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

Paper 3. Making policy count: Developing performance indicators for health and social care partnerships. ADASS Personalisation Network, January 7 2010 Suzy Powell Local Government and Regional Policy, DH. Where are we now?. Current performance systems are complex.

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

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  1. Paper 3 Making policy count: Developing performance indicators for health and social care partnerships 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 Central Government performance framework NHS 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. Public Service Agreements Departmental Strategic Objectives NHS Operating Framework Local Government White Paper 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 partnershippriorities, 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? Putting People First 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 Exercise maximum control over their own life and/or lives of family members Participate as active and equal citizens, economically and socially Stay healthy and recover quickly from illness Retain maximum dignity and respect Ensuring information is Available and accessible for all to support decision-making and access to care services, irrespective of people’s social circumstances and eligibility for statutory services 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 Improving people’s 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 Exercise choice and control Making a positive contribution Economic wellbeing Improved health and wellbeing Maintaining personal dignity and respect Freedom from discrimination and harassment High Quality Care for All Effective – improving people's health, wellbeing and quality of life Personalised – responding to individual needs and preferences Fair – treating people with equity and dignity at all times Safe – making sure people are not put at risk of harm Every Child Matters Enjoy and achieve Make a positive contribution Achieve economic wellbeing Be healthy Stay safe 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 Valuing People Independence – Services provide the support to maximise independence 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.

  8. PrinciplesWhat does this tell us about common themes? Putting People First 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 Exercise maximum control over their own life and/or lives of family members Participate as active and equal citizens, economically and socially Stay healthy and recover quickly from illness Retain maximum dignity and respect Quality of life Health and wellbeing Choice and control Ensuring information is Available and accessible for all to support decision-making and access to care services, irrespective of people’s social circumstances and eligibility for statutory services 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 Improving people’s 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 Exercise choice and control Making a positive contribution Economic wellbeing Improved health and wellbeing Maintaining personal dignity and respect Freedom from discrimination and harassment Inclusion and contribution Dignity and safety High Quality Care for All Effective – improving people's health, wellbeing and quality of life Personalised – responding to individual needs and preferences Fair – treating people with equity and dignity at all times Safe – making sure people are not put at risk of harm Every Child Matters Enjoy and achieve Make a positive contribution Achieve economic wellbeing Be healthy Stay safe 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 Valuing People Independence – Services provide the support to maximise independence 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.

  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 individual’s 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 we’re 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 won’t 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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