Adult social care Risk awareness self-assessment tool

ADULT SOCIAL CARE RISK AWARENESS SELF-ASSESSMENT TOOL

1.Purpose of this tool 3

2. Principles 4

3. Introducing the tool: six key risk domains 5

4. Key sector-led improvement resources 6

5. Summary of key issues to consider when assessing potential levels of risk in adult social care 7

6. Processes for using the risk awareness tool 8

7. Suggested dataset to inform self-assessment 18

8. Further reading and resources 27

Contents

“The establishment of a regional sector-led improvement network has been very helpful. Being able to share progress, risks, issues and successes with partners and establish good relationships with neighbouring authorities has been a really positive outcome of this legislative implementation progress.”Council feedback as part of Care Act Stocktake 6

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1.Purpose of this toolThis tool was developed in 2015 by the Towards Excellence in Adult Social Care (TEASC) programme as part of its role in identifying and managing risks across adult social care.

It complements other more in-depth risk and self-assessment tools Directors of Adult Social Services (DASSs) can use, including those developed by the Association of Directors of Adult Social Services (ADASS) and CiPfA (The Chartered Institute of Public Finance and Accountancy) or within the ADASS regions. The original version of the tool was developed with ADASS regional chairs and piloted by two volunteer councils from each ADASS region.

Feedback from across the country has informed this refreshed and updated version and reflects ongoing work in the regions to adapt and refine the tool to meet local need. We recommend regions continue to develop and integrate this approach with local sector-led improvement (SLI) tools.

We also recommend that consideration is given to completing the self-assessment as part of a collaborative process with corporate colleagues.

1 http://www.local.gov.uk/sites/default/files/documents/managing-risk-underperfor-a54.pdf 2 http://www.local.gov.uk/sector-led-improvement

The aims of the tool are:

a. To promote self-awareness amongst DASSs and their senior colleagues, supporting them in targeting their energies and limited resources on the right issues and identifying mitigating action to address their most pressing risks.

b. To ensure that councils’ political and executive leaders are well informed about the potential risks facing adult social care, reflect these in their corporate risk registers and take them fully into account in their decision-making. The conclusions from this exercise should enable leaders to be confident that their council’s adult social care risks have been assessed using an objective process.

c. To enable ADASS regions to identify issues they should be addressing through SLI activity and the councils that might need most help, in line with the ADASS mandate for sector led improvement1 published by the TEASC Board in December 2012.

d. To provide assurance to the public that risks in adult social care are being rigorously assessed and managed. The ADASS mandate strongly encourages councils to carry out regular self-assessment exercises as this lends credibility to the sector-led improvement system.2

We acknowledge with thanks the contribution of ADASS regional colleagues to the updating of this tool and Rachel Ayling and David Walden who were commissioned by the LGA to undertake this refresh based on feedback from the sector.

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2. PrinciplesThis tool is not designed for performance management; its starting point is a recognition that monitoring performance is different from monitoring risk and that even the best performing councils will be experiencing risks and challenges in the current financial climate.

DASSs already have existing systems and processes to manage performance in place, with key adult social care activities monitored at regional or national level. We have included a suggested data set based on that already collected by councils which could usefully inform the self-assessment (see page 18).

The tool is intended for confidential use given the sensitivity of much of its content; ADASS regions already encourage DASSs to discuss conclusions from self-assessment with an experienced, trusted and objective ‘challenger’ such as a peer director or regional Care and Health Improvement Advisor (CHIA) and the results of these conversations are not reported other than in an anonymised way.

The tool is not intended to replace or duplicate other self-assessment tools including those developed by ADASS and the LGA. It operates as an effective high-level check on the key domains of risk within adult social care and where a DASS decides on a more in-depth look at an aspect of the risks identified eg safeguarding, use of resources or commissioning, they can consider one of the more in-depth tools highlighted on page 6.

Where one of these other tools has already been used, this tool can still be used to triangulate findings with data from a range of other sources.

The tool is not intended to be onerous to complete and many DASSs have found they can complete it quite quickly and privately or during a meeting with their senior management team.

The tool suggests ways of using existing key performance indicators to identify significant risk whilst recognising that some types of risk are easier to capture and collate than others. The SLI approach emphasises the importance of triangulating both hard and soft data to tease out local stories within a culture of openness and trust. Most regions are developing and refining their own benchmarking datasets and we anticipate this tool will support genuine, honest reflection and discussion between trusted colleagues within each region.

“The support from the Care and Health Improvement Programme and communications planning was very good. Some of the products developed were of an excellent quality, particularly the programme planning tools which contained some very useful materials that could be easily tailored for local use.”Council feedback as part of Care Act Stocktake 6

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3. Introducing the tool: six key risk domains

Leadership and governance

Performance and outcomes

(includingsafeguarding)

National priorities and partnerships

Culture and challenge

Commissioning and quality

Resource andworkforce

management

RiskAreas

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Performance and outcomes

(including safeguarding)

National priorities and partnerships

Culture and challenge

Commissioning and quality

Resource andworkforce

management

RiskAreas

Leadership and governance

4. Key sector-led improvement resourcesThis graphic illustrates links to other key tools and LGA offers which can support a more in-depth analysis of specific risk domains once this self-assessment is complete. Links to these can be found on page 31.

LGA peer

challenge

programme on

specific issues

ADASS/Cipfa social

care risk tool

Resources in adult

social care self-

assessment toolkit

Making safeguarding

personal-guide and toolkit

Commissioning for

better outcomes

Other market

shaping,

sustainability and

commissioning

toolkits

High Impact

Change Model for

Managing Transfers

of Care

Resources

to support

Transforming Care

for people with

learning disabilities

LGA integration self-

assessment tool and

workshops

Making

safeguarding

personal temperature

check

LGA corporate

peer challenge

programme

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5. Summary of key issues to consider when assessing potential levels of risk in adult social care

RISK DOMAIN KEY ISSUES TO CONSIDER

1. Leadership and governance • political change• organisational change• the experience of political and managerial leaders• priority given by the council to adult social care

• corporate challenges • adverse events

2. Performance and outcomes • safeguarding adults• DOLS• performance• customer satisfaction

• pressures on the front line• delayed transfers of care (DToC) attributable to adult social

care• carers

3. Commissioning and quality • quality issues (and the links with safeguarding above)• market shaping and sustainability• market position statement – process and product

4. National priorities and partnerships • health and wellbeing partnership• Better Care Fund • Care Act implementation• Transforming Care for people with learning disabilities

• DToC/winter pressures• STPs• health and care integration

5. Resource and workforce management

• percentage of corporate spend on adult social care• use of the council tax precept-current and/or future increases• corporate financial context including reserves• scale of adult social care budget reductions (past and future)• overspends• impact of budget reductions

• unit costs• demand pressures/changes in activity• outlook-future• adult social care staff vacancy levels• recruitment and retention across sector

6. Culture and challenge • local account – process and product• participation in sector led improvement activity• peer review exercises and other external scrutiny• local performance management arrangements

• political scrutiny• organisational development

* this list is not exclusive; it can be added to or refined to suit local need (including options for individual councils and at regional/sub-regional level)

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6. Processes for using the risk awareness tool We recommend that all six domains and the key issues to consider are explored in each self-assessment, recognising however, that processes for completing, collating and considering the outputs will vary depending on the region. Some of the approaches in use (as at September 2015) include:

Rating scalesUse of high-level rating systems (eg RAG ratings) either for each domain, for each risk area, or for specific indicators.

Top three risksInclusion of overarching questions about the DASS’s view of the three top risks (and/or of their key strengths).

Mitigating actionsInclusion of notes on the mitigating actions being taken to address the risks – especially those that might be shared with peers as interesting or useful practice.

Action plansTranslation of the findings into an action plan (and/or formal risk register, including mitigating actions).

Who should complete the assessments?Many DASSs will wish to involve their assistant directors and other senior managers (including key corporate colleagues such as chief finance officers) in this process. Some DASSs might complete the tool as part of an informal session with their senior management teams and/or ask the relevant assistant directors to complete some sections. We do recommend that the council’s statutory DASS takes ownership of, and signs-off, the final version of the self-assessment.

Who should challenge the assessments?Each ADASS region recommends external challenge from a ‘critical friend’ for each DASS completing the self-assessment and associated action plan; this is usually arranged in negotiation with the ADASS regional branch and options include buddying systems (eg private and informal exchanges between peer DASSs), the involvement of experts employed by the region or the involvement of CHIAS.

Who should see the completed assessments?DASSs are encouraged to share at least the findings from their risk assessment with both their chief executive and portfolio holder to help raise and share awareness and understanding of the risks and mitigating actions being taken

The self-assessments are sensitive, confidential documents which will never be shared outside the region. Most regions however, recognise the benefits of collating high-level findings and sharing learning in a sensitive and anonymised way so that risks can be mitigated through ongoing SLI activity. Some convene regular challenge workshops to discuss their findings and the implications for their local SLI programme. Most use their regional accounts to report to stakeholders and the public about top-level risks and action underway to mitigate these.

What existing data should be used as part of the self-assessment?Individual councils and regions may have a view about which data already collected for national returns might be useful to consider as part of the self-assessment. We have included a suggested dataset which can be used as a starting point on page 18.

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6. Processes for using the risk awareness tool 1. LEADERSHIP AND GOVERNANCEThis section asks you to reflect on your council’s operating environment, and especially on any major political or organisational changes that may be creating risks for adult social care at the current time.

Leadership and governanceQ1. Have there been political changes to your council this year? If yes, how have they impacted on your strategy for adult social care? How are you managing this impact? Is more change likely after the next local and/or national elections?

Q2. Have there been significant changes in the corporate management team this year? If yes, how have they impacted on your strategy for adult social care and how are you managing the impact?

Q3. Are you considering devolution and if so, what are the challenges and opportunities?

Q4. Have there been any changes to your council’s organisational structures which have impacted on adult social care this year? (This might include changes to departmental structures, merging of back office functions etc)

Q5. How far have senior management changes within adult social care (ie at director or assistant director level) impacted on the delivery of adult social care this year? Are there significant senior vacancies now, and how are you managing any impacts of this?

Q6. What is your span of control? What experience and training do you have in adult social care?

Q7. Is adult social care clearly visible within the council (eg are you a full member of the chief executive’s senior management team?).

Q8. Is the council experiencing unexpected events or pressures this year (eg in children’s services, environmental services etc) which may have affected the priority given to adult social care? Have there been any negative inspections (eg Ofsted)?

Q9. Has adult social care recently been subject to judicial review (or are there any ongoing judicial reviews)? If yes, please briefly describe any impact/potential impact you are concerned about.

Q10. How confident are you are meeting all obligations under the Care Act, given financial and other pressures within adult social care?

Q11. Has there been significant adverse local or national media coverage of adult social care about your council this year?

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6. Processes for using the risk awareness tool 2. PERFORMANCE AND OUTCOMES (including adult safeguarding)This section asks you to reflect on the effectiveness of your adult safeguarding arrangements and any headline risks to your current adult social care performance, including your front line response.

Safeguarding Q1. How does adult safeguarding fit into your organisation’s overall strategy? Can you demonstrate that it is a top priority for your council and key partners?

Q2. What methods do you (and the safeguarding adults board) use to assess your safeguarding practices and outcomes? Have externally recommended practice standards and tools such as Making Safeguarding Personal3, the ADASS Adult Safeguarding Improvement Tool, been adopted?

Q3. Specifically, are people who experience safeguarding processes asked about what outcomes they want? If so, is this recorded? To what extent is the impact of safeguarding interventions monitored at individual and strategic level?

Q4. Are you confident that your arrangements are effective across the whole care system? Are partner and provider agencies appropriately involved? Please identify any exceptions which concern you and how you are tackling this.

Q5. Have you sought or received external feedback on your safeguarding performance (eg through a regional stocktake/temperature check or safeguarding peer review) this year? If yes, please briefly summarise the main recommendations (and/or attach the report). Are you confident that the recommendations will be implemented?

Q6. Overall, based on routine performance monitoring, learning from safeguarding adults reviews and external feedback, how confident are you that your system’s adult safeguarding practices are effective, person-centred, and robust? Do you think there are any urgent areas for improvement?

NB. Specific issues relating to the Mental Capacity Act and DOLS are covered in section 5 Q14 below.

Performance and outcomesQ7. Have you identified areas where adult social care performance/outcomes could be improved? If yes, are you feeling confident that you can achieve the desired improvements over the next year?

Waits at the front lineQ8. Have you specified target response times (eg for assessments, reviews and provision of services)? Are these targets being achieved? If no, what or where are the exceptions and how are you addressing them?

NB If your concerns relate mostly to MCA/DOLS, please use Section 5, Q14 to address these. If your concerns relate mostly to recruitment and retention issues, or staffing shortfalls, please use Section 5, Q13, to record these).

3 http://www.local.gov.uk/topics/social-care-health-and-integration/adult-social-care/making-safeguarding-personal

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6. Processes for using the risk awareness tool 3. COMMISSIONING AND QUALITYThis section asks you to reflect on the current state of your local market including the availability, quality, diversity and sustainability of care services. It also asks you to think about your capacity to influence and shape your local market in line with Care Act responsibilities.

Service qualityQ1. Do you have agreed quality standards (or outcomes) for all your commissioned services? If yes, how do you monitor these in partnership with CQC? Is relevant information – including any serious concerns – routinely reviewed by your management team and shared within your council, including with elected members?

Q2. Do you have effective joint arrangements for assuring the quality of services, including routine liaison with CQC and CCGs and mechanisms for sharing specific concerns and addressing poor performance in tandem with commissioners in partner agencies?

Q3. Are you and/or CQC currently tackling quality concerns (and/or serious incidents) within one or more services (including embargoes on new placements)? Please give details.

Q4. Overall, based on your CQC Local Authority Profile, dialogue with CQC, and local monitoring, how does the quality of your local registered provision compare with other councils? Please comment on the work you are doing to support improvement and on whether you think this is having an impact.

Market shaping Q5. Can you predict what types and range of services will be needed over the next five to 10 years? Does your analysis take account of likely purchasing by others, including CCGs and self-funders? What plans do you have to ensure a sufficiency and diversity of supply for everyone who might need care and support, however funded?

Q6. Are you currently commissioning services which will reduce demand for formal, state-funded care including building capacity in the community to support people differently? Are plans to do this underpinned by effective engagement with citizens and communities?

Q7. Have you identified specific market gaps, particularly in relation to (a) affordable nursing home placements, (b) specialist provision for people with high-level complex needs, (c) domiciliary care and/or (d) other? If yes, please specify, and comment on how this is impacting your local care system. What are you doing to address any gaps, and how successful have your actions been so far?

Q8. Have you had recent instances of care provider business failure and/or unexpected withdrawals of providers from the market? Are provider bids for adult social care service contracts falling below usual levels? If yes, what are the reasons? What measures are you taking to manage the loss of services that would be hard to replace including any contingency plans and risk mitigation?

Q9. Have you undertaken a major re-commissioning exercises this year? If yes, has this exercise gone well? Has it created any pressures, management challenges or unintended consequences that have been difficult to manage?

Q10. Are you able to understand the true costs to the council of providing/commissioning care and are providers challenging the current prices set? If there is a gap, have you taken this into account in the setting of fees and in your medium term financial plan? Please comment on any specific local challenges.

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6. Processes for using the risk awareness tool Q11. How would you describe the state of your relationships with providers, and how are these changing? Are you able to have open and mature discussions about your future strategy and plans for innovation, as well as about more immediate issues such as fee setting?

Q12. Are you confident you have the capacity (eg in relation to needs analysis, market mapping, engagement with providers, commissioning, procurement, and contract monitoring) and capability ( eg adult social care has current knowledge and skills, including use of CBO and other tools) to address your market shaping responsibilities under the Care Act? If not, does your council have plans to tackle this?

Q13. To summarise, what concerns do you have about the sufficiency and sustainability of local adult social care services? Are you confident you can mitigate the most pressing risks?

NB If your risks and concerns relate mostly to the budget, you can use Section 5A to discuss this separately. If your risks and concerns relate mostly to recruitment and retention issues, you can use Section 5B to record these separately.

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6. Processes for using the risk awareness tool 4. NATIONAL PRIORITIES AND PARTNERSHIPSThis section asks you to reflect on progress achieved in partnership working with the NHS and other key partners to identify any specific pressures or obstacles you need to tackle

Partnership working with the NHS, housing, and the voluntary and community sector (VCS)Q1. Please briefly outline your local partnership landscape including the main CCGs, trusts, housing and voluntary and community sector stakeholders operating in your geographical area and how your partnership activity is organised/governed. Would you describe your partnership context as particularly complex or challenging?

Q2. In general, how would you characterise your relationship with your a) commissioning CCG partners b) primary care providers c) secondary care providers d) housing providers and e) VCS organisations, and the beneficial outcomes achieved from these relationships to date?

Q3. Is your local health economy experiencing significant financial, organisational and/or performance challenges which are likely to impact on the deliverability of your STP and/or BCF? If yes, please describe and try to explain the nature and degree of difficulty. NHS challenges could include being financially challenged, subject to the NHS success regime, in special measures, involved in the ECIP programme, and/or subject to other special intervention or scrutiny.

Q4. How involved have you been in the development of your local STP and has this been agreed with your council and elected members? Does it properly reflect the risks facing both the NHS and adult social care and does it reflect a joint approach to tackling the challenges involved? If you have concerns, please briefly describe what these are.

Q5. How does your 2017/18 BCF funding compare with the previous year? Has your level of funding enabled you to sustain investments in jointly agreed priorities? NB Other concerns relating to your budget can be recorded in Section 5A.

Q6. How well is your system currently meeting its BCF-related improvement targets in relation to (a) non-elective admissions (b) delayed transfers of care attributable to adult social care and (c) admissions to care homes? What are the most pressing ongoing challenges? How confident are you that they can be resolved?

Other national prioritiesQ7. What arrangements have you in place to monitor implementation of the Care Act, including for carers? Are you experiencing specific and/or unexpected implementation challenges?

Q8. What action are you taking to implement the recommendations of Transforming Care for people with learning disabilities? How confident are you that you can deliver your agreed transformation plan including timescales?

Q9. Optional question on any other national or regional priorities – eg health and care integration – for agreement by regions.

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6. Processes for using the risk awareness tool 5. RESOURCE AND WORKFORCE MANAGEMENTThis section asks you to reflect on your budget situation and the impact of budget reductions so far. It also asks questions about your workforce pressures – both those affecting your own department and the challenges across the wider sector.

A. Use of resourcesNB in answering these questions, you may choose to cross-refer to your ADASS budget survey return

Q1. Has your council made very high percentage savings since 2010/11? Has it accepted the council tax freeze grant for some years? Has it applied the social care precept in the current year and does it intend to do so next year?

Q2. How would you describe the current level of the council’s useable reserves?

Q3. Please briefly describe any corporate financial challenges such as corporate overspends or unusual budget pressures in other service areas such as children’s services which are a cause of concern for your council now?

Q4. To what extent has your council protected adult social care budgets over the last five years and is this changing?

Q5. Has adult social care’s gross and/or net expenditure reduced in the last few years? If yes, when did it start to reduce and what is the cumulative impact? Is your expenditure on adult social care low per head of population relative to other councils? What is the target budget reduction in the current year?

Q6. Did adult social care overspend its budget last year or is an overspend projected for the current year? If yes, please briefly describe the measures you are taking to address this. Are you satisfied that day to day control over adult social care expenditure and income works as well as it might do?

Q7. Are you experiencing specific demand pressures that are causing you concern (eg rises in new care home placements and/or expensive packages for young people with disabilities)? Conversely, are your demand management measures proving successful in some or all areas? Overall, how confident are you that you can continue to manage demand within current resources?

Q8. Do you have a significant amount of in-house care provision? Are you planning to bring any provision back in-house? What are your medium-term plans for in-house provision?

Q9. How do your unit costs now compare with your neighbouring councils? What immediate plans, if any, do you have either to contain or increase fees? Please outline your strategy and comment on any associated risks, including reference to the impact of the National Living Wage on your current and planned fee levels. NB You may decide to cross-refer to Section 3, Q10.

Q10. How would you summarise the impact of your budget reductions/efficiencies programme so far? Have personal budgets for people who use services and carers been significantly reduced? Please comment on whether you are managing to protect investment in preventative services or whether you believe you have had to make unpalatable cuts as opposed to efficiencies.

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6. Processes for using the risk awareness tool Q11. Do you have an agreed medium-term financial plan (MTFP) for next year and the year after? If so, are you confident you can deliver it? If you have concerns, please give brief details – eg about the aspects of your MTFP that you are least confident about.

Q12. To summarise, how confident are you that you can continue to protect the quality, availability, diversity and safety of adult social care services over the next three years? Please share any additional thoughts/observations (if any) about your local resource challenges.

Workforce management and developmentQ.14 Please describe the strengths and assets of your senior team(s); where you think there is room for improvement, how you are addressing this?

Q15. Are there particular areas of your own adult social care service/department where there are high rates of sickness/absence, high numbers of vacancies and/or high use of temporary/agency staff? If yes, what are you doing to address this? Please comment on specific challenges such as recruitment or retention problems and reflect on whether these are particularly serious in your council area.

Q16 Specifically, do you have sufficient capacity (numbers, skills and competency) to deliver your Safeguarding/MCA/BIA requirements? Assuming you have resource shortfalls and waiting lists, please describe the measures you are taking to manage this situation and mitigate any risks.

Q17.Across your wider care sector, are there workforce challenges that are of concern or worsening (especially in relation to recruitment and retention and/or training and competency)? If yes, please give brief details by specifying which types of role are in short supply, which services are most affected and how this is impacting the care system.

Q18.Is your sector very reliant on immigrants from the European Union? If so, please comment on whether/how Brexit might impact on the workforce supply in your council area and whether you have any plans or discussions underway with providers about this

Q19. Are you engaging with your local partners and providers to address local workforce challenges? If yes, please briefly describe relevant initiatives such as jointly planned recruitment campaigns, media campaigns or training and development and comment on their impact so far. Overall, how confident are you that the steps being taken will mitigate risks to workforce supply?

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6. Processes for using the risk awareness tool 6. CULTURE AND CHALLENGEThis section invites you to reflect on how you participate in your region’s sector-led improvement (SLI) activity, challenge your own performance and invite external challenge. It also prompts thinking about the culture in adult social care and the wider council, and the degree to which individuals and communities can offer feedback and influence decision-making.

Participation in SLI activityQ1. Do you and other senior staff participate regularly in regional ADASS branch meetings and SLI events? Please say which post holders are involved, which networks they are involved in and how often you/they attend.

Local performance managementQ2. What regular/routine methods do you use to monitor adult social care performance – including the use of benchmarking?

Q3. How do you assure the quality and reliability of your monitoring data? Please mention any concerns about data accuracy and describe any recent work to improve this where applicable.

Q4. Has adult social care adopted any externally recognised performance frameworks/standards such as Think Local, Act Personal’s Making it Real?4 Please briefly describe how these frameworks are used, and what impact you think this has had.

Q5. In addition to any peer challenge exercises, has adult social care invited challenge or support from an external agency eg independent consultancy or local Healthwatch?

Q6. What political overview and scrutiny arrangements are in place for adult social care? Please briefly summarise any formal scrutiny exercises undertaken over the last year and what impact this has had.

Co-productionQ7. What methods have you used to enable people who use services (including carers) and the wider population to co-produce care and support solutions at both individual and strategic level in the past year?

PersonalisationQ8. How confident are you that personalised approaches to care and support (including for carers) are embedded throughout adult social care? How do you assess/measure this?

4 http://www.thinklocalactpersonal.org.uk/Browse/mir/aboutMIR/

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6. Processes for using the risk awareness tool

Organisational culture and developmentQ9. How confident are you that your council’s leaders and senior managers consistently demonstrate the positive behaviours and standards consistent with the council’s organisational values and principles? How confident are you that your managers in all tiers lead by example in this regard? Please briefly describe activities such as leadership development and appraisal processes that are in place).

Q10. How do you assess the current state of the culture in adult social care and individual teams? How are you embedding personalisation and asset-based approaches across adult social care? Do you have any particular organisational development challenges? Please briefly describe any organisational development activities undertaken in adult social care, including reflections on their impact.

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7. Suggested dataset to inform self-assessment1. LEADERSHIP AND GOVERNANCE

Name of portfolio holder:

Length of time in post:

Date of next local election:

Name of chief executive:

Length of time in post:

Name of DASS:

Length of time in post:

Duration of career experience in adult social care:

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7. Suggested dataset to inform self-assessment2. PERFORMANCE AND OUTCOMES (including safeguarding)

SafeguardingDate of publication of the annual safeguarding adults board report:

Use national (eg SALT), local or regional data as required.

Examples could include:

Safeguarding adult collection:• number of safeguarding adult reviews

• percentage of user defined outcomes achieved.

Local data eg: • recent trends in safeguarding alerts/referrals/concerns/enquiries

• enquiries completed within any agreed local timescales.

• percentage of safeguarding concerns responded to with 48 hours.

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7. Suggested dataset to inform self-assessment

Performance and outcomesASCOF indicator Council (year) Change since

previous year (improving/little change/worsening)

Regional average (year)

National average (year)

ASCOF 4A: Feeling safe

ASCOF 4B: Services helping people feel safe

ASCOF 1A: Social care-related quality of life

ASCOF 1C(1): Percentage in receipt of direct payments

ASCOF 1C(2): Percentage in receipt of direct payments

ASCOF 1D: Carer reported quality of life

ASCOF 2A(2): Permanent admissions of older people per 100,000 population

ASCOF 2A(1): Permanent admissions of adults aged under 65 per 100,000 population

ASCOF 2C(2): Delayed transfers of care that are attributable to social care per 100,000 population

ASCOF 2B(1): Proportion of outpatients still at home 91 days after discharge into reablement/rehabilitation

ASCOF 3A: Overall satisfaction of people who use services

Add other indicators if required

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7. Suggested dataset to inform self-assessment

Pressures on the front line

Use local and/or regionally-agreed indicators as required.

Examples might include:

Percentage of cases allocated to a social worker:

Percentage of assessments for new clients completed within 28 days or agreed local timescales:

Percentage of assessments for new carers completed within 28 days or agreed local timescales:

Percentage home care packages in place within seven days:

Percentage of clients receiving a review in the year or agreed local timescales:

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7. Suggested dataset to inform self-assessment3. COMMISSIONING AND QUALITY

Date of published Market Position Statement(s) (including annual refresh): CQC local authority profile:

Percentage of registered services that have been inspected over last year (Where inspection results are known, include in table below):

Number of new registrations in last reporting period:

Number of de-registrations in last reporting period:

Care homes

Number of services rated outstanding:

Number of services rated good:

Number of services rated requiring improvement:

Number of services rated inadequate:

Number (or percentage) subject to enforcement action:

Domiciliary care agencies

Number of services rated outstanding:

Number of services rated good:

Number of services rated requiring improvement:

Number of services rated inadequate:

Number (or percentage) subject to enforcement action:

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7. Suggested dataset to inform self-assessment4. NATIONAL PRIORITIES AND PARTNERSHIPS

Date of publication of HWB strategy (including refresh):

Date of publication of JSNA (including refresh):

Date of publication of STP:

BCF indicators (where not already included in form):

Non-elective admissions per 100,000 population:

Target: Actual (in last reporting period):

Optional local indicator/s:

Target/s: Actual (in last reporting period):

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7. Suggested dataset to inform self-assessment5. RESOURCE AND WORKFORCE MANAGEMENT

Use of resourcesCouncil Cipfa Comparator Average

Council’s total service expenditure per 100,000 population in last reported year (CLG RO return).

Percentage growth/reduction in council’s total service expenditure between 2010/11 and last reported year (expressed in cash terms).

The percentage of the council’s total service expenditure that is spent on adult social care [excluding schools] (CLG RO return).

Gross current expenditure on adult social care per 100,000 population in last reported year. (PSS EX1/adult social care-FR).

Percentage growth/reduction in gross current expenditure between 2010/11 and last reported year (PSS EX1/adult social care-FR – bridging year data) (expressed in cash terms).

Projected growth/reduction in adult social care budget in the current year (ADASS Budget Survey) – specify net or gross.

Percentage overspend on adult social care budget last year, and projected overspend on adult social care in current year – specify net or gross.

Percentage of adult social care gross current expenditure spent on residential and nursing care in last reported year. (PSS EX1/adult social care-FR). Break down by client group if required).

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7. Suggested dataset to inform self-assessmentNumber of people receiving long-term support per 100,000 population aged 65 or over in last reported year – over 65s (SALT).

Number of people receiving long-term support per 100k population aged 18 to 65 in last reported year – under 65s (SALT).

Number of people supported in long-term residential/nursing care per 100,000 population aged 65+ in last reported year – over 65s.

Number of people supported in long-term residential/nursing care per 100,000 population aged 18 to 65 in last reported year – under 65s.

Average unit cost of residential and nursing care (aged 65+ – all groups) (PSS EX1/adult social care-FR).

Average unit cost of residential and nursing care (Aged 18 to 65 – LD only) (PSS EX1/adult social care-FR).

Average unit cost of domiciliary care-external providers (PSS EX1/adult social care-FR).

Average unit cost of domiciliary care- in-house provision (PSS EX1/adult social care-FR).

(NB Because of regional and local variation, regional benchmarking may be more useful than national benchmarking. Councils may wish distinguish between in-house and external care provider costs).

Workforce (in-house services)From the NMDSPercentage of management/supervisor posts that are vacant:

Percentage of care manager/social worker posts that are vacant:

Percentage of direct care delivery posts that are vacant:

Local indicators:Percentage of DOLs applications allocated for assessment:

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7. Suggested dataset to inform self-assessment6. CULTURE AND CHALLENGE

Participation in SLI activity

Date of publication of last local account:

PEER REVIEWDate of last peer review/challenge exercise:

Topic(s) covered:

Date of publication (if applicable):

Date review completed (if applicable):

Local performance monitoring

Number of ombudsman complaints in last year:

Number of ombudsman complaints upheld in last year:

Recent staff survey results (if relevant):

Attach other local performance reports/supporting evidence as applicable, and list here:

ADULT SOCIAL CARE RISK AWARENESS SELF-ASSESSMENT TOOL 27

8. Further reading and resourcesSector-led improvementLGA, How can sector-led improvement help you?http://www.local.gov.uk/sector-led-improvement

Adult safeguardingLGA, Making safeguarding personal: guide and toolkit, 2014 http://www.local.gov.uk/topics/social-care-health-and-integration/adult-social-care/making-safeguarding-personal

ADASS, MSP temperature check 2016https://www.adass.org.uk/making-safeguarding-personal-temperature-check-2016

LGA, Adult safeguarding improvement tool, 2015 http://www.local.gov.uk/our-support/peer-challenges/peer-challenges-we-offer/safeguarding-adults-and-adult-social-care

Market shaping and sustainabilityLGA, Market shaping and commissioning toolkitshttp://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/care-and-support-reform/implementation/general-duties/market-shaping

LGA and IPC, Market shaping toolkit http://ipc.brookes.ac.uk/what-we-do/market-shaping/market-shaping-toolkit.html

LGA and Cordis Bright, Market sustainability toolkithttp://www.cordisbright.co.uk/news/post.php?s=social-care-market-sustainability

LGA and TLAP, Commissioning for market diversityhttp://www.thinklocalactpersonal.org.uk/Latest/Top-Tips-Commissioning-for-Market-Diversity/

LGA, Commissioning for better outcomes route map http://www.local.gov.uk/commissioning-better-outcomes-route-map-updated-edition

ADULT SOCIAL CARE RISK AWARENESS SELF-ASSESSMENT TOOL 28

8. Further reading and resourcesThe Care ActLGA, Resources to support implementation http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/care-and-support-reform

LGA, Care Act stocktakes http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/care-and-support-reform/stocktake

Transforming care for people with learning disabilities

Transforming Carehttp://www.local.gov.uk/transforming-care

LGA, Learning disabilities efficiency project, 2011http://www.local.gov.uk/sites/default/files/documents/lga-learning-disability-s-d9a.pdf

Partnerships, integration, STPs and the Better Care FundLGA integration websitehttp://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/integration-and-better-care-fund

LGA integration tool A facilitated workshop to explore local capacity and capability to lead integration.

http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/integration-and-better-care-fund-0

STPs http://www.local.gov.uk/sustainability-and-transformation-plans-stps-how-do-you-know-if-stps-are-making-positive-impact

LGA, The journey to integration: learning from the seven leading localitieshttp://www.local.gov.uk/sites/default/files/documents/journey-integration-learn-6a9.pdf

Place-based leadership http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/integration-and-better-care-fund/better-care-fund/integration-resource-library/leadership

LGA online resource library for integrationA wider, looser selection of support, including case studies as well as other people’s resources.

http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/integration-and-better-care-fund/better-care-fund/integration-resource-library

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8. Further reading and resourcesReducing delays in discharge from hospitalLGA, High impact change model: managing delayed transfers, 2016http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/systems-resilience

Emergency Care Improvement Programme (ECIP)http://ecip.nhs.uk/

ECIP improvement tools

http://www.ecip.nhs.uk/Tools-and-Resources/Improvement-Tools

Risk and finance

ADASS/CIPFA Advisory risk tool, 2016 http://www.cipfa.org/cipfa-thinks/cipfa-thinks-articles/updated-the-cipfa-adass-social-care-budget-assessment-tool

LGA, Adult social care efficiency programmehttp://www.local.gov.uk/our-support/efficiency-and-income-generation/care-and-health-efficiency

LGA, Making best use of reducing resources in adult social care self-assessment toolkit, 2014http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/financial-and-sustainability-risks/managing-risk/self-assessment-toolkit

IPC/Oxford Brookes University, What are the opportunities and threats for further savings in adult social care? February 2016https://ipc.brookes.ac.uk/publications/John_Bolton_What_are_the_opportunities_for_further_savings_in_adult_social_care_Feb_2016.pdf

WorkforceSkills for Care, Recruitment and retention websitehttp://www.skillsforcare.org.uk/Recruitment-retention/Recruitment-and-retention.aspx

Skills for Care, Commissioning for wellbeing qualification

http://www.skillsforcare.org.uk/Topics/Commissioners/Commissioners.aspx

Skills for Care, Workforce shaping and commissioning for better outcomes, 2015

http://www.skillsforcare.org.uk/Documents/Leadership-and-management/Workforce-commissioning/Workforce-shaping-and-commissioning-for-better-outcomes.pdf

Skills for Care and LGA, Principles of workforce integration

http://www.skillsforcare.org.uk/Leadership-management/Workforce-integration/Workforce-integration.aspx

The King’s Fund, Supporting integration through new roles and working across boundaries

https://www.kingsfund.org.uk/publications/supporting-integration-new-roles-boundaries

LGA, The social work healthcheck

http://www.local.gov.uk/sites/default/files/documents/social-work-health-check--06e.pdf

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8. Further reading and resourcesDigital maturity

LGA, Transforming social care through the use of information and technology, 2016http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/informatics/transforming-care-through-technology

LGA, Social care digital maturity self-assessmenthttp://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/informatics/social-care-digital-maturity

NHS England, Local digital roadmapshttps://www.england.nhs.uk/digitaltechnology/info-revolution/digital-roadmaps/footprints/

Developing digital

LGA, Using data and technology to transform outcomes for patients and citizenshttp://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/informatics/developing-digital

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8. Further reading and resources by risk domain1. Leadership and governance

LGA corporate peer challenge programmehttp://www.local.gov.uk/our-support/peer-challenges

2. Performance and outcomes (including safeguarding)

Making safeguarding personal-guide and toolkithttp://local.gov.uk/topics/social-care-health-and-integration/adult-social-care//making-safeguarding-personal

Making safeguarding personal temperature checkhttps://www.adass.org.uk/making-safeguarding-personal-temperature-check-2016

3. Commissioning and quality

Commissioning for better outcomeshttp://www.local.gov.uk/sites/default/files/documents/commissioning-better-outc-bb6.pdf

Other market shaping, sustainability and commissioning toolkitshttp://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/care-and-support-reform/implementation/general-duties/market-shaping

4. National priorities and partnerships

High impact change model for managing transfers of carehttp://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/systems-resilience

Resources to support Transforming Care for people with learning disabilitieshttp://www.local.gov.uk/transforming-care

LGA integration self-assessment tool and workshopshttp://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/integration-and-better-care-fund-0

5. Resources and workforce management

ADASS/Cipfa social care risk toolhttp://www.cipfa.org/cipfa-thinks/cipfa-thinks-articles/updated-the-cipfa-adass-social-care-budget-assessment-tool

Resources in adult social care self-assessment toolkithttp://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/financial-and-sustainability-risks/managing-risk/self-assessment-toolkit

6. Culture and challenge

LGA peer challenge programme on specific issueshttp://www.local.gov.uk/our-support/peer-challenges/peer-challenges-we-offer

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