Star rating is right

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.

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.

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.