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Star rating is right

Posted: 31 January 2002 | Subscribe Online


The difficulty of applying fair standards to all departments, the lack of resources, local factors... None of these mean that applying transparent performance measurements is wrong, says Anna Coote.

For too long, social services have been undervalued in our country. Blamed when things go wrong. Ignored when things go right. Often expected to fail. Sometimes set up to fail." So said health secretary Alan Milburn at the National Social Services Conference in October last year.

For many in his audience, he never spoke a truer word. But the main item in his speech went down like a lead balloon. This was his announcement of the new "star-rating" system for social services departments, based on procedures already in place for health care trusts. For hard-pressed social workers, it sounded like more surveillance, more interference, more blame and vilification. The last thing they needed at the start of a new recruitment drive.

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It cannot be comfortable for any organisation to find itself subjected to absolute and relative appraisal - in public. Not only to be judged against a set of standards, but also to be measured against others - to be forced to compete for a place in the charts, where everyone can see and compare. There are some good arguments in favour of this approach.

The case for rigorous performance management is unanswerable. Social services are publicly owned, financed by our taxes and intended to meet the needs of the most vulnerable members of society. Why should we put up with anything less than consistently high standards? And is there any justification for keeping the quality of performance a secret? Surely, people have a right to know whether their local social services department is better or worse than others? Freedom of information is an important underpinning of a democratic welfare state.

For higher scoring departments, there are promises of greater autonomy - generally considered a positive development in social services, as in health care. If this is genuinely a move by central government to loosen its grip and allow local managers to manage, it can only be welcomed. And if the end result is better services across the board, who can argue with that?

On the down side, critics of NHS league tables point out that performance measurement is a fiendishly inexact science. A hair's breadth can separate categories, so that trusts yielding similar results end up being treated quite differently. A common set of indicators is applied to organisations operating in widely differing circumstances, yet it is difficult and often impossible to control for local factors so that the final score is fair. It is hard to justify burdening health trusts or social services departments with responsibility for conditions they cannot control - such as unemployment, for example, or poor housing or a large refugee community? All these are likely to affect their client base, and the strains and constraints upon their ability to meet local needs.

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There are also crucial differences between health and social care that make introducing a star-rating system a far more delicate task where social services are concerned. First, the government is pouring billions of pounds into health but not into social services - so it will be a tougher struggle for social services departments to improve performance. Secondly, star rating is apparently offered as part of a policy package that includes more choice for service users.

Increasing choice is always tricky, but it may be easier in the health sector than in social care, while for many who are involuntary social work clients, talk of choice is just a cruel joke. Thirdly, the NHS is still a cherished national treasure, while social services are, as Milburn put it, undervalued, ignored and either seen or set up to fail. Finally, improvements in social services are seen by government as a means to an end: to shift frail elderly patients out of hospital and thereby help the NHS achieve its targets. This is bound to influence the allocation of resources within social services, not necessarily in ways that benefit their neediest clients.

A useful test of a policy innovation is to imagine what would happen if it were implemented and then reversed. Suppose it were announced later this year, for example, that there would be no more public information about the relative performance of health trusts. The government would be accused of suppressing politically awkward data. There would be a campaign to protect the public's "right to know". It is much easier to start a flow of information than to stop it. Transparent performance measurement is not a bad idea. Everything will depend on the sensitivity with which the new system is designed and handled.

Anna Coote is director of public health, The King's Fund.



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