Scottish Government

REPORT OF THE JPIAF SUB-GROUP ON SINGLE SHARED ASSESSMENT PERFORMANCE MEASURES
PERFORMANCE MEASURES FOR CARERS' ASSESSMENTS - CONSULTATION PAPER

1. INTRODUCTION

Most social care is provided by unpaid carers rather than by Council, NHS or independent sector employees. According to the 2001 Census, one person in ten in Scotland is providing unpaid care to a family member, friend or neighbour because of long-term physical or mental ill-health, disability or problems related to old age ( see Annex 1). The Strategy for Carers in Scotland, the Joint Future policies on short breaks, and the strengthened provisions to support carers in the Community Care and Health (Scotland) Act 2002, are key elements in modernising social work services in Scotland. It is important that the impact of the Act, and the wider Strategy and policy framework, is monitored to establish the extent to which carers are being supported effectively.

The paper has been prepared by the JPIAF SSA PIs Sub-group, set up in October 2002 to advise the multi-agency JPIAF Steering Group on the definition of Single Shared Assessment (SSA) for reporting purposes, to specify performance indicators to measure waiting times for assessment and services, and to develop performance measures for Carers Assessments.

The JPIAF SSA Subgroup's report consists of three consultation papers:

• Consultation Paper 1: Counting Single Shared Assessments
• Consultation Paper 2: Performance Measures for Carers Assessments.
• Consultation Paper 3: Waiting times for community care assessments and services.

The papers follow a similar format, setting out the specification and rationale for the proposed performance measures and discussing the definitions required to produce the PI on a consistent and comparable basis. Consultation questions are also included but comments are welcome on any issues raised in the papers. For ease of use, there is some repetition of information between papers.

Electronic copies of all the consultation papers, and the covering letter, can be found on the Scottish Executive's website at www.scotland.gov.uk/views/views.asp.

Responses are requested by 26 September 2003 , and should be sent to:

Derick Wilson
Joint Future Unit
Scottish Executive Health Department
St. Andrew's House
Regent Road,
Edinburgh EH1 3DG
e-mail: Derick.J.Wilson@scotland.gsi.gov.uk; Telephone: 0131-244 5481

1.1 JPIAF SSA Performance Measures Subgroup Members

The Subgroup was also assisted by contributions from Jackie Welsh, Glasgow City Council (on time interval measures) and by Felix Otton, Scottish Executive (on carers' assessments).

Mike Brown and Anne Mollison were principal authors of Consultation Papers 1, 2 and 3.

2. PERFORMANCE AND MANAGEMENT INFORMATION REQUIREMENTS

The main objective of this consultation paper is to identify and define a small number of performance indicators for inclusion in the national "Joint Performance and Information Assessment Framework" (JPIAF) being developed for joint community care services. The JPIAF guidance is contained in Scottish Executive Health Department Circular No. CCD 1/2003 issued on 28.2.03. This described the performance information which should be included in the full Joint Future Local Partnership Agreements due by 1 ^St April 2003. JPIAF implementation is being phased, with full implementation in 2004-05.

The focus of the paper is on monitoring the new and strengthened rights for carers introduced by the Community Care and Health (Scotland) Act 2002. Draft guidance on the new statutory rights for carers was issued in November 2002 as Circular 10/2002 and was subsequently replaced by the final guidance issued on 31 ^st March 2003 as Circular No. CCD 2/2003. (All CCD Circulars are available at: http://www.show.scot.nhs.uk/sehd/ccd.asp). The PIs proposed are intended to meet local and national monitoring requirements for carers' assessments as set out in the Circular.

While the JPIAF primarily concerns community care services for adults, the provisions of the 2002 Act apply to:

• Adults caring for adults with community care needs
• Young carers caring for adults or for another young person
• Carers of disabled children, whether the carer is a parent or not.

All three groups of carer are covered by the monitoring proposals set out in this paper.

The key changes introduced by the Act are:

For this reason, the PIs proposed in this paper mainly concern Carers' assessments. However, assessments are not an end in themselves, but a means to achieve better support for carers, and therefore better outcomes for both carers and the people they are caring for. PIs for Carers' assessment need to be part of a much wider set of data about support to carers, as suggested by the proposals on monitoring and evaluation in the draft guidance (CCD 10/ 22.11.02):

A larger Carers' dataset has also been proposed in the recent consultancy report commissioned by the Scottish Executive " Supporting Carers: Monitoring and Outcomes Measures" (February 2002). An extract from this report, setting out the consultant's view of the type of data that might be collected in the short-, medium-, and long-term, is appended as Annex 2. The section on monitoring from the revised Scottish Executive guidance to the new Carers' legislation (CCD2/2003) is also attached at Annex 3.

A major obstacle to the development of performance indicators (PIs) for support to carers in Scotland is the almost complete lack of national statistical information about carers in contact with Local Authority, Health services. Nothing is currently collected nationally on Carers' assessments, and the only information available on the provision of support to carers concerns respite care. The respite care data itself is limited to: (a) a small amount of data collected in Scottish Executive statistical returns on respite care in residential homes, and on domiciliary care provided for respite reasons; and (b) the Accounts Commission respite care performance indicator (discussed further in section 4.7 and in Annex 4).

For practical reasons we propose a phased approach to data collection, starting with basic information in the short term. The much richer set of information required in the medium to long-term would either have to be collected through a sample survey or through first specifying the carer dataset that each Council should collect in their social care client information systems, from which an extract for statistical purposes could be returned to the Scottish Executive. We recommend that a short-life working group is set up to take this forward, with representation from key stakeholders, including carers' organisations, the Scottish Executive, the Association of Directors of Social Work (ADSW), the Social Work Statistical Liaison Group (SWSLG), NHSScotland, and the MGF2 Social Care Data Standards Project.. This should include work to resolve data quality problems with the current Accounts Commission respite care performance indicators ( see Annex 4).

Before considering specific proposals for PIs for Scotland, the subgroup reviewed the data on Carer's Assessments collected in England and Wales. This is briefly summarised in Annex 5.

References in the paper to "RAP" refer to the annual community care "Referrals, Assessments and Packages of Care" statistical returns from English Councils to the Department of Health in London. This is a useful source of assessment data definitions.

3. PROPOSED PERFORMANCE MEASURES

3.1 Introduction

The Scottish Executive guidance ( see extract at Annex 3) proposes the following indicators:

In this paper we specify proposals for 1 and 2, and discuss 6 and 7. Proposals 3 and 4 are for local development initially - any national data on aggregated need and unmet need would have to be developed alongside similar data for cared-for people; such developments largely presuppose standardised assessment tools or instruments such as the "Resource Use Measure" (RUM). Proposal 5 is not discussed - this is part of the work of another JPIAF subgroup.

3.3 Proposed PIs and their rationale

3.3 Proposed PI specifications

We first consider the specification of the PIs, together with enough of the definitions to make sense of the proposals. The remaining definitions are then presented in the next section of the paper, including the rules to cover double counting. Clearly carers may care for more than one person, and vice versa, but to help us consider one issue at a time we suggest that the proposals are first considered for the simpler case of one carer providing care to one person only.

It is possible to count separately:

• carers who have been assessed in the year,
• carers who have requested an assessment in the year, and
• carers who have been offered an assessment in the year.

However, many individuals would be included in two or all three of these separate counts, and it would not be possible to produce a robust total annual count of carers across the three categories without double counting. Our preferred solution is to first count carers assessed, then to count carers who have been offered an assessment which for whatever reason has not taken place in the year, then to count the remaining carers who requested an assessment but have had none offered:

Carers' PI-1: Numbers of carers assessed, offered, or requesting assessment in the year.

The table would still allow separate counts of the total number of carers requesting an assessment (rows 7 and 14, assuming no un-requested offers or assessments). The total number of adult carers offered assessment equals rows 3 + 4.

The table would provide the data required to calculate the following derived PIs:

Carers' PI-2: Number of carers assessed in the year, by client-group of cared-for person.

Use "-" for cells with less than 5 people

Scottish Executive guidance ( see extract at Annex 3) refers to the duty of Local Authorities under the Race Relations (Amendment) Act 2000 to carry out ethnic monitoring of their services for carers and service users. Proposed Carers' PI-3 would collect this data in a similar format to PI-1.