Health and social care - annual performance reports: statutory guidance

2. Content of reports

2.1 Layout of reports

It is for integration authorities to decide the layout of their own performance reports. However, performance reports must meet the content requirements set out in the regulations, as described throughout this guidance.

Annex A provides a high-level checklist to help guide integration authorities produce their reports.

Accessibility

Integration authorities should assess how accessible their annual performance reports are to their local communities and wider public. This may result in decisions to use more diverse forms of publication to communicate their reports in an accessible way, such as through easy read versions, shorter summaries, diagrams, videos and/or other forms of media.

It is up to each integration authority to tailor, present and communicate their performance report and supplementary documents in a form that they consider most appropriate, and in accordance with the public sector equality duty. The accessibility of annual performance reports must be enhanced by ensuring that reports are published in an easily accessible, visible online location.

In addition, the Health and Social Care Scotland website hosts key documents from all of Scotland’s integration authorities, including strategic plans and performance reports. This should be kept up to date.

Publication of annual performance reports can be supplemented by launch events or other forms of engagement with local communities and supported people to further reflect and capture thoughts on the performance of local services.

Planning with People: Community Engagement and Participation Guidance supports public bodies that plan and deliver health and social care services in Scotland, including integration authorities, to effectively undertake community engagement and participation.

2.2 Assessing performance

The Public Bodies (Joint Working) (Content of Performance Reports) (Scotland) Regulations 2014 set out the content requirements for annual performance reports. The regulations state that performance reports must include:

• an assessment of performance in relation to the integration authority’s strategic plan
• an assessment of performance in relation to the national health and wellbeing outcomes, including;
  • a description of the extent to which arrangements set out in the strategic plan and the expenditure allocated in the financial statement have achieved, or contributed to achieving, the national health and wellbeing outcomes
  • information on the integration authority’s performance against the national indicators (including a comparison between the reporting year and the five preceding reporting years)
• information about the number of significant decisions that have been made outside of strategic planning and reasons for such decisions

While there is flexibility in structuring annual performance reports, performance must be measured in the context of arrangements set out in strategic plans and financial statements. The national health and wellbeing outcomes and core integration indicators should be used as key tools to achieve this.

The national health and wellbeing outcomes are set out in the Public Bodies (Joint Working) (National Health and Wellbeing Outcomes) (Scotland) Regulations 2014 and provide a strategic framework for the planning and delivery of health and social care services. They focus on the experiences and quality of services for people using those services, carers and their families. More information can be found in the National Health and Wellbeing Outcomes Guidance.

A set of core integration indicators were developed in consultation with a wide range of stakeholders across all sectors. They were agreed by the Ministerial Strategic Group for Health and Community Care. Integration authorities should report against these core indicators in their performance reports. In line with the Performance Report Regulations, data should be included for both the year which the report covers, and the five preceding years. However, integration authorities remain free to include as much historical data beyond this minimum requirement as they see fit.

Public Health Scotland (PHS) publishes the data for the core integration indicators, which stem from different sources, in a single publication to provide clarity and consistency. These data are published online in a format that allows national benchmarking. Consistent with the rest of the performance report, integration authorities are expected to report these indicators in a way that best suits their own local needs and that of the public in terms of understanding what they say about local progress towards the national health and wellbeing outcomes.

The core integration indicators provide an indication of progress towards the outcomes that can be compared across integration authorities, described at Scotland level, and over the longer term. In addition, integration authorities will need to collect and understand a wide range of data and feedback to help understand the system at local level, and report on these within their performance reports.

As well as covering performance at integration authority level, where appropriate, integration authorities may also wish to consider reporting on the performance for each locality, and how performance in localities contributes towards the performance of the integration authority as a whole. It is for integration authorities to decide what these local measures should be and how they should be presented and interpreted.

Reflecting on performance and taking action

Performance monitoring and reporting should be an active process. The legislative requirement to produce an annual performance report is an opportunity for integration authorities to interrogate, reflect, and act upon their local performance in a transparent manner.

A number of tools to support performance monitoring have been developed at a national level, including the Health and Social Care Whole System Dashboard, the Social Care Response and Delayed Discharge Dashboard and the TURAS Care Management tool. Consideration should be given as to how to make best use of these products as part of the performance monitoring approach.

Integration authorities should consider performance in the context of ambitions set out in their strategic plans, learning from experience, recognising successes and considering interventions where insight and information indicates that ambitions are not being met or performance is falling short of expectations.

In taking action in relation to performance, integration joint boards should consider the output from performance reports in determining the effectiveness of the directions issued to health boards and local authorities in delivering the vision set out in their strategic plan.

Integration authorities may find value in co-producing recommendations and actions stemming from their annual performance report with supported people, carers, family members, and their wider local community. Co-production is about working together to make decisions and achieve change. Further information on co-production is available on the Scottish Co-production Network website.

Using data

In addition to the national health and wellbeing outcomes and related indicators, wider forms of data may also helpfully allow integration authorities to evaluate the vision and priorities set out in their strategic plans through their annual performance reports.

While data on local activity and services will primarily be available from integration authorities’ systems, there are a number of national publications that may further assist performance monitoring and reporting. These include:

• Acute hospital activity and NHS beds information – Public Health Scotland
• Census data – Scottish Government
• Delayed Discharges in NHS Scotland – Public Health Scotland
• Discovery – Public Health Scotland
• Health and social care analysis statistics – Scottish Government
• Insights in Social Care: Statistics for Scotland – Public Health Scotland
• Local Government Benchmarking Framework – Improvement Service
• Scottish Health Survey – Scottish Government
• Scottish Index of Multiple Deprivation – Scottish Government
• ScotPHO profiles tool – Scottish Public Health Observatory
• Overview of Poverty – Public Health Scotland
• Percentage of end of life spent at home or in a community setting – Public Health Scotland

The Local Intelligence Support Team (LIST) provide on-site expert analytical advice to integration authorities and can support meaningful and actionable use of intelligence.

Public Sector Equality Duty (PSED)

The PSED Scottish Specific Duties require IJBs to publish a report on progress in mainstreaming the general equality duty, equality outcomes and progress thereon at regular intervals (at least every 2 years). These Duties also require IJBs to publish this information in a manner that is accessible to the public and, as far as practicable, to employ an existing means of public performance reporting. This means that integration authorities should consider including this information in their annual performance report.

Some IJBs make their equality outcomes complementary to the national health and wellbeing outcomes. In order for this approach to be effective, integration authorities should enquire as to which national health and wellbeing outcomes can be disaggregated by protected characteristic in their area. This approach may also bring an added degree of efficiency to your reporting.

Further information and guidance is available from the Equality and Human Rights Commission.

2.3 Financial performance and Best Value

The Performance Reporting Regulations require integration authorities to include information on their financial performance, for the reporting year and by comparison with the five preceding years, or with all previous reporting years if this is less than five years.

This must include not only the total amount spent by the integration authorities in the course of the year, but also the total amount and proportion of spend in the reporting year broken down by the various services to which the money was allocated. It should also identify whether there has been an under or overspend against the planned spending for the year and, if this is the case, an assessment as to why this occurred.

The report must also set out the amount paid to, or set aside for use by, each locality. Information on the proportion of money spent on particular services, and on any underspends or overspends within the integration authorities, must be provided both for the reporting year and the five preceding years.

The report must also assess whether the best value has been achieved in terms of the planning and delivery of services. This should include, where applicable, identification of whether there were opportunities for further efficiencies. For more information, integration authorities are referred to the statutory Best Value Guidance for Local Authorities.

We have also issued Finance Guidance for Health and Social Care Integration and Integration Financial Assurance which integration authorities will wish to consider when preparing this section of the report.

2.4 Reporting on localities

The 2014 Act requires an integration authority’s strategic plan to specify two or more localities within its area. A locality is a smaller area within the borders of an integration authority, the purpose of which is to provide an organisational mechanism for local leadership of service planning to be fed upwards into the integration authority’s strategic plan. Read more information in the localities guidance.

The Performance Report Regulations require that each performance report includes a description of the arrangements made in relation to:

• consulting and involving localities
• an assessment of how these arrangements have contributed to the provision of services
• the proportion of the integration authority’s total budget that was spent in relation to each locality.

In line with the Performance Report Regulations, a comparison of the proportion of spend should be included for both the year which the report covers, and the five preceding years. It is recognised that local areas can face practical challenges in disaggregating and reporting all of the required information at locality level.

2.5 Inspection of services

The Performance Reporting Regulations require the performance report to include details of any inspections carried out relating to the functions delegated to the integration authority, by any of the following scrutiny bodies, including joint inspections, in the course of the year:

• Healthcare Improvement Scotland
• the Care Inspectorate
• Audit Scotland
• Accounts Commission

This must include all recommendations which the body has made alongside the actions taken by the integration authority to implement the recommendations.

Where appropriate, information may be provided via a link where the inspection reports and action plans can be found through their usual routes of publication.

2.6 Integration Joint Monitoring Committee recommendations

For integration authorities who have adopted a lead agency model, should the Integration Joint Monitoring Committee have made any recommendations in the course of the year as to how integration functions should be carried out, then the annual performance report must include a list of these, and how the integration authority is responding to each recommendation.

2.7 Review of a strategic plan

If the integration authority has reviewed its strategic plan during the reporting year, the performance report must include a statement as to why the review was carried out, whether this resulted in any changes to the plan, and if changes were made, a description of what these were.