Older People's Best Value Review

Report to:

Adult Services Panel

Performance Panel

Date:

21st November 2005

24th November 2005

Subject:

Older People's Best Value Review

Report of:

Director Of Social Services

Contact officer:

Steve Peddie 01942 827854

Purpose / summary:

To present to Panel Members an update on progress in older people’s services and to request that improvement plans detailed under this review are discharged. Ongoing work and performance monitoring under the umbrella of the ‘Innovations Forum’ is monitored through Performance Plus™.

Alternative options considered and reason for selecting the one recommended:

The report is for Members information and advice. Alternative options are not applicable

Recommendation / decision:

That the report on the Older People Best Value Review be accepted and approved.

Key Decision:

This report does not involve a key decision.

Implications:

Financial:

There are no direct staffing or financial implications to this report

Staffing:

Policy:

No

Equal Opportunities - Has a Diversity Impact Assessment been conducted?

No

Wards affected:

All

Special Interest Members – Which have been consulted

None

Tracking/Process:

Performance Panel

Consultation

Ward Members

Partners

24th November 2005

-

-

-

Panel

Overview & Scrutiny

Cabinet

Council

21st November 2005

-

-

-

There are no Background Papers to this Report within the meaning of Section 100D of the Local Government Act 1972.

Proper Officer

Bernard Walker

Date

2nd November 2005

1. Background

1.1 The Best Value Review of Services to Older People was undertaken in 2002 and reported on in 2003. Subsequent to this Review there have been considerable changes in the reporting environment:

1.2 Wigan Council, like all councils, is judged twice annually on its performance in all areas of social care for adults and children. Hundreds of individual cells of information are completed in one particular return, the ‘Delivery Improvement Statement’. 28 adult services performance indicators in particular have greater weight (PAF indicators) but the Commission for Social Care Inspection holds performance meetings three times per year within councils and undertakes announced and unannounced regulatory activity throughout the year as part of its regulatory activity.

1.3 Performance information is summarised in an annual letter from CSCI (a ‘record of achievement’). The annual letter containing the provisional judgement for 2005/6 comments:

“The Council …is implementing a coherent strategy for responding to national priorities and can show good progress year on year and in some areas, sustained high performance. There is evidence of clear links between strategic objectives and front-line performance and an established culture of continuous improvement. This is particularly the case for older people’s services where there was strong performance to further extend the balance of care and choice.”

“Wigan has continued to build, year on year improvements in outcomes for Older People, in some cases from an already high baseline. There has been further progress to support more over 65s with intermediate care services and to maintain minimal delayed transfers from hospital. Emergency admissions appear to be above the IPF average.”

“The Council has delivered further increases in intensive home support coverage ahead of its planned target and the IPF average. Good progress has been made to stem the rate of supported admissions for Older People.”

“A Pilot Area Agreement (LAA) target ....should deliver further improvement in outcomes and further investment in services.”

“Plans and resources have been put in place with the PCT/Trust and other partners, including service users and carers, to tackle falls and strokes through specific preventative services. A new one-stop multi-disciplinary prevention service to respond to people with low to moderate needs has been established. The Council is also reporting an 8% increase in assessments for new service users over 65. The Single Assessment process is reported to be fully implemented locally, with all key milestones met.”

“The Council through it’s partnerships with universities has commissioned a range of studies to underpin strategic needs assessment. Examples include the research programme on loneliness in older people, which is commendably using Older People as researchers for the project.”

“The Council has been awarded a Charter Mark for its Occupational Therapy services. The contribution of service users and carers was commended as a major factor leading to the award.”

1.4 In terms of the standard on cost and efficiency CSCI reports: “The Council serves all people well in relation to cost and efficiency. Commissioning for services is based on sound analysis of local population needs, including minority groups, and is successful in balancing cost and quality requirements. Spending on Adult Social Care Services has increased significantly over the last 3 years although the outturn of £268.5 (per capita) remains below the IPF average of £303. The Council has a strong track record of delivering year on year efficiencies for social care services in terms of investing in quality, choice and coverage of services, while maintaining comparatively lower unit costs. Good progress on needs assessment, service commissioning and in reducing sickness absence. The Council has a track record of probity and efficiency across social care services and there is a higher level of engagement already in Health Act Flexibilities, with joint commissioning, some integrated teams and pooled budgets both in place and developing.”

1.5 Wigan received in November 2004 the following overall rating on its Adult and Older Peoples services:

The 2005 judgement is due shortly and is not expected to be a worse outcome than this, since the overall value of performance indicators has improved again this year by 5% on last year.

1.6 Over 2003/4, Internal Audit conducted a review, which it reported on in draft form internally to the Department in December 2004 as part of its 2003/4 schedule and as part of the Best Value Compliance Protocol approved by Performance Panel.

1.7 This review was conducted in accordance with this protocol and utilised a matrix format documenting the current position for each task. As a result of the review a fairly extensive list of improvement areas were itemised for action to improve. These ranged from the need to develop a wider range of integrated services, producing relevant key information, reviewing billing systems, increasing take-up of Direct Payments, increasing the numbers of assessments, increasing the numbers of assessments leading to service provision, reducing hospital discharge delays, undertaking staff skills analysis, discussing local priorities of older people, helping more older people to live at home, reducing unit costs, increasing carer assessments, increasing intensive home care and improving access to ethnic minorities.

1.8 The review reported that, in discussion with managers, it was considered that a number of tasks were no longer relevant – given, for example, that performance indicators may have been deleted from the Department of Health’s performance assessment framework.

1.9 There were a number of instances where, for example, ‘Older people helped to live at home’, ‘assessments of older people’ or ‘delayed discharges’ were described by internal audit as “action requiring significant improvement”; they were, at the same time described by the Commission as ‘good’ or even a ‘top banded performance’, because the targets we set internally were less realistic.

1.10 A particularly perverse situation occurred with the unit cost of residential and nursing care where the Department’s unit cost last year became too low to rate highly with the Commission, and was flagged up as an area of concern, whereas it is not low enough for the Best Value Improvement Plan. This situation has been referred to within reports to Cabinet on the judgement by the Audi Commission on ‘Value For Money’.

1.11 Since April 2005, the Department, following Cabinet approval, has been working on the implementation of Fair Access to Care Services in Adults Social Care, which has the effect of raising eligibility criteria. This policy decision is reducing the number of people who can be ‘counted’ as ‘helped to live at home’ (including Direct Payments). This policy decision is necessarily, also affecting how effectively the Department can achieve some of those original targets in the improvement Plan following the Best Value Review.

2. Proposals:

2.1 It is with this complicated new context in mind that the Department seeks, under existing protocols, to be discharged from its obligations regarding this Improvement Plan.

2.2 The original Review Improvement Plan set 4 objectives. One of these focuses on consultation for the Single Assessment Process, where this has been implemented already. One of them deals with public awareness of Fair Access to Care Services, where our Delivery Improvement Statement made it mandatory to make criteria public on the website by 1st April 2003. and it has been in place since, then reviewed annually.

2.3 One of the improvement plan focuses is on gaps in provision – particularly of public information. The Joint Review rated Wigan as the best it had seen at provision of public information; through subsequent annual questionnaires the public of Wigan has reinforced this view. The renewed focus on the Access to Services Best Value Review is a process in which the Department is fully engaged.

2.4 In terms of billing, there has been a lot of work on billing with the only outstanding work pending being on ‘Agresso’ implementation, which is a corporate initiative in which, again the Department is fully engaged and sharing resources.

2.5 Direct Payment take up is very strong (as our performance letter indicates) but targets were set in the absence of comparator data. This now sets our current (but below that original target) performance as high, which is why year on year targets have been amended. The performance indicator E49 has been dropped from the PAF dataset and replaced with two new indicators on which Wigan is a top performer in both. The definition of E50 has been radically changed and it no longer measures the same thing so it is impossible (and against performance directives) to ‘maintain’ the old target.

2.6 Data supports the fact that Wigan has very few (if any) attributable delayed hospital transfers but ‘on the spot’ collection of this data from NHS sources is complicated (and these are often contested before validation). The Department believes that CSCI is applying sufficient pressure to drive down any delays.

2.7 Targets for PAF performance indicators C32, B12 and so on have been changed annually according to discussions with the Commission, in light of changes in definition, managing the market and so on. Comments at the beginning of this document, made by the Commission, answer most of these areas. Wigan has an excellent performance helping people to live at home, has made good progress in reducing residential placements and altered the balance of care provision (top band performance on B11). In order to manage the market Members have approved consolidation of terms and conditions for Home Care staff, which has not reduced costs but has enabled us to plug a gap in weekend care provision where people’s care services were threatened. Services to carers are improved but need to improve further, as do services to ethnic minorities.

2.8 The work for the modernisation of services for older people can be encapsulated in what is being termed the ‘Innovation Forum’ project. This work is being conducted under the oversight of the National Audit Commission. The work of the forum is helping the Council to achieve targets within the ‘Local Area Agreement’ and the Older People ‘key line of enquiry’ in Comprehensive Performance Assessment.

2.9 There is one overall target for the Innovation Forum: to reduce by 2008 the number of hospital bed days by 20% against the projected target. There are 6 strands of work representing 6 levels of intervention; at the lowest level this is about increasing universal services at the voluntary sector / volunteering level. At the highest level, or apex, is the need to reduce acute care. At the cornerstone of the strategy is the need to build up a ‘preventative strategy’, focusing on:

2.9 All of this work is being performance managed. Work is being co-ordinated through the Assistant Director for Commissioning and is reporting to the Health and Social Care Partnership.

3. Conclusions

3.1 Panel Members can be assured of the accountability measures within the national performance assessment arrangements, which are signally different from those of other departments. These are augmented by the arrangements within the Health Partnership to monitor the progress of the ‘Innovations Forum’ project, driving the modernisation of older people’s services which are set up within Performance Plus. Recent progress in the use of Performance Plus now enables all partners to view and use data within the system.

3.2 Older people’s services in Wigan appear to have attracted a number of accolades. Services have improved and are recognised to have done so. The Joint Review Action Plan was a comprehensive plan, which in many ways has superseded many Best Value Action Plans. Comprehensive performance reports are produced several times a year to the Commission.

3.3 Services to older people improved last year from serving most people with promising prospects to having excellent prospects; this year there has been further improvement. The basis of this judgement should give reassurance that better value is indeed being provided through the Council to Older People in Wigan.

3.4 The Department seeks to be discharged from further requirements to report on progress in respect of the Best Value Review for Older people.

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