The report will form part of the performance record for the Council, and will be published on the CSCI website in November.

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1 Mr Hugh Dunnachie Director of Social Services London Borough of Hillingdon Civic Centre High Street Uxbridge Lodnon UB8 1UW Dear Hugh ANNUAL REVIEW OF PERFORMANCE Thank you for arranging our recent annual review meeting. This letter and report set out the Commission for Social Care Inspection s (CSCI) view of the performance of social services in your area during the last year, and comment on improvements for the year ahead. The report is intended to help the Council improve outcomes and the quality of service to service-users and carers. It is also intended to improve the prospects for improved performance ratings in the future. In assessing performance, CSCI reaches judgements about performance against a set of standards and criteria, drawing on evidence from a number of standard sources. These include: the published PAF performance indicators and other statistical data up to 2003/04, plus data supporting planned targets for 2004/05; evidence agreed in the course of our monitoring meetings that have been formally recorded; and monitoring information from the Delivery and Improvement Statements completed in October 2003 and May Details of the standards and criteria have been published, and are available from CSCI, or may be seen on CSCI s performance website. A summary of the evidence used has also been sent to you separately. The report is in two parts. The first is a summary of improvement recommendations that highlights the strategic issues for the Council. The second part summarises the strengths of performance 1

2 over the last year, and the priorities for improvement in the year ahead. These are organised around six standards against which the Council is assessed. The annual review does not attempt to review all aspects of performance, but focuses on the main performance issues for which CSCI has current information. The report will form part of the performance record for the Council, and will be published on the CSCI website in November. You are asked: to present it to an open meeting of the relevant executive committee of the Council, within two months of the date of this letter, and to inform me of the date on which this will take place; to make the report available to members of the public at the same time; and to copy this letter and report to the Council s appointed auditor, and to NHS and education partners. Progress will continue to be monitored during the year through our usual processes, and a further annual review meeting will take place during 2005/06. Performance (Star) Ratings will be confirmed in November, based on an assessment of overall performance using all admissible evidence. The evidence summarised in this letter will be used to help arrive at the rating, but may be updated where further evidence becomes available. Yours sincerely Jeunesse McTigue Business Relationship Manager Copy: Council Chief Executive 2

3 Performance Review Report for LONDON BOROUGH OF HILLINGDON Social Services: 2004 Summary of improvement recommendations The review of social services in Hillingdon has highlighted the following performance issues that need to be addressed over the next twelve months. Further information about the standards against which social services are assessed is contained in the detailed report. Child and family services the Council should continue to demonstrate that recent strategic developments result in positive and sustainable outcomes for children and families; the completion of initial assessments within seven days has slipped significantly since 2002/03. The Council will need to regain previous performance levels to ensure assessments are timely; the Council needs to consider joint working and pooled budget options more fully in the light of the Children Bill; and the Council should monitor the impact of preventative strategies. Services for adults and older people the Council have developed a number of positive initiatives across all aspects of adult services. These include: an accommodation strategy for people with mental health problems; a learning disability services modernisation strategy; and a re-structuring of the assessment and care management process. the Council will need to monitor and evaluate the outcomes from these initiatives to ensure quality of service is enhanced and sustainable; unit costs for residential and nursing care for adults are high, especially within services for people with learning disabilities. 1

4 This will need to be addressed within the Council s commissioning strategy. The Council will need to continue to work with providers to ensure services available in the authority reflect demand and need; the Council should monitor closely the assessment and care planning processes. On-going monitoring of the waiting time for assessments should continue. All service users should be receiving a statement of needs and how they will be served. The eligibility criteria should be consistently applied across all user groups. More service users should be receiving a proper review; and the CSCI Inspection of services for older people judged the Council as serving some people well, with uncertain prospects for improvement. The Council s detailed and thorough response action plan, which addresses the inspection s recommendations, will need to be implemented and improvements be realised and sustainable. For both adults and children s services it was encouraging to note the appointment of a permanent Director and the positive contribution already made to the organisation; senior management positions in older people s and adults services are still being covered by interim staff. Permanent heads of service should be in post by October This should facilitate consistency in strategy implementation and to promote joint working opportunities with partner agencies; training needs are high across the Council and will increase as changes to processes are implemented. The Council should evaluate staff training needs and ensure that appropriate funds and time are set aside for these activities. 2

5 Performance Review Report 2004 LONDON BOROUGH OF HILLINGDON SERVICES FOR CHILDREN AND FAMILIES The Council has made significant improvements in its strategic approach to children s services and this has been supported with increased council funding of children s services. Hillingdon is using the Children Bill as a yardstick for developing future services. Council-wide reviews, using Best Value principles, are underway. These will review services for vulnerable children and include a review of lifelong learning. The Council should demonstrate that recent strategic developments result in positive outcomes for children and families. The Council continues to: increase life chances for Looked After Children (LAC). The number of LAC with at least one GCSE and the number of LAC leaving care who are in education, training or employment are above the outer London average; sustain positive outcomes for children on the Child Protection register. The outcomes on the time that a child is on the register, reviews and the number of re-registrations are all better that the outer London average; and work with children and young people to encourage them to attend school and prevent offending. The short term stability of LAC, (LAC with three or more placements in a year, PAF A1) remains strong. The number of LAC with the same foster carer for more than two years (PAF D35) has decreased from 62% to 50% but remains above the outer London average. National priorities and strategic objectives education, training and employment outcomes and the proportion of looked after children with five GCSE s (PAF A4) have improved and compare well to other similar authorities. The recent Local Public Service Agreement (LPSA) for looked after 3

6 children and care leavers supports the Council s efforts in this area; adoptions of looked after children are improving steadily, in line with the national priority and planning framework (PPF); the Council has created an asylum service that includes all services for unaccompanied asylum seeking children (UASC), a substantial cohort of Hillingdon s children in need; waiting times for the Children and Adolescent Mental Health Service (CAMHS) have been reduced after the creation of three new mental health posts; the Council have held four events for children to assist in gathering feedback; and it is acknowledged that the Council have a number of initiatives planned or already being implemented that should result in service improvement in the coming year. These include: a block contract for the recruitment of additional foster carers which specialises in recruitment from black or minority ethnic communities; a Best Value review looking at services for vulnerable children and a strategic review of children with disabilities services. Area for improvement the Council should demonstrate that the inter-agency strategy for children with disabilities will result in better outcomes. Cost and efficiency the unit cost indicator for services for looked after children has decreased by nearly 150. The indicator for foster care was significantly better than planned ( 607 compared with the projection of 675). This is of particular importance in light of the growing number of children looked after by the department; and the Council should realise some efficiency gains from an increase in the number of in-borough placements. 4

7 the unit cost indicator for residential placements was planned to be 1540, while outturn hit In spite of recent improvements, the unit costs of services for LAC and for fostering services also remain high. The Council should ensure their commissioning strategy continues to include Best Value principles; there are no instances of the Council using Health Act flexibilities to implement joint/integrated services. This will need to be addressed in preparation for the Children Bill. Effectiveness of service delivery and service outcomes there have been significant improvements and a sustained strong performance in child protection arrangements. These are reflected in the PAF indicators, where the stability of placements (PAF A1), re-registration rates (PAF A3), de-registrations from the child protection register (PAF C21) and reviews of children on the register (PAF C20) are all strong. The Council has stated that all requirements surrounding the Victoria Climbie self audit have been implemented; school absenteeism (PAF C24) and final warnings or convictions (PAF C18) of looked after children indicate that related services are effective and compare well within outer London. These support maximising the life chances of LAC; and the Council are aware of the needs of UASC as evidenced by a Judicial Review which praised the quality of services. The Council have targeted health and employability issues in establishing an asylum service. the number of Looked After Children per 10,000 population increased from 79 in 2002/03 to 91. A further increase to 109 is expected this year. The Council needs to invest appropriately to ensure services are effective and can be provided on a timely basis; all looked after children need to have a named qualified social worker (currently performance is 95.2 per cent); and to help promote independence the Council should further promote the uptake of direct payments and break services. 5

8 Quality of services for users and carers the Council has developed and established an effective scrutiny and monitoring process involving Members. all reviews need to be completed on time for looked after children (currently 87 per cent). At the same time the Council should ensure that reviews are effective; the high proportion of children in need who are repeatedly referred to social services indicate that the response to the initial referral often does not meet the needs for children and their carers; although substantial improvements have been observed on the Spring DIS, core assessments completed within 35 days remain an area for improvement this year; just over half of initial assessments were completed within seven workings days, a significant deterioration from the previous year. Although it is acknowledged that high priority referrals are allocated immediately, all referrals are screened within 24 hours and assessments are completed in depth and detail, the Council needs to return to 2002/03 performance levels to ensure that assessments are completed on time; and Only half of the children looked after for more than four years in a foster placement have been in their current fostering placement for more than two years (PAF D35). This is a deterioration from 2002/03. It is accepted that the number of children on care orders placed with parents are not included in this indicator nor are children in supported accommodation. Fair access the Council has an asylum service that includes support for children and young people. The introduction of an asylum service has enabled a holistic approach to services for asylum seeking children and young people, including educational and health needs as well as social care needs; the Council has completed a recruitment drive for foster parents specifically targeting people from Eritrea. There is a contract with 6

9 an independent fostering agency that specialises in meeting the needs of children and young people from the black and ethnic communities; and the relative spend on family support (PAF E44) has significantly increased from 2002/03. Capacity for improvement improving services for children is a council priority. There has been corporate recognition of the centrality and cross-cutting nature of services for children and this has been reflected in the Leader s Statement; permanent staffing levels within the children and families division are at 90 per cent. The Council has a staff recruitment and retention strategy to recruit staff from ethnic backgrounds reflecting the diverse community and consider that they have achieved this at user contact level; the Council are undertaking regular performance reviews of their plans to ensure that proposals for safeguarding children are developed and monitored; and staff morale is reported to have improved across children s services. governance arrangements for service provision have been improved with the involvement of the corporate planning and corporate parenting group, and it will be important that these arrangements can demonstrate continued improvement; only 15 per cent of the Council s childcare workers have earned the NVQ level 3 qualification, well below the outer London average of 32.6 per cent. The Council need to monitor achieving all childcare workers having the appropriate qualifications to work with children; and the Council s review of its recruitment, appraisal and retention strategy for foster carers and adopters is welcomed, but the outcomes need to be monitored to assess the impact on quality, coverage and outcomes of children and families. 7

10 SERVICES FOR ADULTS AND OLDER PEOPLE The Council works within a complex system of health service organisations and has succeeded in building some effective partnerships to improve service delivery to some user groups, especially with regards to delayed transfers from hospital. The Council expect to sustain this level of service delivery. The joint review action plan from 2003 has been incorporated into the social services business plan and is currently being implemented. The Council had a CSCI inspection of its older people s services in March 2004, judged as serving some people well with uncertain capacity for improvement. The inspection noted that there was little provision for older people with mental health or mental illness needs, including users from black and minority ethnic communities. The Council has provided a wide reaching action plan from the recommendations of the report that has been approved by Members. The Council will need to monitor how these objectives are implemented and sustained. National priorities and strategic objectives the focus for social services is consistent with the Government s agenda on promoting independence; the Council has an agreed learning disability modernisation strategy that also captures feedback from service users and carers; the Council has made significant progress in building relationships with partners to improve services for older people; the development of supported housing options for people with learning disabilities and people with mental health problems is a priority for the Council. A joint commissioning team and strategies are already in place; and the Council is progressing well towards the mental health National Service Framework targets and were judged as generally meeting the criteria for an effective Local Implementation Team (LIT) by the Strategic Health Authority. 8

11 the implementation of the detailed and through action plan from the older people s inspection should be monitored to ensure better outcomes for older people; the Council has a number of development plans in progress for adult and older people s services. As the development model has proved successful, the Council could consider using it to develop other plans in adults and older people s services and where improved performance is needed; and more needs to be done to involve service users in the planning process and particularly people from black and ethnic communities. Cost and efficiency there is a joint commissioning team in place with a lead commissioner for each service user group. The Council is committed to commissioning quality services that represent good value for money; the Council expects to further develop an integrated and coordinated approach to the management of equipment and adaptations for adults. This is planned to yield efficiency gains for the Council; the Council reports that there has been a budget realignment for all services and the interaction between operational and financial activities have been strengthened; and all adult client groups received additional council funding in 2003/04. This included an extra 1.9million for older people services and an extra 1.4million for learning disabilities. unit costs for residential and nursing care for adults are significantly higher than the outer London average, especially for people with a learning disability. The Council will need to continue to work with providers to ensure that service needs drive service provision; and the Council will need to demonstrate that the additional funding provided for all user groups has had an effective impact on the type and quality of services and is sustainable. 9

12 Effectiveness of service delivery and service outcomes the Council has significantly improved performance in helping people with mental health problems to live at home (PAF C31, now in top band). Independence has also been improved for people with physical disabilities, older people and people with learning disabilities; and the Council s promotion of its direct payment programme has improved performance on direct payments (PAF C51), which is well above the outer London average. intermediate care services being developed with the PCT were having some impact but the older people s inspection found them to be fragmented, unco-ordinated and with scope for improvement; the Council should monitor closely the assessment process to ensure that waiting lists are kept short. Within older people s services, the number of assessments completed within four weeks is 59 per cent, below the outer London average of 63.4 per cent; the Council should ensure that the integration of older people s mental health services provides outcomes which meet the needs of the community; care plans, statements of needs received (D39) and service options should be shared in writing with service users. The Council s outturn of 81 per cent was below their expected target of 85 per cent; and as identified in the inspection of services for older people, the Council should develop further training for staff on applying eligibility criteria, carers assessments, and compliance with electronic filing. Quality of services for users and carers the Council has developed plans for an Early Intervention Service for people with Mental Health problems. It is expected that the service will be operational in 2004; and 10

13 the Council have agreed a Learning Disability Modernisation Strategy. As a result, four people, previously in long-term care, have already been reviewed and are now in supported housing. although recent improvements have been observed on delayed transfers of care, performance remains below the outer London average. The Council will need to monitor these improvements to ensure these are sustained over the long-term and take every opportunity to make further progress; and the Council should monitor whether their existing placements meet individual needs and provide quality for service users. For example, only 86.5 per cent of those in residential care have a single room (PAF D37) putting performance below the outer London average. Fair access the Council reports that there is now a Performance and Equality manager and that social services are driving forward the equalities and diversity agenda; there is now an advocacy forum in place for people with a learning disability allowing further opportunities. Additional revenue has been approved for this year to support moving on ambitions for service users; there is a translation and interpretation service in place that provides a specialist service to social services; and the diversity of front line staff reflects that of the community. the Council needs to demonstrate how it will fully implement the requirements of the Race Relations (Amendment) Act. A Race Equality Scheme impact assessment has been devised but the findings of the inspection for older people s services was that not all staff or community representatives were aware of this; the Council should ensure that consideration is given to the needs of black and ethnic minority communities and that this is reflected in service provision; 11

14 the Council should ensure that information on services are available in the languages of diverse ethnic groups within the community and that such material is readily available for all; and eligibility criteria for services should be equitable across all service user groups and in particuler avoid age discrimination. During the older people s inspection, some staff stated that care packages were more generous for younger adults than older people. Capacity for improvement the Council has responded positively to the comprehensive performance assessment, and a number of improvement plans have been or are being developed. By the autumn DIS it is hoped that these plans will have started to positively effect performance indicators; there has been recognition of the importance of partnership working in order to efficiently deliver services. This is reflected in the use of health act flexibilities (eight against the outer London average of 5.9). Management performance processes have been defined and reviewed to ensure the benefits of joint working are maximised for service users, carers and staff; and the Director of Social Services, appointed last year, appears to have the commitment of Members and staff to modernise the department and its services. there are still senior management positions in social services that are covered by interim staff. Permanent heads of service should be in post by October This should facilitate consistency in strategy implementation and to promote joint working opportunities with partner agencies. The Council will need to ensure that new postholders facilitate consistent implementation of the Hillingdon Improvement Plan and other initiatives; and staff turnover remains high in Hillingdon (14.1 compared with the outer London average of 12.9). The Council will need to ensure that their retention and recruitment plan, as set out in the Hillingdon Improvement Programme, supports social services to retain a higher proportion of staff. 12

15 Jeunesse McTigue Business Relationship Manager 10 September

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