Research Policy and Planning: The journal of the Social Services Research Group – Vol 17 (3) 1999
What do you need to know? Lessons from Joint Reviews for knowledge workers in Social Services
Lloyd Davis, Information Manager – Audit Commission/SSI Joint Review Team
This paper examines the lessons from Audit Commission/SSI Joint Reviews specifically for Research, Information and Planning staff in Local Authority Social Services. There are many things that most authorities need to know better. They need to know more about people entering the system, what works for those people, how much services cost and how they can ensure value for money. The most important message is that what you need to know, is what you need to know. That is, that local authorities can improve the management of their social services by deciding what they want social services to achieve and how they will measure how well they are achieving. Local authorities do not do this, central government will. In its proposals for a performance assessment framework, DH is doing just that. Local authorities need to be pro-active in ensuring that central government understands how local priorities fit into performance management. One of the keys to success in research, information and planning will be working with others. Dissemination of research findings and initiatives that have worked is vital, and there are opportunities for data collection reviews to be made more easily available to local authority information staff
Building knowledge in social services
Under the expected Best Value regime, the work of staff in research, information and planning will become increasingly important. In future, it will no longer be sufficient for local authorities to provide good services, to consult with service users and the wider public and to ensure value for money; they will also need to be able robustly to demonstrate that this is the case.
What you need to know is…
The review team has identified a number of areas where Important information is poorly collected and understood. Among these areas are:
- who’s coming through the door;
- what works;
- what things cost;
- who you can get value for money from.
Who is coming through the door?
Despite the efforts expended on the Department of Health Referrals Assessments and Packages of Care (RAP) project, it is clear from some simple analysis of data collected in reviews that local authorities still provide us with data that is neither consistently defined nor consistently collected. If we look, for example, at reported referrals per 10,000 population under 18 to children and families services, the highest and lowest authorities differ by a factor of more than 10. We do not believe that children’s services are so different around the country but we would like to know better what differences there are and why they occur. The current data do not allow this depth of analysis.
Neither is it possible to draw very sensible conclusions from data provided on referrals over time. The conventional wisdom in social services is that there are more older people needing services each year. Yet the data provided to us shows that almost as many authorities estimated a fall in such referrals as estimated an increase and one authority estimated a 20% fall in referrals for older people in a single year.
Many people have an opinion on what works for service users. Few have hard evidence. Local authorities need to have strategies for critically appraising research findings and for balancing the need for academic rigour with the pragmatic use of ‘dirtier’ information. It is clear to the joint review team that more work needs to be done on defining good outcomes for service users and on measuring these outcomes. Within a limited resource regime, however, it is not sufficient to define outcomes these measures then need to be assessed in the light o the costs associated with them. Local authorities have simple mechanism available for finding out what works in the form of case reviews, some of which have statutory guidance attached, but joint reviews have noted a wide variation in reported reviewing practice If we look at the number of reviews reported as a proportion of the number of referrals (i.e. taking account of the general level of care management activity) w again see a ten-fold difference between highest and lowest (Figure 1). While this tells us nothing about what happened in these reviews or whether things improved as a result, it is tempting to believe that those departments that do almost as many reviews as they get referrals will be getting a better picture of what work for their service users than those that review much fewer.
Figure 1: The number of reviews as a proportion of the number of referrals also varies ten-fold
Reviews of Children & Families cases as proportion of referrals
Source: Finance & activity data collected in Joint Reviews
What do things cost?
Social services departments still do not know well enough how much their services cost. Many authorities have found membership of benchmarking groups useful. An example is those groups facilitated by Rho Delta consultants (which started in London but are being replicated in Wales, the West Midlands and elsewhere). These groups have concentrated so far on top-down costing and making improvements to their CIPFA questionnaire returns. More work needs to be done on modelling costs from the bottom up, especially in children’s services. Authorities could learn much from studying the Personal Social Services Research Unit publication, ‘Unit Costs for Health and Social Care‘, currently in its 6th volume (Netten et al., 1998) – this document shows unit costs for all main service areas and an explanation of the cost structures and some of the rationale and methodology behind the figures. It is to be hoped that work can be included in future volumes that help local authorities cost more innovative services. Both approaches to costing will be useful to Authorities in demonstrating Best Value. The Department of Health has made it clear that efficiency and value for money will be an important part of judgements made in the Performance Assessment Framework (PAF).
The Department of Health will have to improve the measures of efficiency that are currently included in the PAF, since the unit costs proposed are far too unreliable and tell us little about overall efficiency. If year-on-year changes in any two of the chosen unit costs were used to assess performance over the last year a very mixed picture would appear (Figure 2).
From whom can you get value for money?
Joint Review reports have repeatedly shown that, particularly in community care services, provision the independent sector can be cheaper. They have al shown that cheaper services are not necessarily of lower quality than those provided in-house. Better information about costs and outcomes would enhance authorities’ abilities to make better and more justifiable decisions about who should run their services. In children’s services, it appears that there are diseconomies of scale in looking after children, that is, the more children an authority looks after, the more it spends per child (Figure 3). Our interpretation of this is that, if authorities planned some services better, using intelligence from past provision, they would be able get better value for money from their providers.
Most of all .. you need to know what you need to know
In our 1998 Annual Report (Joint Reviews, 1998) we wrote: “Management information needs to be improved. This is a matter of defining what services are for and measuring them. It is a management issue, not technology problem.” This message has echoes in the Performance Assessment Framework. The White Paper Modernising Social Services, (Department of Health 1998) defines what central Government considers services to be for, and the consultation paper on PAF (Department of Health, 1999) sets out ways of measuring them. Authorities need to ensure that their own definitions a measures are robust and that they are taken in consideration by Joint Reviews, DH Social Care Regions and SSI when judgments are made about performance.
Figure 2: If unit costs are used to assess efficiency improvements a very mixed picture appears
Percentage change in expenditure per week on older people’s residential & nursing care
Source: Department of Health Key Indicators, 1998
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Figure 3: It appears that there are diseconomies of scale in looking after children
Number of children looked after per 10,000 population under 18
Source: Department of Health Key Indicators, 1998
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Working with others
Dissemination of findings and making the most of others’ work is bread and butter to researchers. As a team, we are convinced that even more could be done to pull together research findings and make sense of them. We are working on a series of thematic research briefings, primarily so that reviewers are better informed. However, it is likely that material that reviewers find useful will be similarly useful to people in local authorities and we plan to publish these briefings more widely.
A Joint Review only comes to a council once every five years but there are ways in which social services’ information staff can work with us or with our tools outside of the context of their Review. Several authorities have reproduced elements of a review both before and after the team has visited them. The questionnaire for users and carers has been used both to provide information for councils whose review is a long way in the future and for some who have decided to repeat the exercise annually to help them measure progress against their action plan.
As the Joint Review programme continues, we a building large databases from our primary data collections. ‘ We intend to open up these databases in the near future so that authorities can compare themselves with those that have been reviewed. We also believe that researchers could find things of value in the even larger, but softer, database consisting of structured position statements provided at the start of each Review and we are investigating ways of giving wider access this material.
Department of Health (1998) Modernising Social Services. London HMSO.
Department of Health (1999) A new approach to Social Service Performance. London: HMSO.
Joint Reviews (1998) Getting the best from Social Services. London Audit Commission
Netten, A et al (1998) Unit costs of Health & Social Care Volume 6. Canterbury: PSSRU, University of Kent.