10.6 Measuring Outcomes in Adult Social Care

1. Introduction

This chapter provides a summary of the ways in which local and national performance indicators and outcome information can be used to measure how well care and support services are achieving the outcomes which matter most to people. It provides information about the national Adult Social Care Outcome Framework (ASCOF) as well as local and regionally agreed key performance information.

A summary of the ASCOF is published annually by NHS England. Local Health and Wellbeing Boards can use ASCOF data, alongside other local information sources, to inform their Joint Strategic Needs Assessment and the development of Joint Local Health and Wellbeing Strategies (see Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies).

2. Adult Social Care Outcomes Framework

The ASCOF is used both locally, regionally and nationally to measure progress against key priorities and strengthen transparency and accountability. It measures how well care and support services achieve the outcomes that matter most to people and provides comparable information on the outcomes and experiences of people who use adult social care, and carers.

1. ‘Quality of life: people’s quality of life is maximised by the support and services which they access, meaning how good they perceive their life to be across multiple aspects, while ensuring that public resources are allocated efficiently.
2. Independence: people are enabled by adult social care to maintain their independence and, where appropriate, regain it.
3. Empowerment – information and advice: individuals, their families and unpaid carers are empowered by access to good quality information and advice to have choice and control over the care they access.
4. Safety: people have access to care and support that is safe, and which is appropriate to their needs.
5. Social connections: people are enabled by adult social care to maintain and, where appropriate, regain their connections to their own home, family and community.
6. Continuity and quality of care: people receive quality care, underpinned by a sustainable and high-quality care market and an adequate supply of appropriately qualified and trained staff’. (Adult Social Care Outcomes Framework: Handbook of Definitions, Department of Health and Social Care)

The ASCOF sets priorities which focus on how well services help adults with care needs and unpaid carers achieve outcomes across the following six key areas:

‘The key roles of the ASCOF are:

• locally, the ASCOF provides councils with robust information that enables them to monitor successes of local interventions in improving outcomes that matter most to people, and to identify their priorities for making improvements. Local Authorities can also use ASCOF to inform outcome-based commissioning models.
• locally, it is also a useful resource for Health and Wellbeing boards who can use the information to inform their strategic planning and leadership role for local commissioning.
• locally, the ASCOF also strengthens accountability to local people. By fostering greater transparency on the outcomes delivered by care and support services, it enables local people to hold their council to account for the quality of the services that they provide, commission or arrange. Local authorities are also using the ASCOF to develop and publish Local Accounts (see CBC Local Account) to communicate directly with their communities on the outcomes that are being achieved, and their priorities for developing local services.
• regionally, the data supports sector led improvement; bringing councils together to understand and benchmark their performance. This, in turn, stimulates discussions between councils on priorities for improvement, and promotes the sharing of learning and best practice.
• at the national level, the ASCOF demonstrates the performance of the adult social care system as a whole, and its success in delivering high-quality, personalised care and support. Meanwhile, the framework supports Ministers in discharging their accountability to the public and Parliament for the adult social care system, and continues to inform, and support, national policy development.

The Adult Social Care Outcomes Framework: Handbook of Definitions (Department of Health and Social Care) contains detailed definitions for the each of the measures (which are called metrics in the framework) covered by ASCOF. It also includes worked examples where possible, to support consistency in reporting and interpretation of the metrics. The intended audience for the handbook is local authorities, members of the public and other stakeholders with an interest in social care outcomes, such as health and wellbeing boards, local Healthwatch, and the voluntary and community sector.

3. ASCOF Sources

The ASCOF draws together data from a range of sources, including that collected by local authorities – for example client level data collection, the Adult Social Care Survey, Survey of Carers in England, the adult social care workforce data set and the safeguarding adults data collection and nationally collected data from the Office of National Statistics and Care Quality Commission.

Data collected under the ASCOF is not used by the Government to manage the performance of local authorities, rather it is used to inform and support sector led improvement and strengthen local transparency and accountability.

4. Central Bedfordshire

The Adult Social Care and Housing directorate has a comprehensive and a robust approach to performance management. This approach consists of 17 scorecards, 301 performance indicators (Directorate, Corporate and Executive), monthly service meetings and a monthly Performance Board, chaired by the Director of Adult Social Care and Housing.

4.1 Directorate

• Adult Social Care – 124 measures across 6 areas (includes management information, regional comparisons and ASCOF measures);
• Contracts, Commissioning & Performance – 40 measures across 4 areas, (includes management information);
• Finance – 53 measures across 3 areas (includes management information);
• Housing – 84 measures across 4 areas (includes management information).

4.2 Corporate and Executive

For Adult Social Care and Housing, there are currently 33 quarterly measures reported to corporate and executive:

• 10 for Adult Social Care;
• 13 for Contracts, Commissioning & Performance;
• 10 for Housing.

This approach ensures the directorate can evidence its contribution to the delivery of the Council’s priorities, vision, and plan. Within Adult Social Care this is specifically in the areas living independently and living well.

4. East of England Balanced Scorecard

The Eastern Region Association of Directors of Adult Social Services (ADASS) commission a Regional Intelligence Group (RIG) of local government officers to support them in developing evidence-based policy, and in monitoring and managing the performance of councils with Adult Social Care responsibilities.

A key element of this is the performance benchmarking tool, known as the East of England Balanced Scorecard. This benchmarking tool enables the in-year comparison of performance and finance, by the 12 East of England councils.

The East of England Balanced Scorecard is restricted to Performance, Finance and Senior Management colleagues and is the data source for the Regional Assessment of Performance (RAP) which is a document that considers risk, areas of development / strength and audit. This replaced the Self Awareness Tool (SAT) from 2024 and is completed annually by the Director of Adult Social Services, as part of the East of England Sector Led Improvement Programme (see Balanced Score Card (ADASS – login required).

5. Further Reading

5.1 Relevant information

Adult Social Care Outcomes Framework – Handbook of Definitions (DHSC) 

Measures from the Adult Social Care Outcomes Framework (NHS England)

Social Care User Surveys (ASCS and SACE Data Collections, NHS Digital) 

Care Data Matters (DHSC)