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Making policy count: Developing performance indicators for health and social care partnerships

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Paper 3 Making policy count: Developing performance indicators for health and social care partnerships ADASS Personalisation Network, January 7 2010 – PowerPoint PPT presentation

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Title: Making policy count: Developing performance indicators for health and social care partnerships


1
Making policy count Developing performance
indicators for health and social care partnerships
Paper 3
  • ADASS Personalisation Network, January 7 2010
  • Suzy Powell
  • Local Government and Regional Policy, DH

2
Where are we now?
  • Current performance systems are complex.
  • Indicators do not always overlap.
  • Representation of indicators is unequal.

3
The current performance systems are complex
Performance framework for LAs and their partners
Policing and Community Safety framework
NHS performance framework
Central Government performance framework

There is a complex web of performance
architecture, with several overlapping
frameworks repeating the similar
objectives. Indicators occur in more than one
framework, with different codes and
definitions. The processes and timescales for
local planning are poorly aligned between
different services.
Local Government White Paper
NHS Operating Framework
Public Service Agreements
Departmental Strategic Objectives
Policing Green Paper
National Indicator Set
NHS Vital Signs
APACS Indicators
LA Business Plans
Can cause confusion around how national and local
priorities align, making the job of partnerships
more difficult.
PCT Operational Plans
Policing Plan
Local Area Agreements
4
Indicators do not always overlap
Public Service Agreements (152 indicators)
5 of PSAs 11 of VS
5 of PSAs 25 of APACS
NHS Vital Signs (64 indicators) 37 in neither
PSAs or NIS
APACS (36 indicators) 22 in neither PSAs or NIS
13 of PSAs 30 of VS 10 of NIS
7 of PSAs 28 of APACS 5 of NIS
22 of VS 7 of NIS
25 of APACS 5 of NIS
National Indicator Set (188 indicators)
5
Representation of indicators is unequal
  • For adult social care, the representation amongst
    the national list of priorities set out in the
    NIS is poor both in quantity (only 8 of the 188
    indicators are solely attributable to adult
    social care), and quality.
  • Few of the measures display an outcomes-focus or
    demonstrate what is achieved for people, and
    fewer still display a coherent link to Putting
    People First and the transformational agenda.
  • For other health partnership priorities, the
    situation is better, but problems persist with
    individual indicators, and the overall picture is
    still unclear and poorly aligned with the NHS.

188 National Indicators
31 health and wellbeing
8 adult social care
6
The project
  • Responding to this situation, this project aims
    to
  • Deliver a suite of PIs from which the next
    iteration of the national performance frameworks
    (NIS, Vital Signs and PSAs) will be drawn for
    local partnerships,
  • Develop PIs which
  • Demonstrate real outcomes for those who use
    services and their communities, not just
    processes or inputs,
  • Help Councils to drive improvement in service
    provision by focusing on what really matters, not
    what is easily collected,
  • Provide a clear link to shared policy priorities,
    and together form a coherent picture of what the
    Council has achieved for those it serves,
  • Make the best use of the different elements of
    the performance framework (LAAs and CAA).

7
PrinciplesWhat does Government say about
outcomes?
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
High Quality Care for All
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
8
PrinciplesWhat does this tell us about 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
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
Choice and control
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
High Quality Care for All
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
9
Developing the detail
Following the thematic approach set out, we have
started to build up the detail in each area,
using a variety of existing sources Two Local
Authority-led pilots, in conjunction with the
regional ADASS performance management groups,
are developing PIs drawn from new data
collections. The Personal Social Services
Research Unit at the University of Kent is
developing PIs related to the new national
survey programmes for social care users and
carers. A further LA-led pilot is developing PIs
based on existing data collections related to
adult safeguarding. DH is developing proposals
based on existing national data which is not
currently being used for performance purposes
(e.g. NHS admissions data). CQC is developing
PIs using its own data on commissioning and
quality in residential and domiciliary care.
10
Outcome focused reviews
  • The South East Performance Managers Group is
    leading work
  • developing a PI based around outcome-focused
    reviews.
  • PI concept at the point of assessment or care
    planning, to ask the
  • individual what things matter most to them and
    record this information.
  • At the review, to ask for the individuals view
    on whether these personal
  • aims have been met, or if progress is being made
    towards them.
  • Issues
  • what question the person is asked.
  • who asks the question and does this affect the
    ambition or response.
  • how attributable are the outcomes to adult
    social care.
  • how can this be a national indicator.

11
Outcome-focused reviews
  • Approach following discussions with local
    authorities, a package around this agenda has
    been proposed
  • National A PI for the future NIS which acts as
    a driver for the policy of outcome-focused
    reviews. The PI would be along the lines of all
    those who have, or should have, undergone a
    review in the year, the proportion undergoing an
    outcome-based review.
  • Local A process for implementing OBRs which can
    be nationally kitemarked by DH, ADASS and CQC
    as best practice. This model will be published
    alongside the national PI in guidance. It will
    not be mandatory.
  • Assessment To work with CQC to align the
    Self-Assessment with both the national and local
    PIs. The SA would be the point at which Councils
    are required to evidence the robustness of their
    own OBR process (if different from the kitemarked
    model), and the point at which they should inform
    CQC of the data which they have extracted from
    the process.

12
Experience indicators from surveys
  • Work started on the new PPF survey programme in
    early 2008, following the publication of the
    first National Indicator Set.
  • Since then, we have made progress on a number of
    fronts
  • Developed a new survey approach
  • Commissioned PSSRU to develop the new survey
  • Produced a draft of the survey for discussion
  • Held a national consultation on the future
    options in summer 2009
  • and were now preparing for piloting in
    Councils in early 2010
  • before running the first national survey in
    2010/11
  • The new Carers Survey has been in development
    since 2007 and was piloted in 25 LAs in April
    2009. It is being run nationally, on a voluntary
    basis, for the first time in 2009/10.

13
Next steps PPF Survey
  • We plan to pilot the PPF Survey in early 2010,
    with additional studies to assess impacts of the
    survey
  • Understanding the impact of being supported to
    complete the survey
  • Understanding the issues in residential care
  • Making the survey accessible for those with
    learning disabilities and,
  • Exploring the role of advocates.
  • The development of the PPF Survey is iterative
    we wont achieve all the aspirations for the
    first year.
  • Future options might include
  • Testing other collection methodologies
  • Further alignment with the NHS survey programme
  • Expansion to other groups self-funders, carers
    etc.
  • Develop the Capacity for Benefit model
  • Develop surveys in languages other than English
  • Streamline with regulatory requirements.

14
Next steps Carers Survey
The Carers Survey will run nationally in 2009/10
for the first time. Based on the feedback and
data from this first survey, further developments
may be made to ensure the survey is robust. We
have commissioned PSSRU to lead a pilot to
develop proposals for a PI to be drawn from the
new survey. This work will being in February
2010, and will be led by an Advisory Group
including LA and carer orgs. Some of the issues
to be considered include The balance of
different outcomes in building a composite
outcome PI how should this be weighted? How
regularly should the Carers Survey be repeated
to support the PI? If annually, this would mean
two national surveys per year. Would a biennial
survey be sufficient to support improvement and
planning?
15
Timeline
  • By January 2010, to have completed scoping across
    all health and social care partnership areas to
    establish a list of PI proposals for further
    development, based on analysis of current PIs and
    identified gaps
  • Over January-April 2010, to support PI pilots and
    development leads in undertaking data development
    with a view to determining the robustness of
    proposals
  • By May 2010, to agree the suite of recommended
    PIs in outline (i.e. the titles and concepts, but
    not all technical detail). We will bring
    together all the workstrands and review proposals
    against common criteria (see Annex A) to
    prioritise the strongest candidates and,
  • By September 2010, to have completed data
    development to allow for future national PIs to
    be published, in keeping with the convention of
    six months notice for Local Authorities.

16
Get involved
  • There are many ways to support this work
  • Support development work or pilots for specific
    new PIs
  • Support existing pilots by shaping guidance and
    technical detail or testing approaches in your
    own area
  • Test out candidate PIs and feed back on their
    operation and value
  • Suggest other ideas to fill gaps in the
    framework
  • Comment on the strategy and approach to
    performance or,
  • Join the online PI development community
  • https//govx.socitm.gov.uk/spaces/nisdevelopment
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