ITEM NO. A2
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REPORT OF THE LEAD MEMBER FOR COMMUNITY SERVICES AND HEALTH
_________________________________________________________________________
TO CABINET
ON 8th DECEMBER 2009
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TITLE:
THE CARE QUALITY COMMISSION (CQC): PERFORMANCE JUDGEMENT
FOR SALFORD ADULT SOCIAL CARE SERVICES 2008-2009
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RECOMMENDATION:
That this report and actions be noted.
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EXECUTIVE SUMMARY:
Introduction.
CQC has a responsibility to monitor the performance of councils providing social care
services to adults and the way this is done is set out in their Performance Assessment
Guide.
The Principles of Performance Assessment.
The CQC performance assessment methodology is built around the following key
principles, it:

is outcomes focused assessing the areas that are important to people who use social
care services, their carers and the public;

respects the local autonomy of councils;

is based on evidence that reflects local priorities and is used locally;

uses professional judgement;

is proportionate, sustainable, transparent, and adds value; and

has robust quality assurance processes.
Reasons why the Performance Assessment process for 2008-9 changed.
Changes in policy.
CQC took particular account of the following in their approach to assessing performance in
the year 2008-09:

‘Putting People First: A shared vision and commitment to the transformation of Adult
Social Care’, – the cross Government concordat, to which CQC and local government
are signatories, which sets out a range of policies on strategic needs assessment,
prevention and early intervention, information provision, personalisation and user
involvement. Together, these form a transformation agenda for adult social care and
build on the principles embedded in Our Health, Our Care, Our Say.

‘Strong and prosperous communities’ – the Local Government White Paper which sets
out a new role for local agencies working in partnership, reflected in a more holistic
approach for inspectorates coming to a combined view of quality of life in an area – the
first area assessments are due for publication in autumn 2009 as part of the
Comprehensive Area Assessment (CAA).
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
‘Carers at the heart of 21st century families and communities’ sets out the
government’s vision for carers for the next ten years. It aims to improve support for
carers through a range of measures, including: providing comprehensive information;
training to strengthen and empower carers in their caring role (Caring with Confidence);
training for professionals; funding to PCT’s for flexible breaks and development of new
models of break provision; improving emotional support to carers, and helping them to
stay in employment.

Comprehensive Area Assessment (CAA) that will replace the Comprehensive
Performance Assessment (CPA) from April 2009. CAA is a new framework for
assessing performance of local services in delivering outcomes for local communities.
There will be a focus on those who are vulnerable, at risk of harm and at risk of social
exclusion. CAA is being developed and jointly delivered by the inspectorates that have
responsibility for assessing the relevant organisations and services that are expected to
drive improved outcomes for local people. The ASC assessment of performance will
make a significant contribution to the CAA area and organisational assessments
through a coherent alignment of the respective frameworks.
Outcomes framework – judgments about performance.
In line with changes to the legislation there will no longer be a star rating for adult social
care. Instead the assessment of performance in terms of delivery of outcomes will be
graded individually and then aggregated up into an overall judgement for the delivery of
outcomes.
The grades will continue to define whether a council is performing: ‘poorly’, ‘adequately’,
‘well’ or ‘excellently’. A performing ‘poorly’ grading will be determined by a failure to meet
‘adequate’ performance.
CQC will assess the ‘leadership’ and ‘commissioning and use of resources’ domains but
the assessment will be ungraded. The assessment of both of these will be expressed as a
narrative and will inform the CAA Organisational Assessment.
In order to judge adult social care in Salford CQC use a variety of different sources of
evidence including the annual Self Assessment Survey (SAS) completed by the
Community, Health and Social Care Directorate, statistical information (PI’s), additional
evidence submitted by the Directorate, judgements and findings from Service Inspections.
A performance summary report is gathered from the Performance Assessment Notebook
(PAN) and is the main public document about a council’s performance, which informs the
performance judgement.
CQC have formally announced the 2009 performance judgment for Salford’s adult social
care services based upon the Performance Assessment Notebook (PAN).
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The performance judgment for Salford Council is as follows:
The council is performing:
Delivering Outcomes Assessment
Overall Salford council is performing:
Outcome 1:
Improved health and emotional well–being
Outcome 2:
Improved quality of life
Outcome 3:
Making a positive contribution
Outcome 4:
Increased choice and control
Outcome 5:
Freedom from discrimination and harassment
Outcome 6:
Economic well-being
Outcome 7:
Maintaining personal dignity and respect
Excellently
Excellently
Well
Excellently
Excellently
Excellently
Excellently
Well
CQC also made a written assessment of Leadership and Commissioning and Use of
Resources:
Leadership.
The council has partnership boards for all main service user groups that provide a forum
where councillors and senior managers meet with carers and people who use services.
This allows them to influence overall plans for services. For example, people’s views have
influenced the local health and wellbeing strategy for older people. Strong leadership is
helping multi agency working for the benefit of the local population. A particular success is
the development of multifunctional Gateway Centres that give access to a range of health
and other public services. There are improved outcomes from the development of
integrated teams. The council has demonstrated leadership capacity to manage significant
change over the last year.
The council has plans for developing personalised services and these include a number of
strands of activity. Project management approaches, communication plans and additional
leadership capacity have been introduced to ensure that there is timely progress in the
development of self directed care.
The council continues to work closely with NHS Salford (the local primary care trust) on
future partnership arrangements. Six integrated care teams are now operational and the
remaining two will be fully operational after April 2009. The management arrangements for
the integrated teams are set out in partnership agreements. Integrated planning and
purchasing of services (known as commissioning) help ensure that there is joint action to
deliver the agreed priorities.
Training and development is helping to ensure that staff and managers have appropriate
skills in planning the purchasing of services, contracting and procurement.
Information about staff turnover, vacancy levels and sickness absence shows that there are
no difficulties in the overall management of human resources. A co-ordinating group works
across the whole social care sector to promote access to appropriate training and a
comprehensive approach to training for the introduction of the Deprivation of Liberty
Safeguards shows that the council has the necessary ability to undertake its responsibilities
under the Mental Health Act.
There is a proactive approach to planning joint training with health partners and to
continuing to provide placements for student social workers.
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Information from regulated services suggests a relatively poor compliance with standards in
relation to staff training in domiciliary care agencies. The council’s work to improve a range
of issues in relation to regulated services is covered under Commissioning and use of
resources.
A business planning system which incorporates the regular distribution of performance
information helps ensure that information remains accurate. Performance information is
used to decide how to allocate resources. A system of a “critical friend” review helps to
ensure that targets within the business plan are challenging but realistic. Business plans
are used to create links between a team’s objectives and individual objectives. Training
and service delivery are supported by the use of information technology (IT).
What the council does well:
 The strategic planning for improved outcomes is informed by information about the
needs of the population and the engagement of local people.
 Priorities and resource implications have been jointly considered and agreed with
health organisations.
 Multi agency and cross sector workforce planning is delivering changes to meet
future needs.
 Performance management information is well developed and used by managers at
all levels.
What the council needs to improve:
There were no areas for development identified under Leadership.
Commissioning and Use of Resources.
Service users can influence commissioning decisions through well developed partnership
boards and carers and people with sensory impairments have been involved in the
redevelopment of services.
The local Joint Strategic Needs Assessment (JSNA) is held in a shared information
repository and is used to help decide the strategies for commissioning.
The council has achieved significant efficiency savings in relation to its independent living
service and is continuing to work on the development of commissioning and contracting
processes that ensure good value for money.
The council has, for the eighth successive year, achieved a balanced budget. It has
delivered a programme of efficiencies, which have improved consistency and also achieved
improvements in quality. The council has a particularly effective approach to using acute
care data to demonstrate the case for investment in community services and has produced
savings in both acute care and long term social care as a result. It has plans to further
increase the number of placements for people with learning disabilities.
For quality reasons, the council has continued to pay a variable fee for contracts covering
supported adults in residential care, though the percentage of contracts that received such
payments remains very low. The council has developed plans for a differential pricing
policy to be implemented that is linked to a quality monitoring framework which will include
the use of existing Care Quality Commission (CQC) ratings together with additional council
criteria.
What the council does well:
 The council has a particularly effective approach to using acute care data to
demonstrate the case for investment in community services and has gone on to
demonstrate savings in both acute care and long term social care as a result.
 There is clear evidence that partnership working leads to joint action to tackle
agreed priorities and improve outcomes.
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
Commissioning decisions are based on an awareness and understanding of local
needs. Proactive forward planning is demonstrated by an increase in intermediate
care and decisions to decommission residential services and develop services for
people with complex needs.
What the council needs to improve:
 The council is introducing a more robust approach to contract monitoring which will
include monitoring visits to all providers and the payment of quality premiums in
order to achieve an overall improvement in the quality of commissioned services.
Actions:
1.
The council will be expected to progress any issues identified through this process
to ensure continued improvement to services.
2.
It is recommended that identified Directorates adopt the ‘one council’ approach to
responding to the specific areas identified for continued focus for improvement
Specific support plans will need to be developed to minimise risk.
3.
The Strategic Director, Community, Health and Social Care is expected to take a
report to an open meeting of the relevant executive committee of the council by
31st January 2010 and to inform CQC of the date on which this will take place. The
council should make the report available to members of the public at the same time
and they must copy the grading letter and report to the council’s appointed auditor.
_________________________________________________________________________
BACKGROUND DOCUMENTS:
(Available for public inspection)
The Local Government White Paper, ‘Strong and Prosperous Communities’, 2006;
Department of Health's White Paper, "Our health, Our care, Our say", 2006;
Local Government and Public Involvement in Health Act, 2007;
Putting People First: a shared commitment to the transformation of adult social care, joint
concordat, 2007;
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KEY DECISION:
YES / NO
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DETAILS:
Please see attached documents from CQC:
1. Salford Annual Performance Assessment judgement letter
2. Salford Summary Report
20091012 Salford
APA Letter.doc
20091012 Salford
summary report (with judgements) FINAL.doc
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_________________________________________________________________________
KEY COUNCIL POLICIES: All Salford City Council Pledges.
_________________________________________________________________________
EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS:- The assessment incorporates
equalities assessment.
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ASSESSMENT OF RISK:
Medium
To maintain the existing top rating for adult social care, support will be required from a
range of ‘one council’ leads for services and functions.
Specific support plans will need to be developed to minimise risk.
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SOURCE OF FUNDING: Mainstream funding and use of specific grants.
_________________________________________________________________________
LEGAL IMPLICATIONS Supplied by N/A
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FINANCIAL IMPLICATIONS Supplied by N/A
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OTHER DIRECTORATES CONSULTED:
_________________________________________________________________________
CONTACT OFFICER:
Alan Bunting
TEL. NO.
0161 793 2868
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WARD(S) TO WHICH REPORT RELATE(S):
All
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