Opposition forces DH to reject payment by results scheme

The government has rejected a national payment by results scheme for adult social care after it faced unanimous opposition from sector leaders.

It backed off from the idea after social care leaders said it was “inappropriate” for the sector because of the difficulties in ascribing national tariffs to local contracts between councils and providers.

The plan was mooted in a consultation on a new quality framework for adult care, published last November, as a way of incentivising providers to improve quality. The Department of Health issued the final framework yesterday.

Responding to the consultation, it said “respondents were almost at one in considering [national payment by results] approaches inappropriate in adult social care”. The Local Government Group said it ran counter to the government’s emphasis on localism, while the Association of Directors of Adult Social Services said it would support a “more limited local approach”.

The DH said it would now consider what actions would “incentivise quality improvement”, in the context of the framework. The framework’s overall aim is to make councils accountable downwards to users and the public for performance, rather than upwards to ministers, and the DH said it would not be used as a national performance management tools.

It includes four domains or themes outlining what social care users, their carers and families should expect from services, with each domain including outcome statements describing more specifically the outcomes to be reached, each of which will be measured by a set of indicators.

The domains for 2011-12 are:

• Enhancing quality of life for people with care and support needs.

• Delaying and reducing the need for care and support.

• Ensuring that people have a positive experience of care and support.

• Safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm.

Among the outcomes that people can expect are:

• Carers can balance their caring roles and maintain their desired quality of life.

• People manage their own support as much as they wish, so that are in control of what, how and when support is delivered to match their needs.

• Earlier diagnosis, intervention and reablement means that people and their carers are less dependent on intensive services.

• People are protected as far as possible from avoidable harm, disease and injuries.

As previously reported, instead of the now-scrapped annual performance assessment of councils’ commissioning, authorities will be expected to produce local accounts of their performance.

Council performance against outcome indicators will still be published annually, alongside a “national data set for adult social care” capturing raw data on service quality.

Paul Najsarek, joint chair of the Adass standards and performance network, said the document recognised that improvements were driven by strong local leadership and accountability to service users and citizens.

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