Performance indicators and carers: a flawed relationship

Despite the increase in expenditure described in the Commission for Social Care Inspection’s State of Social Care report published earlier this year and the increase in the number of carers’ assessments completed by local authorities, carers are still noticing a gap between their needs and what they receive in the way of services. This is the “brownie points” culture forced on to workers by the perverse incentives created by a performance indicator that measures process rather than performance.

In the rush to capture numbers of carers’ assessments and commissioned services, there was a risk of the tick-box culture taking over. If much of the local authority support for carers is in the voluntary sector and directly accessible without a carers’ assessment – which has to be good news for carers – local authorities score badly in failing to reflect the benefits of such services. And it seems as though in some cases directors of adult social care may have sought to move funding from carers’ centres, or Crossroads, or put in additional processes just so the work done with a carer could be captured for the indicators.

We know from experience that carers resent having things done to them that don’t have an obvious purpose. My experience of working with local authorities in England and Wales shows that staff often feel as frustrated as carers about the point of undertaking a time-consuming and sometimes intrusive assessment. Trying to sell it as a positive experience where carers can say what their role is, describe what would help support them in their role and maintain their health and well-being often feels like a fruitless task when they are driven by the need to meet targets around the number of assessments completed rather than the quality of outcomes for carers.

The beacon authorities for supporting carers (Hertfordshire, Rochdale, Sefton and Sunderland) have produced a DVD and video where 18 carers talk about their experiences of assessments and what really has made a difference to them. Although some of the good practice mentioned by the carers relates to local initiatives, the beacons have been careful not to put anything in the DVD that couldn’t be delivered by front-line staff anywhere taking a bit of time to listen, and using resources that should be available everywhere, even during times of financial restraint.

None of this is rocket science. Carers have always been fairly modest in their demands. The good news from the DVD is that often what they most value is being listened to and workers doing what they said they would do, rather than huge packages. When I have used the DVD as part of the training that I do with local authorities, participants have often been inspired by the small things that make a difference for example, carers talk about the value of meeting other carers, help to access adult education, having an emergency plan in place even though they haven’t had to use it.

Now what we need is a more effective measure of performance around carers reflecting what matters to them and how well supported they are across the board not just in commissioned services. Flexible provision requires flexible measures of performance.

Sally Anfilogoff is an independent consultant and trainer in the public sector

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This article appeared in the 27 September issue under the headline “Gap remains between what carers need and what they get”

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