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Friday, 29th August, 2008

Improving the standards and delivery of the services we receive is an age old problem but does centralised performance management drive improvement?  A new discussion paper by Paul Clarkson and colleagues looks at performance ratings in social care over time.  Revealing comparisons are drawn between England, which has had a centralised comparative system of composite ‘star’ ratings since 2002 plus ‘Performance Assessment Framework’ indicators and Northern Ireland where performance measurement processes are less centrally driven. Looking at two comparable indicators (admissions to residential/nursing care and delayed discharges from hospital) they find that the number of delayed discharges fell in England as did the number of older people being admitted to residential /nursing homes – suggesting that, in those cases at least, ‘top-down’ initiated incentives were working. By 2007, 81% of English councils received the highest ratings of two or three stars compared to just 33% in 2002.  So does this signal success for the English centralised system?  Possibly not, as both countries are now moving towards the position of the other, with the English system taking on a lighter touch with fewer central targets while Northern Ireland considers introducing more targets and tighter monitoring; it remains to be seen how performance improvement will be affected by these ongoing changes.  

Further information on the project this paper is based on is available here.