Hackles raised after inspectors accuse councils of ‘coasting’

The 2005 star ratings told a story of overall improvement (news, 1 December).

As has been the case since the ratings were introduced in 2002, there was a year-on-year increase in the average score, from 1.77 to 1.92, a larger rise than in 2004.

Three-quarters of councils scored two or three stars and just three authorities were given no stars.

Of the 46 indicators that inform the ratings, average performance improved in 21, stayed the same in six and dropped in eight. The rest were not comparable with 2003-4.

Improvement was apparent particularly on the adult side: delayed discharges and admissions to residential and nursing care were down and the use of direct payments up.

Progress was slower on children’s priorities, with only slight increases in the long-term stability of placements for looked-after children and in their educational achievement.

The message from the Commission for Social Care Inspection has been a tough one, though, and not just for those councils in the bottom two categories or those that dropped down this year.

For the second year running, it has pointed a finger at “coasting” councils – those that have failed to improve sufficiently – although the number of such authorities has dropped from 51 to 22 since 2004.

And it has identified problems afflicting councils in general.

One of these is services for carers. A new indicator for carers revealed that only 65,000 were receiving direct services.

Although this figure excludes indirect services for carers – for instance, respite provided by home care for their loved ones – it represents a small proportion of the estimated 900,000 who put in more than 50 hours’ caring a week.

David Behan, captionChief inspector David Behan wants authorities to commission more information services and support groups for carers. He says: “It’s absolutely fundamental that these individuals receive proper support.”

Imelda Redmond, chief executive of Carers UK, welcomes the CSCI’s focus on carers this year, expecting it will produce a shift in authorities’ practice. She says: “We often hear from local authorities that they don’t do an assessment because they can’t offer carers anything. We think that’s short-sighted of them – for instance, they can refer them to a voluntary organisation.”
Commissioning of services was another problem identified on the adult side. In its report on the ratings, the CSCI says commissioning must be more efficient and based on a better analysis of local need.

The call comes at a critical time for councils. Strong strategic commissioning is expected to be at the heart of the forthcoming white paper on social care and health, with its vision to shift services away from acute settings into prevention. And the government’s reforms of primary care trusts are intended to strengthen their commissioning function, which has come in for criticism (news analysis, 1 December).

Martin Green, chief executive of the English Community Care Association, says there are significant problems with councils’ performance in this area.

He says: “They think only in terms of what they are prepared to pay for but what they should be doing is thinking about the needs of their whole community. There’s no clear strategic direction Martin Green, captionfor what commissioning is there for.”

He calls for the CSCI to be given the power to punish councils for poor commissioning, in the same way as it can issue enforcement notices against poor providers.

Questions about commissioning are inseparable from questions about resources, however.

Behan says councils can make better use of their resources by commissioning more preventive services, but adds: “Efficiency can contribute so much but there’s a fundamental question about whether there are sufficient resources.”

For the ADSS and the LGA, this year’s improvement has been particularly impressive given resource constraints.

ADSS president Julie Jones says: “Despite the continuing, widely acknowledged underfunding of our services, [the CSCI’s] assessment tells us that most councils are serving most adults and children well.”

This explains the ADSS’s anger with the CSCI’s “coasting” claims.

Jones says: “Coasting suggests a lack of energy. There’s no lack of energy. Another way of looking at authorities that are described as ‘coasting’ is to say they are sustaining their performance in difficult circumstances.”

Directors have also raised questions about the validity of some indicators in judging performance. Chief among them are those concerned with promoting home care as an alternative to residential care, which, claims Jones, does not reflect much of councils’ preventive work.

For instance, indicator C32, measuring the proportion of older people helped to live at home, does not cover those receiving extra care or sheltered housing, despite their increasing use as an alternative to residential care.

Behan sympathises with their concerns and says these issues will be addressed in the overhaul of the performance framework for adult services to take account of the outcomes in the white paper.

These are expected to resemble those in the adult green paper – improving users’ health, quality of life and economic well-being, promoting choice and personal dignity, tackling harassment and discrimination, and enabling people to contribute to their communities.

Behan insists this reform to the inspection system should happen in one go to provide councils with stability. However, such stability may be compromised by a continuing debate about the purpose and structure of inspection, notably the extent to which it should be determined by national or local priorities.

The arrival of local area agreements, in which councils and their partners agree targets with the government in exchange for funding freedoms, points the way to a more localised inspection regime rather than a single set of indicators.

The comprehensive performance assessment for councils, of which the star ratings form a part, will be reformed in 2008, and many inside and outside local government are calling for a shift in this direction.

Jones is among them. She says: “A balance needs to be struck [between local and national targets]. But it would require everybody to be at a higher level of performance before you can trust that to happen.”

Star ratings in full from CSCI website at www.csci.org.uk 

Progress of children’s services slowed by structural change
The past year has been turbulent for councils trying to implement the Children Act 2004 and meet the demands of new annual performance assessments, reports Amy Taylor.

The star ratings show that more than 75 per cent of councils are now serving most adults well but only 63 per cent are achieving this in children’s services. Adult services are also improving more quickly.

Although some councils have improved their children’s services and implemented the changes, such as the creation of children’s services departments, there is a feeling that the effort of restructuring has hindered performance. Stephen Meek, programme director for children at the Local Government Association, says: “Councils have been looking at internal structure and that probably has had an impact on the rate of progress.”

He says that while leadership also has an influence on performance, some councils have much more established children’s services departments than others, making them better equipped to do well.

Colin Tucker, director of children’s services at Sandwell Council, speaking in a personal capacity, agrees that the Children Act changes may have had an effect, with inspectors taking an outcomes-based approach more quickly than some local authorities.

This year Sandwell was found to be serving most adults well with promising capacity to improve, but dropped from one star to zero because of its children’s services.

Three quarters of councils scored in the top two grades, 3 or 4, in the first annual performance assessment ratings for children’s services, but overall performance was better in education than in children’s social care. While 76 per cent scored a grade 3 or 4 in education, this fell to 65 per cent for children’s social care.

Paul Robinson, director of education at Wandsworth Council, says some of the assessment ratings are “questionable” and argues that the process is weighted towards provision for vulnerable children rather than a general picture of how a local authority is performing.

Such a focus could be more detrimental to education ratings because vulnerable children are less representative of its client group compared with that of social care.

Meek predicts that the gap in performance between children’s and adult’s services will narrow as the Children Act changes are bedded in.

And with the social care and health white paper to be published next year, adult services will be the focus of change and subsequent inspection results could look very different.

Serving clients well

Children’s services

  • 50 per cent of looked-after children achieved at least 1 GCSE or a GNVQ (2003-4: 49 per cent).
  • 50 per cent of children looked after for at least four years had been in a foster placement for at least two years (49 per cent).
  • 78.1 per cent of looked-after children had a dental check and health check in the previous 12 months (75.1 per cent).
  • 99 per cent of child protection reviews were completed in time (95 per cent).

    Adults’ services
  • 91 in every 10,000 older people admitted into residential or nursing care (2003-4: 97).
  • 57 in every 100,000 adults receiving direct payments (li).
  • 33 delayed discharges from hospital per 100,000 older people (46).
  • 11.5 households gained intensive home care per 1,000 population aged 65-plus (11).
    (See graphs above.)

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