Has social care performance in England improved? An analysis of performance ratings across social services organisations

Abstract

Performance measurement in the English public sector has been implemented in a top-down manner. The mechanics of this regime (centralised targets, public reporting of performance data and the use of rewards and penalties) are driven by central government and are intended to hold agencies to account for their performance and regulate their behaviour. This paper examines whether the operation of such a regime has resulted in the improved performance of social care organisations. Comparable data from Northern Ireland Health and Social Services Trusts, where performance measurement processes are less centrally driven and rewards and penalties are less contingent on ratings, are used to investigate the potential impact of different performance regimes. Indicators of admissions to residential care and delayed discharges from hospital are used to signal progress in the meeting of social care objectives in the two countries.We find that in England social care organisations have broadly improved their performance over time in composite ('star') ratings and with generally higher ratings across individual indicators, with noteworthy improvement across key threshold indicators (measures which councils must perform well on to obtain a good summary rating). The comparative analysis highlights the differences across the two countries with an improvement in performance over time in England and a fairly static picture in Northern Ireland. These improvements may reflect a host of factors other than the incentives created by centralised targets and measures. Our data show, for example, that external characteristics of English councils predominantly influence their being reported as 'poor performers'.Evidence suggests that the rate of performance improvement reflects the incentives inherent in the English performance system. An incentive structure that promotes the 3 achievement of specific targets may have influenced the behaviour of local managers responsible for performance in this sector. However, further information from local organisations is required to more fully explicate all the relevant factors that may have a bearing on reported performance. The evidence reported here does, however, point to the beneficial effects (at least for the regulator) of centrally set measures. It is uncertain whether more recent moves away from this target regime in England, towards the development of local indicators and 'individual incentive' regulation, will likewise offer the appropriate inducements for performance improvement.

Performance Measurement and Management in the Public Sector: Some Lessons from Research Evidence

“…Third, controlling gaming—the deliberate manipulation of behavior to secure strategic advantage in evaluation (Smith, )—is an endless and uphill battle. A number of studies show that many performance measurement systems instigate unintended behavioral change such as gaming (de Brujin, ; Hood, ; Courty and Marschke, ; Clarkson et al ., ; Knutsson et al ., ). Gaming emerges even though different countries adopt different performance measurement systems that prioritize very different types of measures.…”

“…A case in point is the study of Clarkson et al . (), which examines whether a UK performance measurement system in the area of healthcare resulted in improved performance. Overall, they found a marked tendency for summary measures of performance—“star” ratings, to use the system's terminology—to have improved over time.…”

A longitudinal study into the effectiveness of the HPO Framework

“…Schmid (2002) analysed the relationships between organizational properties and organizational effectiveness in, amongst others, home care organizations, and discovered that centralization of authority, formalization, workers' autonomy, coordination, control, empowerment and training had the most influence on organizational effectiveness. Clarkson et al (2009) evaluated the effects of performance measurement systems (comprising centralized targets, public reporting of data, and the use of rewards and penalties) that had been implemented in a top-down manner in the English social care sector, and concluded that these systems had helped social care organizations to improve their performance over time. Malley and Fernández (2010) discussed developments of theoretical and practical frameworks used for assessing quality in social care and for understanding the impact of services on the well-being of patients, using the "production of welfare" framework (Davies and Knapp, 1981;Knapp, 1984).…”

“…The social care and rehabilitation sector Social care and rehabilitation organizations are public organizations working under a government framework of the law on social provision (Costa and Anderson, 2011). Social care is administered through local authorities, and in essence is a locally delivered service operating to centrally determined policy goals (Clarkson et al, 2009). The main goal of social care and rehabilitation is to maintain and enhance the individual well-being of people, by supplying services that try to achieve and sustain the optimum state of health of the recipients of these services (Schmid, 2002).…”

Performance improvement, culture, and regimes

“…Likewise, it was not possible to determine that performance improvement on a mass scale happened in the municipal intelligence regime in Quebec (Charbonneau, 2011, p. 548). The numerous comparative studies on the target regime in England, the rankings regime in Scotland and the intelligence regime in Wales are that performance improved on a mass scale in England (Clarkson et al, 2008;Andrews and Martin, 2010). With the insight that was not available to public managers putting together these performance regimes in the beginning of the 2000s, we offer a proposition.…”