect
Planning, commissioning and value for money
What will achievement of these aspirations look
like? Outcomes for individuals and populations
Organisational outcomes
  • How can these outcomes be evidenced?
  • Performance indicators to demonstrate progress in
    achieving outcomes
  • Current NIS measures to be retained
  • New measures requiring development work

Performance indicators
  • Basis for new performance framework as part of SR
    period from April 2011
  • Revised National Indicator Set
  • New Public Service Agreements
  • Basis for CAA Area Assessment

New measures to be adopted by agreement on a
voluntary basis alongside NIS?
Measures to inform CAA Organisational Assessment
10
What does a good PI look like?
Quantity
Quality

How much did we do?
How well did we do it?
Effort
Percent of assessments completed on time
Number of assessments completed
Is anyone better off?
Effect
Number
Rate
Number of assessments leading to an agreed
package of care
Percent of assessments leading to an agreed
package of care
11
Developing the themes
  • Weve now started to build up each of the
    high-level themes across the framework. To do
    this, weve used
  • The outputs of work undertaken to date on this
    agenda, including that by ADASS, CSCI and the
    Brighton Group
  • CSCI grade descriptors to inform the outcomes
    desired
  • Other suggestions and comments from stakeholders
    engaged so far

This is the latest iteration for each of the
themes and gives an illustration of how this will
fit together as a starting block there is much
more to consider as work develops.
12
Quality of life
  • Live independently
  • Have the benefit of the best possible quality of
    life, irrespective of illness or disability
  • Sustain a family unit which avoids children and
    carers taking on inappropriate caring roles

13
Choice and control
  • Exercise maximum control over their own life
    and/or lives of family members

14
Inclusion and contribution
  • Participate as active and equal citizens,
    economically and socially

15
Health and wellbeing
  • Stay healthy and recover quickly from illness

16
Dignity and safety
  • Retain maximum dignity and respect

17
Organisational outcomes
  • Leadership
  • Planning, commissioning and value for money

18
Review of current NIS
  • We have conducted a review of the current 8 adult
    social care measures and the larger group of PIs
    to which social care contributes.
  • This recommended
  • Were now undertaking wider consultation on the
    current NIs through the SSRG network to inform
    this position.

19
Next steps
  • Invite regional ADASS networks and JIPs to take
    the lead in developing one of the themed groups
    in the framework
  • Developing understanding of the outcomes to be
    achieved in consultation with local partners,
    users and carers
  • Scoping potential indicators and reporting on
    early development
  • Continue to engage with key stakeholders at the
    national level.
  • Develop and agree new indicators, looking to
    begin piloting from April 2009 where possible.

20
Any Questions?
  • How do we best involve users, carers and other
    stakeholders both to influence the strategy and
    co-produce PIs?
  • How can we ensure that this work remains on track
    within the overall strategy?
  • What desire is there to reframe the performance
    framework in this way? Do Councils want to
    develop further informal networks for sharing
    performance information alongside the formal NIS?
  • And any other questions you have on the work to
    date
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