Adult care: star ratings and the seven outcomes see councils improve

For a council whose attempts at adult social care provision were rewarded with just one star by the Commission for Social Care Inspection in 2002, Tower Hamlets should be an inspiration for other local authorities. Because two years after the single-star ignominy, inspectors awarded its adult social services the maximum three stars. A stellar performance indeed for the department’s work in one of the UK’s most deprived areas.

However, the star system is being replaced by an assessment framework based on the seven outcomes for service users proposed in the Department of Health white paper, Our Health, Our Care, Our Say.

The shake-up comes just as CSCI has reported an increase in the number of top performing councils.

Infallible system

So is it possible to compare past and present performance or do directors think the goalposts have been moved? More importantly, does the rating system help to improve services?

John Goldup, Tower Hamlets’ corporate director for adult health and well-being, is in a good position to see both sides of the argument: he was in charge of adults’ services as the stars started to shine.

“I don’t think anyone would claim the star-rating system to be infallible,” he says. “The stars are just the headline; what underpins them is a more detailed assessment that I think has been strengthened in the past year by the seven key outcomes. It’s the best measure we’ve got, but I’m sure there are local authorities that feel that their star rating doesn’t accurately reflect the reality of what they do.”

Many of the seven outcomes have proved a sticking point for authorities. Only about one in 10 were assessed as providing excellent outcomes under “freedom from discrimination” and a quarter of councils delivered only adequate outcomes for “freedom from discrimination or harassment”. Goldup points out that before an authority can succeed with these it needs to get the basics right, such as response times to clients. Some of the outcomes are more challenging than others, however, particularly  those seemingly outside the directorate’s control.

“For example, promoting economic wellbeing, given that we’re not primarily an income support agency,” Goldup says. “The important thing to recognise is the impact of your work. You can map the work we do with carers across all the seven outcomes – supporting carers to remain in employment clearly makes a major contribution to economic well-being. It’s also a huge health and quality of life issue and it gives people more choice and control. The seven  outcomes have been helpful in getting us to realise the wider impact we can have.”

Despite the accolades, the Tower Hamlets team is far from complacent. “We’re pleased with what we’ve achieved, but we’re very ambitious with what we’re going to achieve in the future,” Goldup says.

Partnership working

Meanwhile, the 28 one-star authorities are starting to learn the same lessons that Goldup has, including the need for strong partnership working. For instance, Wiltshire, stung by its one star and “uncertain” prospects, has formed ties with the local primary care trust, mental health partnership and voluntary sector organisations.

But for other authorities poor performance can also lead to change at the top, as the London Borough of Harrow found out. Paul Najsarek was installed as adults’ services director last autumn after the department  received one star, the score it has received every year since the rating system began. “The wider assessment framework hasn’t helped us,” he says. “But I can see that considering broader issues over time would be helpful in getting a more rounded view of what we’re doing.”

Najsarek remains optimistic despite worries over low staff morale as a result of the poor rating: “This comparative information is reasonably helpful because it creates a context with the councillors. I find it a helpful lever to get some momentum going.”

Najsarek has already started on a fourpoint plan to improve matters. The first seems obvious, but it addresses an issue that is perhaps common to all poor performing authorities – ensuring that adult social care is put at the top of the agenda. “Since I came into post councillors have agreed to include adult social care as one of the six council priorities,” he says. “Second, we are one of the lowest-funded authorities in London and we need to find creative ways of getting investment.”

Local priorities and funding

Number three on the list is to register adults with Harrow’s new local area agreement, which aligns local priorities and  funding.“That’s important because across the whole council and partner organisations, everybody’s got a contribution to make to improving the well-being of adults,”

Najsarek says. “It’s not just about adult social services doing things better, it’s about leisure services, it’s about health services,  community safety services, bringing all the resources of public services to bear to improve things for vulnerable people.”

The fourth step is to forge links with organisations including regulators such as CSCI, the Care Services Improvement Partnership and the national improvement agencies. “If I can put in place those four things, I’m confident we can improve the way we’re viewed and our rating.”

When it comes to the rating system the future may seem relatively bright for those low-scoring authorities committed to change, but there are complications. Eligibility criteria for services are undeniably getting tougher, with 70% of local authorities funding substantial and critical needs only. In a few years it may be that all authorities will follow.

Harrow will now have to reconsider its decision to tighten its criteria to meet only critical needs in adult care after a High Court judge ruled that this failed to give enough consideration to its duties under the Disability Discrimination Act 2005.

And despite Najsarek’s assurances that the authority will focus on preventive services, for many this is an indicator that access to services may well be further restricted across the UK in order to maintain quality.

After all, councils are scored only on the people they provide services to. So if more start providing services to fewer people perhaps it will give them an improved chance of a better star rating – but at what cost?

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Essential information on inspection and regulation

Councils improve in 2007 star ratings

This article appeared in the 24 January issue under the headline “When the only way is up”