1. Single Outcome Agreements: an initial analysis by CCPS
CCPS membership meeting, September 2008
Single Outcome Agreements published end June 08.
I read all 32 SOAs, took notes, analysed my notes.
Firstly recap on where SOAs sit

2. National performance framework
1 common purpose
5 strategic objectives
7 high level targets
15 national outcomes
45 performance indicators/targets
NB. Single Outcome Agreements to be a mixture of national and local outcomes/indicators
So SOAs reflect 1) how they will meet the national outcomes (mostly structured around these) and 2) what local outcomes they would like to work towards.
In addition to the 45 national outcomes, the Improvement Service developed a menu of local indicators – 49 of those.
CCPS raised some concerns when these were published about whether or not they reflected national aspirations in Changing Lives around personalisation, choice and control etc.

3. Implications and issues
Challenges
“Leap of faith”
Removal of ring-fence – de-prioritising
Lack of clarity around monitoring arrangements
Whose outcomes are they, anyway?
Do as you would be done by?
No clear role for providers in CPPs
Capacity for multi-authority providers (and CCPS?)
Slide from Dec 07 meeting
· ‘Leap of faith’ – nobody knows how this is going to work/work out
· Removal of ring-fence and potential for councils to de-prioritise ‘unpopular’ services and client groups - a real concern for many providers working with homeless people, people with mental illness, learning disability and others (left this in the list as although SOAs don’t touch on removal of ring fence some isues around de-prioritising
· Lack of clarity around accountability, monitoring and reporting of councils’ performance in relation to outcomes and indicators
· Lack of clarity around the process for developing outcomes/outcome agreements – how are they being developed, who is involved, what is the scope for influence
· Will councils take same approach to providers as concordat, ie. focus on outcomes not on inputs?
· No clear role for voluntary organisations in community planning partnerships, which will be locus for service planning
· Potential capacity issues for providers working across several authorities to align locally on Policy

4. Opportunities
Scope for providers to work in partnership with councils to help them demonstrate
achievement of ‘outcomes’
Potential for more ‘joined-up’ and integrated services rather than ‘silo’ services
So in my analysis I’ve tried to figure out whether we were right or not to identify these challenges/opportunities. Before I got on to that, however, I did a purely statistical analysis of the content of the SOAs, so I thought I’d share some of that with you briefly. tHere will be a lot more detail in the report, but I don’t want to bore you with too much numerical stuff just now.

5. General social care references
Focus on shifting the balance of care
Independent living – 25/32
Independent living outcome/indicator – 14/32
Self-directed support – 5/32
Personalisation – 2/32
This refers to things that are not client group specific (will get to client group stuff shortly), so just general references to social care services.
Shifting the balance of care sometimes just indicators given without much commentary on why this important (national agenda?), so made distinction between that and SOAs that had a focus on independent living as a good thing for people who use services (as opposed to a government policy)
Interesting to note that 4 of the 42 ONLY had outcomes/indicators relating to older people.
Were right to be concerned re CL aspirations around personalisation etc.

6. General social care references contd.
Processes – 17/32
Outcome/indicator – 9/32
service user/carer involvement – 8/32
social inclusion for groups using community care services – 7/32
quality of care services – 7/32
Processes e.g. SSA, time between assessment and service, info sharing
Around ¼, but indicators less prevalent

7. General social care references contd.
User satisfaction with community care services – 3/32
Users of community care services feeling safe – 3/32
Quality of life/outcomes for people who use services – 3/32
Less encouraging. These suggest to me that the aspirations in Changing Lives are not well reflected in the SOAs
But maybe that’s because this is general refs to social care, perhaps client groups fair better…
Won’t bore you with all of the details: looked at older people, learning disability, physical disability, drug and alcohol, mental health
Also, adult and child protection, domestic abuse, employability and housing support and carers
Re client group stuff, info will be available to CCPS members in this format

8. Scottish
Borders
NO6
Identifies a need to make sure there is a range of suitable accommodation options to meet the individualised needs of people with mental health needs (other client groups also mentioned) e.g. through self-directed care arrangements and people living independently in their own tenancies
Borders people have improved health and wellbeing
% of key frontline staff in mental health and substance misuse services, primary care and A&E being educated and trained in using suicide assessment tools/suicide prevention training
Reduce annual rate of increase in daily defined dose per capita anti-depressants.
Suicide rate
This comes with some caveats
I did this all myself, from my own notes, therefore this should be used as a guide, not as a definitive statement of what each SOA contains. Hope that you will find them useful for comparison and to get a general impression of how SOAs have dealt with the issues but if, for example, you want to refer to a local outcome or indicator in a tender document or in negotiations with a local authority, PLEASE check the original SOA.
The overall report will not get into naming and shaming territory

9. Learning disability/older people
Mentioned in - 19/32
Local outcome/indicator – 9/32
Care and support services – 6/32
Employability – 10/32
Independent living – 4/32
Older people
Mentioned in - 32/32
Local outcome/indicator – 32/32
Care and support services – 32/32
Social inclusion – 5/32
Participation in decision-making – 5/32
Might be interesting to contrast a couple: learning disability and older people
What does ‘disability’ mean? Does it include learning disability?
four refer to the provision of accommodation for them. Other areas where people with learning disabilities are mentioned include in relation to obesity (two), children and young people (two), personal life plans (one) and pregnancy services (one).
Mostly NO6,7
Service based indicators: increasing the amount of care and support delivered to older people at home (28 containing an indicator to this effect), preventing hospital admissions/re-admissions (25 SOAs contain an indicator) and avoiding delayed discharge (25 SOAs contain an indicator).
Mostly NO6
i.e. for older people the outcome IS getting them a service
Bearing in mind the differences between just these two client groups, and the no of client groups supported by CCPS members, drawing overall conclustions has been challenging. We have started to come up with some conclusions, but hope that others will come to light as a result of discussions this morning.

10. Still a “leap of faith” for service providers
Lack of info on services needed to meet the outcomes detailed
Relationship between vol sect and SOA unclear
Commissioning and procurement not key
Lack of info on funding
Return to our original comments on SOAs – were they justified?
Leap of faith – hoped the SOAs were going to ‘tell us the answers’
Services Ld – 6, pd – 5, mental health – 11, d and a – 18, op - 30
Vol sect services – 15 all BUT staff training etc
7 commissioning or procuring services from the sector, one continuous improvement project to review service level agreements with the voluntary sector, and one stating that SOA local outcomes will be incorporated as appropriate into service level agreements that community planning partners have with local delivery agencies including the third sector.

11. Whose outcomes? National outcomes National indicators
Menu of local indicators
Community care outcomes
HEAT targets
Local outcomes and indicators
national outcome - Services for children, young people and families
Services for older people - two of the 45 national indicators relate to this group. BUT 8 national indicator on mental wellbeing 2 ground nesting birds.
Indicator 29 -increase the proportion of people needing care or support who are able to sustain an independent quality of life as part of the community, through effective joint working is the indicator referred to by the Minister for Public Health as the single overarching indicator for social care. Only 3 SOAs use indicator 29 as an indicator.
Three SOAs use the wording of indicator 29 as a local outcome, and 4 contain a local outcome along these lines but using a different formulation. Of the 7 using this type of local outcome, three only have supporting targets relating to older people, despite the Improvement Service stating in its accompanying notes that baseline information on adults with learning disabilities is available. It is also stated that from April 2008 the 16 community care outcomes developed by the JIT will be promoted as the gold standard in evidencing improvement in relation to this indicator, perhaps adding to the ambiguity as to whether this should be treated as an indicator or an outcome. Only 2 SOAs conform to the ‘gold standard’ of including use of the outcomes framework as an indicator.
HEAT – older people and mental health

12. Monitoring and reporting
What if no outcome/indicator?
Outcomes c.f. indicators
Statutory obligations
Things that aren’t mentioned
How SOAs are monitored and reported on is going to be vital
Patchy re required actions
Will things that are mentioned in the SOA but don’t have a relevant outcome or indicator (e.g. required actions) be commented on in monitoring.
e.g. only 9 of 19 SOAs mentioning learning disability have an outcome or indicator related. Other plans
Will outcomes or indicators prove to be more important (e.g. where independent living outcomes have indicators only re older people’s services, (how) will outcomes for other service users in this regard be measured.
What about things that are statutory obligations e.g. DDA – will those who have mentioned them get credit for achieving them?
What about things that aren’t mentioned – what does this mean, and will anybody pick up on it?
Joint working, ageing population (25 c.f. 7)

13. Other issues De-prioritising? Do as you would be done by?
Providers assisting in demonstration of outcomes?
Providers influencing?
Again – what does it mean if something isn’t mentioned or doesn’t feature as highly?
Other plans
Focus on thigns in SOA?
Older people and children are priorities
What does this mean for services to other client groups?
Commissioning and procurement
CCPS survey?

14. Capacity for providers
If they all do it differently, have to read them all
Under all national outcomes, have to read all of each one
Extrapolation and interpretation
e.g. independent living but not ‘your’ client group
3 working weeks
How to fit in if all doing differently

15. And also Role for national policy/national picture?
e.g. The Same As You c.f. only 19 even mention ld; Changing Lives c.f. only 2 mention personalisation