Guidance

The adult social care outcomes framework 2023 to 2024: handbook of definitions

Updated 21 December 2023

Introduction

The metrics contained in this handbook were developed by the Department of Health and Social Care (DHSC) in consultation with the Association of Directors of Adult Social Services (ADASS), the Local Government Association (LGA), the Care Quality Commission (CQC) and NHS England (NHSE).

The adult social care outcomes framework (ASCOF) is used both locally, regionally and nationally to measure progress against key priorities and strengthen transparency and accountability. Importantly, it measures how well care and support services achieve the outcomes that matter most to people.

The ASCOF also sets outcomes-based priorities for care and support, focused around 6 key objectives for people who draw on care and support, unpaid carers and professionals who provide care and support:

1. Quality of life: people’s quality of life is maximised by the support and services which they access, given their needs and aspirations, 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.

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 to communicate directly with local 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, its success in delivering high-quality, personalised care and support, and achieving good outcomes. Meanwhile, the framework supports ministers in discharging their accountability to the public and Parliament for the adult social care system, enabling oversight of care and support services, and continues to inform, and support national policy development

The government does not seek to performance-manage councils in relation to any of the metrics set out in this framework. Instead, the ASCOF will inform and support improvement which is led by the sector itself, underpinned by strengthened transparency and accountability in other outcomes and performance frameworks that will support understanding of how adult social care is delivering good outcomes for people.

This handbook provides detailed definitions for each ASCOF metric, alongside worked examples where possible, to support consistency in reporting and interpretation of the metrics. The intended audience for this 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.

Through joint strategic needs assessments (JSNAs), health and wellbeing boards identify the current and future health and care needs of the local population, building a robust evidence base of local needs and also looking at local assets available. From this, boards develop joint local health and wellbeing strategies (JLHWSs, previously called joint health and wellbeing strategies), to drive local services by setting the framework for NHS, public health and social care commissioning, and delivering improved outcomes for local communities.

Health and wellbeing boards will have an interest in where the NHS, public health and ASCOFs overlap locally to help inform priorities. The metrics from the outcome’s frameworks are not intended to overshadow local evidence to inform JSNAs and JLHWSs but can be used alongside this evidence to transparently demonstrate health and wellbeing boards’ progress in improving outcomes to their community. Where the NHS, public health and ASCOFs come together, local partners will be able to see how well they are delivering integrated services for their communities, especially around specific health and care issues.

The full suite of ASCOF metrics, at both the national, regional and individual council level will be published annually by NHSE. See Measures from the adult social care outcomes framework on NHS England’s website.

Changes to indicators for 2023 to 2024

Metrics that have been removed from the ASCOF from 2023 to 2024

The metrics that have been removed from the ASCOF this year, are:

• metric 1E from ASCOF 2013 to 2022, ‘The proportion of adults with a learning disability in paid employment’, is not being replaced
• metric 1F from ASCOF 2013 to 2022, ‘The proportion of adults in contact with secondary mental health services in paid employment’, is not being replaced
• metric 1H from ASCOF 2013 to 2022, ‘The proportion of adults in contact with secondary mental health services living independently, with or without support’, is not being replaced
• metric 2C (1) from ASCOF 2013 to 2022, ‘Delayed transfers of care from hospital, per 100,000’, is not being replaced
• metric 2C (2) from ASCOF 2013 to 2022, ‘Delayed transfers of care from hospital that are attributable to adult social care, per 100,000 population’, is not being replaced
• metric 2C (3) from ASCOF 2019 to 2022, ‘Delayed transfers of care from hospital that are jointly attributable to NHS and adult social care, per 100,000 population’, is not being replaced
• metric 4B from ASCOF 2013 to 2022, ‘The proportion of people who use services who say that those services have made them feel safe and secure’, is not being replaced

The following metrics, which were included as placeholders in the 2018 to 2019 draft handbook, have also been removed:

• metric 2E: ‘Effectiveness of reablement services’
• metric 2F: ‘Dementia - A measure of effectiveness of post-diagnosis care in sustaining independence and improving quality of life’
• metric 3E: ‘The proportion of carers who report that they have been included or consulted in discussion about the person they care for’

Metrics that have been introduced for ASCOF 2023 to 2024

The metrics that have been introduced for ASCOF this year, are:

• metric 2D has been introduced to replace metric 2B (as in the 2018 to 2019 handbook for ASCOF 2024 onwards: ‘The proportion of older people (65 and over) who were still at home 91 days after discharge from hospital’
• metric 2E has been introduced introduced to replace metric 1G (as in the 2018 to 2019 handbook) for ASCOF 2024 onwards: ‘The proportion of people who receive long-term support who live in their home or with family’
• metric 4B has been introduced for ASCOF 2023 onwards: ‘The proportion of section 42 safeguarding enquiries where a risk was identified, and the reported outcome was that this risk was reduced or removed’
• metric 6A has been introduced for ASCOF 2023 onwards: ‘The proportion of staff in the formal care workforce leaving their role in the past 12 months’
• metric 6B has been introduced for ASCOF 2023 onwards: ‘The percentage of adult social care providers rated good or outstanding by CQC’

Changes to data source - SALT to CLD

By 2024 to 2025, client level data (CLD) will replace the short- and long-term support (SALT) collection as the primary source of information about local authority adult social care activity.

Previously, all metrics were planned to move to CLD for 2023 to 2024. However, there will now be a dual running of both data sets during this year, to enable quality assurance and comparison before SALT formally ends in 2024 and is replaced with CLD.

For most of the metrics affected, NHSE has developed methods for reproducing them using the CLD data sets. Guidance on upcoming methodologies is available within the ‘Longer term development options’ and ‘Further guidance’ subheadings for each metric.

This work has been carried out in collaboration with local authority and DHSC analysts on our CLD SALT metrics reference group, as well as consulting previous proposals from the pilot phase.

Using the handbook of definitions

This handbook sets out the following information for each metric:

Title

Identifier (1A, 1B and so on) and name of the metric as it appears in the ASCOF.

Rationale

A brief description of the rationale for the inclusion of the metric.

Definition and interpretation

Guidance on the definition of the metric, including the definition of related terms and any notes on interpretation.

Alignment

Whether the metric is shared with, or complementary to, metrics in the public health or NHS outcomes frameworks.

Risk adjustment

Comments on factors that could affect the comparability of the metric, for example age distribution of the local population, and possible adjustments to support more meaningful comparisons between areas.

Formula

The detail of how the metric will be calculated, with a formula and precise definitions of each component (for example, the source table of a data collection or question in a survey).

Worked example

An example of how this formula would be applied to a particular set of data to yield the metric.

Disaggregation

A list of primary support reasons and equality groups by which the metric can be disaggregated, to identify outcomes for different groups and highlight any equality issues.

Frequency of collection

How frequently the data will be collected - biennially, annually or more frequently.

Data source

The data collection or survey from which the metric is drawn - in some cases this may combine data from more than one source.

Return format

Whether the metric will be presented as a percentage or as a number.

Decimal places

Number of decimal places used in the presentation of the metric.

Longer-term development options

Potential improvements or alternatives to current metrics to be explored for future iterations of the ASCOF.

Further guidance

Where to find further guidance relating to the data collections underpinning the metric.

Risk adjustment

To ensure the ASCOF is an effective tool in producing comparable data for local benchmarking purposes, this handbook will set out suggested factors that could be explored for the risk adjustment of each metric.

Risk adjustment improves meaningful comparisons between local authorities by allowing for factors that are outside the control of a local authority, for example, overall age of the local population or levels of need. For some metrics, risk adjustment is reflected in the definition, for example, metrics 2B and 2C (the number of adults whose long-term support needs are met by admission to residential and nursing care homes (per 100,000 population)). This metric is presented as 2 separate metrics, one covering those aged 18 to 64 and the other covering those aged 65 and over, reflecting that the likelihood of long-term support needs requiring residential care, is likely to increase with the age of the person receiving care. As such, this risk adjustment ensures that local authorities with an older than average population are still able to benchmark effectively as the results are adjusted for this risk factor. For other metrics, risks such as higher levels of need are highlighted but not applied to the metrics nationally.

Risk adjustment can make metrics more difficult to understand and interpret. As a result, risk adjustment should only be applied when the improvement in the comparability of the metric is significant enough to outweigh the additional complexity in understanding a risk-adjusted metric. Where risk adjustment is not thought to be appropriate, the current practice of comparing councils with similar authorities can be undertaken for benchmarking purposes.

This handbook will set out suggested factors which could be explored for the risk adjustment of metrics. Decisions on whether to apply risk adjustment are left to local authority discretion and should be made on a case-by-case basis.

The adult social care outcomes framework for 2023 to 2024

Objective 1: quality of life

People’s quality of life is maximised by the support and services which they access, given their needs and aspirations, while ensuring that public resources are allocated efficiently.

1A Quality of life of people who use services

Rationale

This metric gives an overarching view of the quality of life of people who draw on social care. It is based on the outcome domains of social care-related quality of life identified in the adult social care outcomes toolkit (ASCOT) developed by the Personal Social Services Research Unit.^{[footnote 1]}

Definition and interpretation

This measure is an average quality of life score based on responses to the Adult Social Care Survey (ASCS). It is a composite measure using responses to survey questions covering the 8 domains identified in the ASCOT:

• control
• dignity
• personal care
• food and nutrition
• safety
• occupation
• social participation
• accommodation

The relevant questions are listed below:

1. Control - Q3a: Which of the following statements best describes how much control you have over your daily life?
2. Personal care - Q4a: Thinking about keeping clean and presentable in appearance, which of the following statements best describes your situation?
3. Food and nutrition - Q5a: Thinking about the food and drink you get, which of the following statements best describes your situation?
4. Accommodation - Q6a: Which of the following statements best describes how clean and comfortable your home/care home is?
5. Safety - Q7a: Which of the following statements best describes how safe you feel?
6. Social participation - Q8a: Thinking about how much contact you’ve had with people you like, which of the following statements best describes your social situation?
7. Occupation - Q9a: Which of the following statements best describes how you spend your time?
8. Dignity - Q11: Which of these statements best describes how the way you are helped and treated makes you think and feel about yourself?

Each of the questions has 4 possible answers, which are equated with having:

• no unmet needs in a specific life area or domain (the ideal state)
• needs adequately met
• some needs met
• no needs met

Responses to the questions indicate whether the individual has unmet needs in any of the 8 areas. The measure gives an overall score based on respondents’ self-reported quality of life across the 8 questions. All 8 questions are given equal weight.

Interpretation

Guidance on the interpretation of this measure is presented in appendix 2 to this document. The measure gives an overall indication of reported outcomes for individuals - it does not identify the contribution of councils’ adult social care services towards those outcomes.

Alignment

This measure is complementary with measure 2 (health-related quality of life for people with long-term conditions) in the NHS Outcomes Framework. Health-related quality of life is measured using the EQ5D tool.

Risk adjustment

A range of factors may be considered to adjust the measure to improve comparability between councils. Some examples are:

• age of users
• needs of users
• client groups of users

Formula

The formula is x over y.

Where:

X: each respondent is assigned a score based on their answers to questions 3a to 9a and 11. Higher scores are assigned to better outcomes. Scores are assigned as follows:

No needs met (the last answer option for each question) = 0

Some needs met (3rd answer option) = 1

Needs adequately met (2nd answer option) = 2

No unmet needs (1st answer option) = 3

The numerator is then the sum of the scores for all respondents who have answered questions 3a to 9a and 11.

The responses of respondents who were sent the version of the questionnaire for people with a learning disability will be treated in the same way, as this questionnaire has been designed to be equivalent to the non-learning disabilities version.

Y: The number of respondents who answered questions 3a to 9a and 11.

For both the numerator (X) and denominator (Y), weighted data should be used to calculate the measure. The data from the survey will be weighted by NHSE to take account of the stratified sampling technique that has been used when conducting the survey. The weights are automatically calculated within the survey data return along with the ASCOF outcome measures. Further details of how to use the weights when analysing the survey data are available in the methodology document that accompanies each ASCS annual publication.

Exclusions

Any respondents who failed to answer all of the questions from 3a to 9a and question 11 are excluded from the calculation of the measure. For example, a respondent who answered questions 3a to 8a and 11 but did not answer 9a would be excluded from the calculation.

Worked example

The table below represents the responses of 145 users who answered questions 3a to 9a and 11. The data has been weighted to reflect the stratified sampling technique used when conducting the survey.

	No unmet needs (3)	Needs adequately met (2)	Some met needs (1)	No needs met (0)	Total
Control (Q3a)	56	52	24	13	145
Personal care (Q4a)	96	44	5	0	145
Food and nutrition (Q5a)	89	54	2	0	145
Accommodation (Q6a)	72	40	29	4	145
Safety (Q7a)	65	49	26	5	145
Social participation (Q8a)	73	40	19	13	145
Occupation (Q9a)	55	55	22	13	145
Dignity (Q11)	62	51	23	9	145
Total	568	385	150	57	not applicable

Scores are assigned as follows:

• no unmet needs (1st answer option) = 3
• needs adequately met (2nd answer option) = 2
• some needs met (3rd answer option) = 1
• no needs met (the last answer option for each question) = 0

Higher scores are assigned to better outcomes, so the higher the overall score the better the average social care-related quality of life. The maximum possible score is 24.

The numerator for the measure is [(5683) +(3852) +(1501) +(570)] =2,624.

The denominator for the measure is 145.

Therefore, the measure value is 2,624 divided by 145 which equals 18.1.

Disaggregation

Equalities: age, gender, ethnicity, religion, sexual orientation

Primary support reason (all ages):

• physical support
• sensory support
• support with memory and cognition
• learning disability support
• mental health support
• social support

In theory, it is possible to disaggregate the survey results by religion and sexual orientation. However, in practice, there are likely to be significant gaps in the data for these characteristics, at least in the short to medium term. This reflects the content of records held locally by councils.

Please note that some of the disaggregations listed above are not published as part of the adult social care outcomes returns and can only be provided under a data subject access request.

Frequency of collection

Annual.

Data source

Adult Social Care Survey (ASCS).

Return format

Numeric.

Decimal places

One.

Longer-term development options

Not applicable.

Further guidance

Guidance can be found through the NHS England website.

1B Quality of life of people who use services

Adjusted to account only for the additional impact of local-authority funded social care on quality of life, removing non-service-related factors (underlying health and care needs, gender, and so on) (formerly metric 1J)

Rationale

This metric gives a view into the impact of social care on the quality of life of people who draw on social care, which is a composite metric using responses to survey questions covering the 8 domains identified in the ASCOT:

• control
• dignity
• personal care
• food and nutrition
• safety
• occupation
• social participation
• accommodation

This gives an overall score based on respondents’ self-reported quality of life across the 8 questions.

Subsequent research from the Quality and Outcomes of Person-Centred Care Policy Research Unit has identified a way of identifying the impact of local authority adult social care services on individual social care related quality of life.

Definition and interpretation

This measure is based on the quality-of-life scores arising from responses to the Adult Social Care Survey. It is a composite measure using responses to survey questions covering the 8 domains identified in the ASCOT:

• control
• dignity
• personal care
• food and nutrition
• safety
• occupation
• social participation
• accommodation

The relevant questions are listed below:

1. Control - Q3a: Which of the following statements best describes how much control you have over your daily life?
2. Personal care - Q4a: Thinking about keeping clean and presentable in appearance, which of the following statements best describes your situation?
3. Food and Nutrition - Q5a: Thinking about the food and drink you get, which of the following statements best describes your situation?
4. Accommodation - Q6a: Which of the following statements best describes how clean and comfortable your home/care home is?
5. Safety - Q7a: Which of the following statements best describes how safe you feel?
6. Social participation - Q8a: Thinking about how much contact you’ve had with people you like, which of the following statements best describes your social situation?
7. Occupation - Q9a: Which of the following statements best describes how you spend your time?
8. Dignity - Q11: Which of these statements best describes how the way you are helped and treated makes you think and feel about yourself?

Each of the questions has 4 possible answers, which are equated with having:

• no unmet needs in a specific life area or domain (the ideal state)
• needs adequately met
• some needs met
• no needs met

Responses to the questions indicate whether the individual has unmet needs in any of the 8 areas. The measure gives an overall score based on respondents’ self-reported quality of life across the 8 questions. Because people place different degrees of importance on these questions, this measure uses ‘utility weights’ which are multiplier numbers that apply to each possible rating.

Alignment

This is an ASCOF only measure.

Risk adjustment

None.

Formula

The formula for calculating this indicator is set out in the Quality and Outcomes of Person-centred Care Policy Research Unit’s (QORU’s) report titled, ‘Interpreting outcomes data for use in the Adult Social Care Outcomes Framework’.

In summary, the indicator is calculated as follows:

The utility weighted indicator across the domains is calculated (A).

The overall support needed by the service user in carrying out activities associated with daily living (activities of daily living (ADLs) and instrumental activities of daily living (IADLs)) is quantified (B).

Other relevant factors to be considered, as per the formula, are identified (C).

The adjustment factor based on B and C is calculated.

The final adjusted care-related quality of life indicator is calculated as the utility weighted indicator (A) minus the adjustment factor (D)

Worked example

The worked example and how it should be interpreted are published on the NHS England website.

Disaggregation

Primary support reason:

• physical support
• sensory support
• mental health support
• memory
• cognition

Please note that some of the disaggregations listed above may not be published as part of the adult social care outcomes returns and can only be provided under a data subject access request.

Frequency of collection

Annual.

Data source

Adult Social Care Survey (ASCS).

Return format

Numeric.

Decimal places

3.

Longer-term development options

We will consider whether this methodology could be extended to cover further primary support reasons.

Further guidance

Guidance can be found through the NHS England website.

1C Quality of life of carers (formerly metric 1D)

Rationale

This is an overarching outcome metric for the quality of life of unpaid carers, which combines individual responses to 6 questions measuring different outcomes related to overall quality of life. These outcomes are mapped to 6 domains:

• occupation
• control
• personal care
• safety
• social participation
• encouragement and support

Definition and interpretation

This is an overarching outcome measure for unpaid carers, similar to the equivalent for people who use services, measure 1A - social care-related quality of life.

This is a composite measure which combines individual responses to 6 questions measuring different outcomes related to overall quality of life. These outcomes are mapped to 6 domains listed above under ‘Rationale’.

The 6 questions, drawn from the Survey of Adult Carers in England (SACE), are:

1. Occupation - Q7: Which of the following statements best describes how you spend your time?
2. Control - Q8: Which of the following statements best describes how much control you have over your daily life?
3. Personal care - Q9: Thinking about how much time you have to look after yourself - in terms of getting enough sleep or eating well - which statement best describes your present situation?
4. Safety - Q10: Thinking about your personal safety, which of the statements best describes your present situation?
5. Social participation - Q11: Thinking about how much social contact you’ve had with people you like, which of the following statements best describes your social situation?
6. Encouragement and support - Q12: Thinking about encouragement and support in your caring role, which of the following statements best describes your present situation?

Each of the questions has 3 possible answers, which are equated with having:

• no unmet needs in a specific life area or domain (the ideal state)
• some needs met
• no needs met

Responses to the questions indicate whether the carer has unmet needs in any of the 6 areas. The measure gives an overall score based on respondents’ self-reported quality of life across the 6 questions. All 6 questions are given equal weight.

Interpretation

The measure gives an overall indication of the reported outcomes for carers - it does not, at present, identify the specific contribution of councils’ adult social care services towards those outcomes.

Alignment

This measure is complementary with measure 2.4 (health-related quality of life for carers) in the NHS Outcomes Framework.

Health related quality of life is measured using the EQ-5D tool.^{[footnote 2]}

Risk adjustment

A range of factors may be considered to adjust the measure to improve comparability between councils. Some examples are:

• the intensity of the caring role
• age of carer
• characteristics of the cared for person

Formula

The formula is x over y.

Where:

X: each respondent is assigned a score based on their answers to the 6 questions above. Each of the questions has 3 answers. Higher scores are assigned to better outcomes, Scores are assigned to answers as follows:

• no unmet needs (1st answer option) = 2
• some needs met (2nd answer option) = 1
• no needs met (the last answer option for each question) = 0

The numerator is then a sum of the scores for all respondents who have answered all 6 questions.

 Y: The number of respondents who answered all 6 questions.

Exclusions

Any respondents who failed to answer any of the 6 questions above are excluded from the calculation of the measure.

Worked example

The table below represents the responses of 105 carers who answered all 6 questions:

	No unmet needs (2)	Some needs met (1)	No needs met (0)	Total
Occupation	45	45	15	105
Control	33	52	20	105
Personal care	65	38	2	105
Safety	85	20	0	105
Social participation	58	35	12	105
Encouragement and support	22	36	47	105
Total	308	226	96	Not applicable

Scores are assigned as follows:

• no unmet needs (1st answer option) = 2
• some needs met (2nd answer option) = 1
• no needs met (the last answer option for each question) = 0

Higher scores are assigned to better outcomes so the higher the overall score the better the average social care related quality of life. The maximum possible score is 12.

The numerator for the measure is [(3082) +(2261) +(96*0)] =842.

The denominator for the measure is 105.

Therefore, the measure value is 842 divided by 105 which equals 8.0.

Disaggregation

Client group: carers.

Frequency of collection

Biennial.

Data source

Survey of Adult Carers in England (SACE).

Return format

Numeric.

Decimal places

3.

Longer-term development options

None.

Further guidance

Guidance can be found through the NHS England website.

1D Overall satisfaction of people who use services with their care and support (formerly metric 3A)

Rationale

This measures the satisfaction with services of people using adult social care, which is directly linked to a positive experience of care and support. Analysis of surveys suggests that reported satisfaction with services is a good predictor of people’s overall experience of services.

Definition and interpretation

The relevant question drawn from the Adult Social Care Survey is Question 1: ‘Overall, how satisfied or dissatisfied are you with the care and support services you receive?’, to which the following answers are possible:

• I am extremely satisfied
• I am very satisfied
• I am quite satisfied
• I am neither satisfied nor dissatisfied
• I am quite dissatisfied
• I am very dissatisfied
• I am extremely dissatisfied

The relevant question drawn from the Easy Read Adult Social Care Questionnaire is Question 1: ‘How happy are you with the way staff help you?’, to which the following answers are possible:

• I am very happy with the way staff help me, it’s really good
• I am quite happy with the way staff help me
• The way staff help me is OK
• I do not think the way staff help me is that good
• I think the way staff help me is really bad

The measure is defined by determining the percentage of all those responding who identify strong satisfaction - that is. by choosing the answer ‘I am extremely satisfied’ or the answer ‘I am very satisfied’, and of those responding to the Easy Read questionnaire, who choose the answer ‘I am very happy with the way staff help me, it’s really good’

Alignment

ASCOF only measure

Risk adjustment

While this question asks directly about services, it is potentially subject to influence of exogenous factors. For example, a previous study of home care users suggested that better perceptions of home care were related to, amongst other things, receiving less than 10 hours home care (a proxy for need) and receiving help from others. Further analysis will be required to explore this and establish whether risk adjustment should be applied.

Formula

The formula is x over y multiplied by 100.

Where:

X: in response to Question 1, those individuals who selected the response ‘I am extremely satisfied’ or ‘I am very satisfied’, and those who select the response ‘I am very happy with the way staff help me, it’s really good’, in response to Question 1 of the Easy Read questionnaire.

Y: all those that responded to the question. For both the numerator (X) and denominator (Y), weighted data should be used to calculate the measure. The data from the survey will be weighted by NHS England to take account of the stratified sampling technique that has been used when conducting the survey. The weights are automatically calculated within the survey data return along with the ASCOF outcome measures. Further details of how to use the weights when analysing the survey data are available in the guidance for the 2022 to 2023 Adult Social Care Survey.

Worked example

The number of users who said, ‘I am extremely satisfied’ or ‘I am very satisfied’ was 217 and the number of users who said, ‘I am very happy with the way staff help me, it’s really good’, in response to Question 1 of the easy read questionnaire was 30.

In total the number of users who responded to the question (including the easy read questionnaire) was 398.

(Data weighted to reflect the stratified sampling technique that has been used when conducting the survey.)

The measure value is [((217 plus 30) divided by 398) multiplied by 100] which equals 62.1%

Disaggregation

Equalities:

• age
• gender
• ethnicity
• religion
• sexual orientation

Primary support reason (all ages):

• physical support
• sensory support
• support with memory and cognition
• learning disability support
• mental health support
• social support

In theory, it is possible to disaggregate the survey results by religion and sexual orientation. However, in practice, there are likely to be significant gaps in the data for these characteristics, at least in the short to medium term. This reflects the content of records held locally by councils.

Please note that some of the disaggregations listed above are not published as part of the adult social care outcomes returns and can only be provided under a data subject access request.

Frequency of collection

Annual.

Data source

Adult Social Care Survey (ASCS).

Return format

Percentage.

Decimal places

One.

Longer-term development options

None.

Further guidance

Guidance can be found through the NHS England website.

1E Overall satisfaction of carers with social services (for them and for the person they care for) (formerly metric 3B)

Rationale

This measures the satisfaction with services of carers of people using adult social care, which is self-reported through the SACE. Satisfaction is directly linked to a positive experience of care and support. Analysis of user surveys suggests that reported satisfaction with services is a good predictor of the overall experience of services and quality.

Definition and interpretation

The relevant question drawn from the SACE is question 4: ‘Overall, how satisfied or dissatisfied are you with the support or services you and the person you care for have received from social services in the last 12 months?’, to which the following answers are possible:

• we haven’t received any support or services from social services in the last 12 months
• I am extremely satisfied
• I am very satisfied
• I am quite satisfied
• I am neither satisfied nor dissatisfied
• I am quite dissatisfied
• I am very dissatisfied
• I am extremely dissatisfied

The measure is defined by determining the percentage of all those responding who identify strong satisfaction, by choosing the answer ‘I am extremely satisfied’ or the answer ‘I am very satisfied’.

Alignment

ASCOF only measure.

Risk adjustment

While this question asks directly about services, it is potentially subject to influence of exogenous factors. For example, a previous study of home care users suggested that better perceptions of home care were related to, among other things, receiving less than 10 hours home care (a proxy for need) and receiving help from others. Further analysis will be required to explore this and establish whether risk adjustment should be applied.

Formula

The formula is x over y multiplied by 100.

Where:

X: in response to the question above, those individuals who selected the response ‘I am extremely satisfied’ or ‘I am very satisfied’.

Y: all those that responded to the question.

Exclusions

People who select the response ‘We haven’t received any support or services from social services in the last 12 months’ will not be counted in either the numerator or the denominator.

Worked example

The number of unpaid carers who said ‘I am extremely satisfied’ or ‘I am very satisfied’ was 112.

The total number of unpaid carers who responded to the question was 160 but 7 gave a response of ‘We haven’t received any support or services from Social Services in the last 12 months’.

The measure value is [(112 divided by (160 minus 7)) multiplied by 100] = 73.2%.   

Disaggregation

Equalities:

• age
• gender
• ethnicity
• religion
• sexual orientation

Client groups: unpaid carers

In theory, it is possible to disaggregate the survey results by religion and sexual orientation. However, in practice, there are likely to be significant gaps in the data for these characteristics, at least in the short to medium term: this reflects the content of records held locally by councils.

Please note that some of the disaggregations listed above are not published as part of the adult social care outcomes returns; however, they are part of the publication of the original data source.

Frequency of collection

Biennial.

Data source

Survey of Adult Carers in England (SACE).

Return format

Percentage.

Decimal places

One.

Longer-term development options

None.

Further guidance

Guidance can be found through the SACE guidance page on the NHSE website.

Objective 2: independence

People are enabled by adult social care to maintain their independence and, where appropriate, regain it.

2A The proportion of people who received short-term services during the year - who previously were not receiving services - where no further request was made for ongoing support (formerly metric 2D)

Rationale

Since short-term services aim to re-able people and promote their independence, this metric will provide evidence of a good outcome in terms of maximising independence and delaying dependency on, reducing and preventing further care needs, which is relevant for quality of life but not adequately captured in headline quality of life metric.

As well as measuring a domain of user quality of life (independence), it also captures efficiency (as using low tariff early intervention to reduce the need for higher tariff interventions further down the line).

Definition and interpretation

In this context, short-term support is defined as ‘short-term support which is designed to maximise independence’, and therefore will exclude carer contingency and emergency support. This prevents the inclusion of short-term support services which are not reablement services.

Please note this metric does not consider whether there are any unintended consequences of the decision to provide no further services.

Percentage of those that received a short-term service during the year where the sequel was either no ongoing support or support of a lower level.

Alignment

ASCOF only measure.

Risk adjustment

None.

Formula

The formula is x over y multiplied by 100.

Where:

X: number of new clients where the sequel to ‘short-term support to maximise independence’ was:

• ongoing low-level support
• short-term support (other)
• no services provided - universal services and/or signposted to other services
• no services provided - no identified needs

Source: SALT Measure STS002a Table 1, row ‘Total’, sum of columns, ‘Ongoing low-level support’, ‘Short-term support (other)’, ‘No services provided - universal services and/or signposted to other services’ and ‘No services provided - no identified needs’,

Y: Number of new clients who had short-term support to maximise independence. Those with a sequel of either early cessation due to a life event, or those who have had needs identified but have either declined support or are self-funding should be subtracted from this total.

Source: SALT Measure STS002a Table 1, row ‘Total’, sum of all columns, excluding ‘Early cessation of service (not leading to long-term support)’, ‘Early cessation of service (not leading to long-term support) - 100% NHS funded care or end of life care or deceased’, ‘Early cessation of service (leading to long-term support)’,’No services provided - needs identified but self-funding’ and ‘No services provided - needs identified but support declined’.

Exclusions

Exclusions are in the categories of:

• early cessation of service (not leading to long-term support)
• early cessation of service (not leading to long-term support ) - 100% NHS funded care or end of life care or deceased
• early cessation of service (leading to long-term support)

‘No services provided - needs identified but self-funding’ and ‘No services provided - needs identified but support declined’ are excluded from this measure.

Source: SALT Measure STS002a

Worked example

X: the number of new clients where the sequel to ‘Short-term support to maximise independence’ in the categories below during the year:

‘Ongoing low-level support’ = 214

‘Short-term support (other)’ = 459

‘No services provided - universal services and/or signposted to other services’ = 145

‘No services provided - no identified needs’ = 25

X= 214 + 459 + 145 + 25 = 843

Y: the number of new clients who had short-term support to maximise independence was 4705. Of those, 305 had a sequel of ‘Early cessation of service (not leading to long-term support)’; ‘Early cessation of service (leading to long-term support) ‘,’Early cessation of service (not leading to long-term support) - 100% NHS funded care or end of life care or deceased’, ‘No services provided - needs identified but self-funding’; and ‘No services provided – needs identified but support declined’

Y= 4,705 – 305 = 4,400

The measure value is (843 divided by 4,400) multiplied by 100 = 19.2%

Disaggregation

Equalities: age (18 to 64, 65 and over)

Primary support reason (all ages)^{[footnote 3]}:

• physical support
• sensory support
• support with memory and cognition
• learning disability support
• mental health support
• social support

Frequency of collection

Annual.

Data source

SALT and CLD.

Return format

Percentage.

Decimal places

One.

Longer-term development options

For 2023 to 2024, this metric will continue to be derived from SALT, with figures derived from CLD also provided for comparison purposes.

From 2024 to 2025, these will be derived from CLD, which will replace SALT as the primary source of information about local authority adult social care activity.

NHSE has developed methods for reproducing SALT and ASCOF metrics using CLD. This work has been carried out in collaboration with local authority and DHSC analysts on our CLD SALT metrics reference group, as well as consulting previous proposals from the pilot phase.

The draft document setting out principles adopted from SALT, describing fields and methods used from CLD to reproduce the existing SALT metrics, and describing known limitations is published on AGEM’s website (see the further guidance box) and all local authorities have been encouraged to comment on the methods.

Further guidance

Guidance for 2023 to 2024 can be found through the NHSE adult social care collections page at guidance by clicking on the year.

Guidance for 2024 to 2025 onwards can be found on AGEM’s website.

2B The number of adults aged 18 to 64 whose long-term support needs are met by admission to residential and nursing care homes (per 100,000 population) (formerly metric 2A (1))

Rationale

Avoiding permanent placements in residential and nursing care homes is a good indicator of maximising independence and delaying dependency. Research suggests that, where possible, people prefer to stay in their own home rather than move into residential and nursing care. However, it is acknowledged that for some people drawing on care admission to residential or nursing care homes can represent an improvement in their situation.

This indicator also captures efficiency. Residential and nursing care are often the most expensive forms of interventions. Relying on interventions that maximise independence - where appropriate - would represent a cost saving.

The rationale for having the 2 age groups split is because the 2 populations are different, and so what you might expect as reasonable admissions might be different (for example, previous data indicates that older people are much more likely to have their long-term support needs met in residential and nursing care).

Definition and interpretation

This measure reflects the number of younger adults whose long-term support needs are best met by admission to residential and nursing care homes relative to the population size. The measure compares council records with ONS population estimates.

People counted in this measure should include:

• users where the local authority makes any contribution to the costs of care, no matter how trivial the amount and irrespective of how the balance of these costs are met (including full-cost clients) or location of residential or nursing care
• supported users and self-funders with depleted funds in the following categories:
  • those moving to residential or nursing care as a result of an unplanned review
  • those moving to residential or nursing care as a result of a planned review
  • new clients whose request for support was fulfilled with the sequel of ‘Long-term support (eligible services) - nursing care’ or Long-term support (eligible services) - residential care
  • new clients, who following receipt, or early cessation, of ‘Short-term support to maximise independence’, entered either long-term residential or nursing care
  • existing clients, who following receipt, or early cessation, of ‘Short-term support to maximise independence’, entered either long-term residential or nursing care

Interpretation

Analysis shows that older people are more likely to have their long-term support needs met in residential and nursing care settings than younger adults. Using a 2-part measure means that we can separate age as a factor in the indicator and focus on the contribution of services to reducing the proportions for whom the most appropriate way of meeting their long-term care needs is in either a residential or nursing care setting. It will also help highlight, both nationally and locally, the separate issues that exist for younger adults and for older people.

Previous data collections treated clients whose admission was ‘subject to a 12-week disregard’ as ‘temporary’ for the duration of the 12 weeks. This is because the previous collections sought to capture detail of council funding of care. SALT captures data on sequels to events in the customer journey.

From 2017 to 2018 onwards, SALT identifies those new clients who either request support (STS001) or undertake a period of short-term support to maximise independence (ST-Max) (STS002a) through the route of access ‘Self funder with depleted funds’. It additionally identifies the proportion of those ‘Self funders with depleted funds’ who have been previously provided with either a 12-week disregard or deferred payment since 1 April 2014. This additional information enables the identification of those clients who appear to enter residential or nursing care for a second time when their funds have been depleted; to prevent double counting we can now exclude those clients who were previously provided with a 12-week disregard or deferred payment (DPA).

Alignment

ASCOF only measure

Risk adjustment

Analysis identified age as a factor that influenced the rate of admissions. Instead of applying risk adjustment, the measure has been expressed separately for those aged 18 to 64 years, and those aged 65 years and over. There were no other influencing factors identified from the data available.

Formula

The formula is x over y multiplied by 100,000.

Where:

X: the sum of the number of council-supported younger adults (aged 18 to 64) whose long-term support needs were met by a change of setting to residential and nursing care during the year (excluding transfers between residential and nursing care) in the following populations.

Population	Source: SALT
Long-term support: unplanned review	Measure LTS002a, Table 1aii, sum of columns: ‘Change of setting: move to nursing care from community’; and ‘Change of setting: move to residential care from community’.
Long-term support: planned review	Measure LTS002a, Table 2, Sum of row ‘for those aged 18 to 64’ for columns ‘Change of setting: move to nursing care from community’ and ‘Move to residential care from community’
Short-term support: new clients	Measure STS001, Table 1a, Sum of routes of access - ‘Planned entry (transition), Discharge from hospital, Diversion from hospital services, Self-funder with depleted funds (minus ‘of which previously provided with 12-week disregard or deferred payment (since 1 April 2014)’), Prison and community/other route - ’ for columns ‘Long-term support (eligible services)’ ‘Residential Care’ and ‘Nursing Care’
Short-term support: new clients - Sequel to ST Max	Measure STS002a, Table 5, Sum of row ‘for clients aged 18 to 64’ for columns ‘Residential’ and ‘Nursing’ minus sum of row ‘of whom had a route of access “Self-funder with depleted funds and had previously had either a 12 week disregard or DPA” for columns ‘Residential’ and ‘Nursing’
Short-term support: existing clients	Measure STS002b, Table 2a, Sum of columns ‘Move to nursing care from community’ and ‘Move to residential care from community’
Short-term support: existing clients: Early cessation of ST Max	Measure STS002b, table 4, Sum of row ‘for clients aged 18 to 64’ for columns ‘Change of setting: move to nursing care from community’ and ‘Move to residential care from community’

Y: Size of younger adult population (aged 18 to 64) in area (ONS mid-year population estimates).

Source: Office for National Statistics

Exclusions

People funding their own residence in a care home with no support from the council are excluded.

Worked example

The number of council-supported younger adults (aged 18 to 64) whose long-term support needs were met by a change of setting to residential and nursing care during the year in each category was as below:

Population	Source: SALT
Long-term support: unplanned review	Measure LTS002a, Table 1aii, sum of columns: ‘Change of Setting: Move to Nursing Care from Community’; and ‘Change of Setting: Move to Residential Care from Community’.	7
Long-term support: planned review	Measure LTS002a, Table 2, Sum of row ‘for those aged 18 to 64’ for columns ‘Change of Setting: Move to Nursing Care from Community’ and ‘Move to Residential Care from Community’	8
Short-term support: new clients	Measure STS001, Table 1a, Sum of routes of access – ‘Planned Entry (Transition), Discharge from hospital, Diversion from Hospital Services, Self-Funder with Depleted Funds (minus ‘of which previously provided with 12-week disregard or deferred payment (since 1 April 2014)’), Prison and Community or Other Route - ’ for columns ‘Long-term support (eligible services)’ ‘Residential Care’ and ‘Nursing Care’	5 of which 1 was previously provided with a 12-week disregard.
Short-term support: new clients – Sequel to ST Max	Measure STS002a, Table 5,Sum of row ‘for clients aged 18 to 64’ for columns ‘Residential’ and ‘Nursing’ minus sum of row ‘of whom had a route of access “Self Funder with Depleted Funds and had previously had either a 12 week disregard or DPA” for columns ‘Residential’ and ‘Nursing’	2
Short-term support: existing clients	Measure STS002b, Table 2a, Sum of columns ‘Move to nursing care from community’ and ‘Move to residential care from community’	5
Short-term support: existing clients: early cessation of ST Max	Measure STS002b, Table 4, Sum of row ‘for clients aged 18 to 64’ for columns ‘Change of setting: move to nursing care from community’ and ‘Move to residential care from community’	4
	Total	31

The number of council-supported younger adults (aged 18 to 64) whose long-term support needs were met by a change of setting to residential and nursing care) during the year was 7 + 8 + 4 + 2 +5 + 4 = 31.

Minus the one client who previously received a 12-week disregard, we get 30.

The population of younger adults in the area was 153,471.

The measure value is [(30 divided by 153,471) multiplied by 100,000] which equals 19.5.

Disaggregation

Not applicable

Frequency of collection

Annual

Data source

SALT and CLD, Office of National Statistics (ONS)

Return format

Rate per 100,000 population

Decimal places

One

Longer-term development options

For 2023 to 2024, this metric will continue to be derived from SALT, with figures derived from CLD also provided for comparison purposes.

From 2024 to 2025, these will be derived from CLD, which will replace SALT as the primary source of information about local authority adult social care activity.

NHSE have developed methods for reproducing SALT and ASCOF metrics using CLD. This work has been carried out in collaboration with local authority and DHSC analysts on our CLD SALT metrics reference group, as well as consulting previous proposals from the pilot phase.

The draft document setting out principles adopted from SALT, describing fields and methods used from CLD to reproduce the existing SALT metrics, and describing known limitations is published on AGEM’s website (see the further guidance box) and all local authorities have been encouraged to comment on the methods.

Further guidance

Guidance for 2023 to 2024 can be found through the NHSE adult social care collections page at guidance by clicking on the year.

Guidance for 2024 to 2025 onwards can be found on AGEM’s website.

2C The number of adults aged 65 and over whose long-term support needs are met by admission to residential and nursing care homes (per 100,000 population) (formerly metric 2A (2))

Rationale

Avoiding permanent placements in residential and nursing care homes is a good indicator of maximising independence and delaying dependency. Research suggests that, where possible, people prefer to stay in their own home rather than move into residential and nursing care. However, it is acknowledged that for some people drawing on care admission to residential or nursing care homes can represent an improvement in their situation.

This indicator also captures efficiency. Residential and nursing care are often the most expensive forms of interventions. Relying on interventions that maximise independence - where appropriate - would represent a cost saving.

The rationale for having the 2 age groups split is because the 2 populations are different, and so what you might expect as reasonable admissions might be different (for example, previous data indicate that older people are much more likely to have their long-term support needs met in residential and nursing care).

Definition and interpretation

This measure reflects the number of older adults whose long-term support needs are best met by admission to residential and nursing care homes relative to the population size. The measure compares council records with ONS population estimates.

People counted in this measure should include:

• users where the local authority makes any contribution to the costs of care, no matter how trivial the amount and irrespective of how the balance of these costs are met (including full-cost clients) or location of residential or nursing care
• supported users and self-funders with depleted funds in the following categories:
• those moving to residential or nursing care as a result of an unplanned review
• those moving to residential or nursing care as a result of a planned review
• new clients whose request for support was fulfilled with the sequel of ‘Long-term support (eligible services) - nursing care’ or ‘Long-term support (eligible services) - residential care’
• new clients, who following receipt, or early cessation, of ‘Short-term support to maximise independence’, entered either long-term residential or nursing care
• existing clients, who following receipt, or early cessation, of ‘Short-term support to maximise independence’, entered either long-term residential or nursing care

Interpretation

Analysis shows that older people are more likely to have their long-term support needs met in residential and nursing care settings than younger adults. Using a 2-part measure means that we can separate age as a factor in the indicator and focus on the contribution of services to reducing the proportions for whom the most appropriate way of meeting their long-term care needs is in either a residential or nursing care setting. It will also help highlight, both nationally and locally, the separate issues that exist for younger adults and for older people.

Previous data collections treated clients whose admission was ‘subject to a 12-week disregard’ as ‘temporary’ for the duration of the 12 weeks. This is because the previous collections sought to capture detail of council funding of care. SALT captures data on sequels to events in the customer journey.

From 2017 to 2018 onwards, SALT identifies those new clients who either request support (STS001) or undertake a period of short-term support to maximise independence (ST-Max) (STS002a) through the route of access ‘Self-Funder with Depleted Funds’. It additionally identifies the proportion of those ‘Self-Funders with Depleted Funds’ who have been previously provided with either a 12-week disregard or deferred payment since 1 April 2014. This additional information enables the identification of those clients who appear to enter residential or nursing care for a second time when their funds have been depleted, to prevent double counting we can now exclude those clients who were previously provided with a 12-week disregard or deferred payment (DPA).

Alignment

ASCOF only measure.

Risk adjustment

Analysis identified age as a factor that influenced the rate of admissions. Instead of applying risk adjustment, the measure has been expressed separately for those aged 18 to 64 years, and those aged 65 years and over. There were no other influencing factors identified from the data available.

Formula

The formula is x over y multiplied by 100,000.

Where:

X: the sum of the number of council-supported older people (aged 65 and over) whose long-term support needs were met by a change of setting to residential and nursing care during the year (excluding transfers between residential and nursing care) in the following populations:

Population	Source: SALT
Long-term support: unplanned review	Measure LTS002a, Table 1bii, sum of columns ‘Change of setting: move to nursing care from community’ and ‘Change of setting: move to residential care from community.
Long-term support: planned review	Measure LTS002a, Table 2, Sum of row ‘for those aged 65 and over’ for columns ‘Change of setting: move to nursing care from community’ and ‘Move to residential care from community’
Short-term support: new clients	Measure STS001, Table 1b, Sum of routes of access - ‘Discharge from hospital, Diversion from hospital services, Self-funder with depleted funds (minus ‘of which previously provided with 12-week disregard or deferred payment (since 1 April 2014)’), Prison and community or other route for columns ‘Long-term support (eligible services)’ ‘Residential care’ and ‘Nursing care’
Short-term support: new clients - Sequel to ST max	Measure STS002a, Table 5, Sum of row ‘for clients aged 65 and over’ for columns ‘Residential’ and ‘Nursing’ minus sum of row ‘of whom had a route of access ‘Self funder with depleted funds and had previously had either a 12-week disregard or DPA’ for columns ‘Residential’ and ‘Nursing’
Short-term support: existing clients	Measure STS002b, Table 2b, Sum of columns ‘Move to nursing care from community’ and ‘Move to residential care from community’
Short-term support: existing clients: early cessation of ST Max	Measure STS002b, Table 4, Sum of row ‘for clients aged 65 and over’ for columns ‘Change of setting: move to nursing care from community’ and ‘Move to residential care from community’

Y: Size of older people population (aged 65 and over) in area (ONS mid-year population estimates).

Source: Office for National Statistics

Exclusions

People funding their own residence in a care home with no support from the council are excluded.

Worked example

The number of council-supported older adults (aged 65 and over) whose long-term support needs were met by a change of setting to residential and nursing care during the year in each category was as below:

Population	Source: SALT
Long-term support: unplanned review	Measure LTS002a, Table 1bii, sum of columns ‘Change of setting: move to nursing care from community’ and ‘Change of setting: move to residential care from community	136
Long-term support: planned review	Measure LTS002a, Table 2, Sum of row ‘for those aged 65 and over’ for columns ‘Change of setting: move to nursing care from community’ and ‘Move to residential care from community’	54
Short-term support: new clients	Measure STS001, Table 1b, Sum of routes of access - ‘ Discharge from hospital, Diversion from hospital services, Self-funder with depleted funds (minus ‘of which previously provided with 12-week disregard or deferred payment (since 1 April 2014)’), Prison and community or other route for columns ‘Long-term support (eligible services)’ ‘Residential care’ and ‘Nursing care	78 of which 4 were previously provided with a 12-week disregard
Short-term support: new clients - sequel to ST max	Measure STS002a, Table 5, sum of row ‘for clients aged 65 and over’ for columns ‘Residential’ and ‘Nursing’ minus sum of row ‘of whom had a route of access ‘Self funder with depleted funds and had previously had either a 12-week disregard or DPA’ for columns ‘Residential’ and ‘Nursing’	38
Short-term support: existing clients	Measure STS002b, Table 2b, Sum of columns ‘Move to nursing care from community’ and ‘Move to residential care from community’	10
Short-term support: existing clients: early cessation of ST max	Measure STS002b, Table 4, sum of row ‘for clients aged 65 and over’ for columns ‘Change of setting: move to nursing care from community’ and ‘Move to residential care from community’	8
	Total	324

The number of council-supported older people (aged 65 and over) whose long-term support needs were met by a change of setting to residential and nursing care during the year was 136 + 54+ 74+ 38 +10 + 8 = 324.

Minus the 4 clients who had received a 12-week disregard, or deferred payment we get 320.

The population of older people in the area was 43,384.

The measure value is [(320 divided by 43,384) multiplied by 100,000] which equals 737.6.

Disaggregation

Not applicable.

Frequency of collection

Annual.

Data source

SALT and CLD, ONS.

Return format

Rate per 100,000 population.

Decimal places

One.

Longer-term development options

For 2023 to 2024, this metric will continue to be derived from SALT, with figures derived from CLD also provided for comparison purposes.

From 2024 to 2025, these will be derived from CLD, which will replace SALT as the primary source of information about local authority adult social care activity.

NHSE has developed methods for reproducing SALT and ASCOF metrics using CLD. This work has been carried out in collaboration with local authority and DHSC analysts on our CLD SALT metrics reference group, as well as consulting previous proposals from the pilot phase.

The draft document setting out principles adopted from SALT, describing fields and methods used from CLD to reproduce the existing SALT metrics, and describing known limitations is published on AGEM’s website (see the further guidance box) and all local authorities have been encouraged to comment on the methods.

Further guidance

Guidance for 2023 to 2024 can be found via the NHSE adult social care collections page at guidance by clicking on the year.

Guidance for 2024 to 2025 onwards can be found on AGEM’s website here

2D The proportion of older people (65 and over) who were still at home 91 days after discharge from hospital (formerly metric 2B)

Rationale

Avoiding permanent placements in residential and nursing care homes is a good measure of delaying dependency, and the inclusion of this measure in the framework supports local health and social care services to work together to reduce avoidable admissions. Research suggests that, where possible, people prefer to stay in their own home rather than move into residential care. However, it is acknowledged that for some client groups that admission to residential or nursing care homes can represent an improvement in their situation.

Definition and interpretation

This is a 2-part measure which reflects both the effectiveness of reablement services (part 1), and the coverage of the service (part 2).

2D Part 1:

The proportion of older people aged 65 and over discharged from hospital to their own home or to a residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will move on/back to their own home (including a place in extra care housing or an adult placement scheme setting), who are at home or in extra care housing or an adult placement scheme setting 91 days after the date of their discharge from hospital.

Those who are in hospital or in a registered care home (other than for a brief episode of respite care from which they are expected to return home) at the 3-month date and those who have died within the 3 months are not reported in the numerator.

2D Part 2:

The proportion of older people aged 65 and over offered reablement services following discharge from hospital.

This measure will take the denominator from part 1 as its numerator (the number of older people offered reablement services). The denominator will be the total number of older people discharged from hospitals based on hospital episode statistics (HES).

Interpretation

The rationale for a 2-part measure is to capture the volume of reablement offered as well as the success of the reablement service offered. This will prevent areas scoring well on the measure while offering reablement services to only a very small number of people. The measure includes social care-only placements. Therefore, those that were assessed just on social care needs are included in the data collection.

Alignment

These measures are shared with measure 3.6i (the proportion of older people aged 65 and over who were still at home 91 days after discharge into rehabilitation) and measure 3.6ii (the proportion of older people aged 65 and over who were offered rehabilitation following discharge from acute or community hospital) on page 39 in the NHS Outcomes Framework.

Risk adjustment

None.

Formula

The formula is x over y multiplied by 100.

Where, for 2D part 1 (proportion of successful reablement):

X: number of older people discharged from acute or community hospitals to their own home or to a residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will move on/back to their own home (including a place in extra care housing or an adult placement scheme setting), who are at home or in extra care housing or an adult placement scheme setting 91 days after the date of their discharge from hospital. This should only include the outcome for those cases referred to in the denominator.

Source: SALT measure STS004, Table 1, row ‘Number of discharges above where person was still at home 91 days later’, column ‘Overall total’.

Y: number of older people discharged from acute or community hospitals from hospital to their own home or to a residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will move on or back to their own home (including a place in extra care housing or an adult placement scheme setting).

Source: SALT Measure STS004, Table 1, row ‘Number of discharges in period to rehabilitation where the intention is for the person to go back home (1 October to 31 December), column ‘Overall total’

For 2D part 2 (coverage of reablement services):

X: number of older people discharged from acute or community hospitals from hospital to their own home or to a residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will move on or back to their own home (including a place in extra care housing or an adult placement scheme setting).

Source: SALT Measure STS004, Table 1, row ‘Number of discharges in period to rehabilitation where the intention is for the person to go back home (1 October to 31 December), column ‘Overall total’

Y: total number of people, aged 65 and over, discharged alive from hospitals in England between 1 October and 31 December. This includes all specialities and zero-length stays. Data for geographical areas is based on usual residence of patient.

Source: HES

Worked example

2D Part 1:

The number of people aged 65 and over on discharge and benefited from intermediate care or rehabilitation on discharge and who were still living at home 91 days later was 217.

The number of people discharged from hospital aged 65 and over and entering into joint ‘intermediate care’ or a ‘rehabilitation service’ was 306.

Therefore, the percentage achieving independence was (217 divided by 306) x 100 which equals 70.9%.

2D Part 2:

The number of people discharged from hospital aged 65 and over and entering into joint ‘intermediate care’ or a ‘rehabilitation service’ was 306 (using same figure as above). The total number of people aged 65 and over discharged from hospital was 6,857.

The proportion offered reablement services was (306 divided by 6,857) multiplied by 100 which equals 4.5%.

Disaggregation

Equalities: age (65 to 74, 75 to 84, 85 and over), gender.

Frequency of collection

Annual.

Data source

SALT and CLD.

Return format

Percentage.

Decimal places

One.

Longer-term development options

For 2023 to 2024, this metric will continue to be derived from SALT, with figures derived from CLD also provided for comparison purposes.

From 2024 to 2025, these will be derived from CLD, which will replace SALT as the primary source of information about local authority adult social care activity.

The methodology for the replacement metric has not yet been established, however will be shared with local authorities as soon as it is complete.

Further guidance

Guidance for 2023 or 2024 can be found via the NHSE adult social care collections page at guidance by clicking on the year.

Guidance for HES data is on the NHSE website.

2E The proportion of people who receive long-term support who live in their home or with family (formerly metric 1G)

Rationale

Please note, for 2023 to 2024 only this metric will retain the rationale, definition, and methodology of the previous 1G metric which can still be found in the 2018 to 2019 ASCOF handbook. This means that the metric will only consider people with a primary support reason of learning disability support as the SALT data collection does not enable wider analysis. Once the experimental CLD metric described below is established, which is expected to come into effect for the 2024 to 2025 collection, this metric will move to including all individuals ‘known to the council’, regardless of primary support reason.

Measuring whether someone lives in their own home is again a way to measure independence. This metric has been expanded to cover all those receiving support and not only those receiving support with learning disabilities, as previously. This metric is being badged as experimental as it relies on a new data field captured through CLD (accommodation status). We will review the feasibility of this metric as national CLD data becomes available and full metric calculations are developed. A final decision on inclusion of this experimental metric will be taken in summer 2024.

Definition and interpretation

The measure shows the proportion of all adults who are ‘known to the council’, (see definition below) who receive long-term support and who are recorded as living in their own home or with their family. The information must be captured or confirmed within the reporting period 1 April of the relevant year to 31 March the following year.

‘Living on their own or with their family’ is intended to describe arrangements where the individual has security of tenure in their usual accommodation, for instance, because they own the residence or are part of a household whose head holds such security.

Formula

For 2023 to 2024 the methodology will remain as follows:

The formula is x over y multiplied by 100.

Where:

X: all people within the denominator who are ‘living on their own or with their family’ as per the definition above. The numerator should include those living in their own home or with their family irrespective of whether they have had a review during the year, but the information would have to be captured within the current financial year.

Source: SALT Measure LTS004 Table 2a, sum of row ‘total’ for all columns.

Y: number of working-age clients with a primary support reason of learning disability support ‘known to the council’ 35 during the period. This includes clients who received long-term support during the year and appear in the LTS001a measure (table 1a) of SALT with a primary support reason of learning disability support. All support settings should be included (for example, residential, nursing and community settings but excluding prisons) This measure is a count of eligible adults (aged 18 to 64), who have received long-term support for learning disability during the year

Source: SALT Measure LTS001a Table 1a, ‘Total clients’ with a primary support reason of ‘Learning disability support.

Worked example

Adults who received long-term support during the year with a primary support reason of learning disability support in nursing, residential or community settings (and appear in SALT Measure LTS001a Table 1a) = 722.

Of those adults who received long-term support with a primary support reason of learning disability support, those who are recorded as living in their own home or with their family within the current financial year was 455.

The measure value is (455 divided by 722) multiplied by 100 which equals 63.0%.

Data source

For 2023 to 2024: SALT

For 2024 to 2025 onwards: CLD, ONS

Longer-term development options

From 2024 to 2025, this metric will be derived from CLD, which will replace SALT as the primary source of information about local authority adult social care activity.

NHSE has developed methods for reproducing SALT and ASCOF metrics using CLD. This work has been carried out in collaboration with local authority and DHSC analysts on our CLD SALT metrics reference group, as well as consulting previous proposals from the pilot phase.

The draft document setting out principles adopted from SALT, describing fields and methods used from CLD to reproduce the existing SALT metrics, and describing known limitations is published on AGEM’s website (see the further guidance box) and all local authorities have been encouraged to comment on the methods.

Further guidance

Guidance for 2023 to 2024 can be found via the NHSE adult social care collections page at guidance by clicking on the year.

Guidance for 2024 to 2025 onwards can be found on AGEM’s website

Objective 3: empowerment - information and advice

Individuals, their families and carers are empowered by access to good quality information and advice to have choice and control over the care they access, ensuring that people have a positive experience of care and support.

3A The proportion of people who use services who report having control over their daily life (formerly metric 1B)

Rationale

A key objective of the drive to make care and support more personalised is that support more closely matches the needs and wishes of the individual, putting users of services in control of their care and support. Therefore, asking users of care and support about the extent to which they feel in control of their daily lives is one means of measuring whether this outcome is being achieved.

Of the 8 questions that make up the overarching metric 1A - social care-related quality of life - a preference study conducted by RAND - found that members of the public gave this question the highest weight. As such, an individual metric was felt to be warranted.

Definition and interpretation

The relevant question drawn from the Adult Social Care Survey is Question 3a: ‘Which of the following statements best describes how much control you have over your daily life?’, to which the following answers are possible:

• I have as much control over my daily life as I want
• I have adequate control over my daily life
• I have some control over my daily life but not enough
• I have no control over my daily life

The measure is defined by determining the percentage of all those responding either ‘I have as much control over my daily life as I want’ or ‘I have adequate control over my daily life’. These 2 responses have been chosen to focus the measure on those individuals achieving the best outcomes, identifying no or limited need in this area. The intention is that this will allow for better use in benchmarking.

Interpretation

The measure gives an overall indication of the reported outcome for individuals - it does not, at present, identify the specific contribution of councils’ adult social care towards the outcome (see longer-term development below).

Alignment

ASCOF measure only.

Risk adjustment

A range of factors may be considered to adjust the measure to improve comparability between councils. Some examples are:

• age of users
• needs of users
• client groups of users

Formula

The formula is x over y multiplied by 100.

Where:

X: in response to Question 3a, those individuals who selected the response ‘I have as much control over my daily life as I want’ and ‘I have adequate control over my daily life’.

The responses of respondents who were sent the version of the questionnaire for people with a learning disability will be treated in the same way, as this questionnaire has been designed to be equivalent to the non-learning disabilities version.

Y: all those that respond to the question.

For both the numerator (X) and denominator (Y), weighted data should be used to calculate the measure. The data from the survey will be weighted by NHS England to take account of the stratified sampling technique that has been used when conducting the survey. The weights are automatically calculated within the survey data return along with the ASCOF outcome measures. Further details of how to use the weights when analysing the survey data are available on the NHS England website.

Worked example

The number of users who said ‘I have as much control over my daily life as I want or ‘I have adequate control over my daily life’’ was 156.

In total the number of users who responded to the questions was 210.

(Data weighted to reflect the stratified sampling technique that has been used when conducting the survey).

The measure value is [(156 divided by 210) multiplied by 100] = 74.3%

Disaggregation

Primary support reason (all ages):

• physical support
• sensory support
• support with memory and cognition
• learning disability support
• mental health support
• social support

Please note that some of the disaggregations listed above are not published as part of the adult social care outcomes returns; however, they are part of the publication of the original data source.

Frequency of collection

Annual.

Data source

Adult Social Care Survey (ASCS).

Return format

Percentage.

Decimal places

One.

Longer-term development options

None.

Further guidance

Guidance can be found through the NHS England website.

3B The proportion of carers who report that they have been involved in discussions about the person they care for (formerly metric 3C)

Rationale

Carers should be respected as equal partners in the design of services for the people they care for - this improves outcomes both for the cared for person and the carer, reducing the chance of breakdown in care. This metric reflects the experience of carers in how they have been consulted by both the NHS and social care.

Definition and interpretation

The relevant question drawn from the SACE is Q19: ‘In the last 12 months, do you feel you have been involved or consulted as much as you wanted to be, in discussions about the support or services provided to the person you care for?’, to which the following answers are possible:

• there have been no discussions that I am aware of, in the last 12 months
• I always felt involved or consulted
• I usually felt involved or consulted
• I sometimes felt involved or consulted
• I never felt involved or consulted

The measure is defined by determining the percentage of all those responding who choose the answer ‘I always felt involved or consulted’ and ‘I usually felt involved or consulted’.

Alignment

ASCOF measure only.

Risk adjustment

None.

Formula

The formula is x over y multiplied by 100.

Where:

X: in response to the above question, all those individuals who selected the response ‘I always felt involved or consulted’ and ‘I usually felt involved or consulted’.

Y: all those that responded to the question.

Exclusions

People who select the response ‘There have been no discussions that I am aware of, in the last 12 months’ will not be counted in either the numerator or the denominator.

Worked example

The number of carers who said, ‘I always felt involved or consulted’ and ‘I usually felt involved or consulted’ was 129.

In total the number of carers who responded to the question was 160 with 7 giving a response of ‘There have been no discussions that I am aware of, in the last 12 months’.

The measure value is [(129 divided by (160 minus 7)) multiplied by 100] which equals 84.3%

Disaggregation

Client group: carers.

Frequency of collection

Biennial.

Data source

Survey of Adult Carers in England (SACE).

Return format

Percentage.

Decimal places

One.

Longer-term development options

Not applicable.

Further guidance

Guidance can be found through the NHS England website.

3C The proportion of people and carers who use services who have found it easy to find information about services and/or support (formerly metrics 3D (1) and 3D (2))

Rationale

This metric reflects social services users’ and carers’ experience of access to information and advice about social care in the past year. Information is a core universal service and a key factor in early intervention and reducing dependency.

Improved and/or more information benefits carers and the people they support by helping them to have greater choice and control over their lives. This may help to sustain caring relationships through, for example, reduction in stress, improved welfare and physical health improvements. These benefits accrue only where information is accessed that would not otherwise have been accessed, or in those cases where the same information is obtained more easily.

Definition and interpretation

This measure is in 2 parts and uses questions in the Adult Social Care Survey and SACE.

The question from the Adult Social Care Survey is Question 13: ‘In the past year, have you generally found it easy or difficult to find information and advice about support, services or benefits?’, to which the following answers are possible:

• I’ve never tried to find information or advice
• very easy to find
• fairly easy to find
• fairly difficult to find
• very difficult to find

This portion of the measure is defined by determining the percentage of all those responding who select the response ‘very easy to find’ and ‘fairly easy to find’. The relevant question drawn from the SACE is Question 17: ‘In the last 12 months, have you found it easy or difficult to find information and advice about support, services or benefits? Please include information and advice from different sources, such as voluntary organisations and private agencies as well as social services’. The following answers are possible:

• I have not tried to find information or advice in the last 12 months
• very easy to find
• fairly easy to find
• fairly difficult to find
• very difficult to find

This portion of the measure is defined by determining the percentage of all those responding who select the response ‘very easy to find’ and ‘fairly easy to find’.

Alignment

ASCOF measure only.

Risk adjustment

None.

Formula

The formula is x over y multiplied by 100.

Where:

For 3C part 1 (users):

X: in response to Question 13 of the ASCS, those individuals who selected the response ‘very easy to find’ and ‘fairly easy to find’.

The responses of respondents who were sent the easy reading version of the questionnaire will be treated in the same way, as this questionnaire has been designed to be equivalent to the standard version.

Y: all those that responded to the question.

For both the numerator (X) and denominator (Y), weighted data should be used to calculate the measure. The data from the survey will be weighted by NHS England to take account of the stratified sampling technique that has been used when conducting the survey. The weights are automatically calculated within the survey data return along with the ASCOF outcome measures.

Exclusions

Where:

For 3C part 2 (carers):

X: the sum of all those who in response to the above question of the SACE, selected the response ‘very easy to find’ and ‘fairly easy to find’.

Y: the sum of all those that responded to the above question of the SACE.

Exclusions

People who select the response ‘I’ve never tried to find information or advice’ for the ASCS or ‘I have not tried to find information or advice in the last 12 months’ for the SACE will not be counted in either the numerator or the denominator.

Worked example

3C Part 1 (users)

The number of respondents to the Adult Social Care Survey who select the response ‘Very easy to find’ or ‘fairly easy to find’ was 191.

In total the number of users who responded to the question was 350 of whom 8 gave a response of ‘I’ve never tried to find information or advice’.

The score for the ASCS is [(191 divided by (350 minus 8)) multiplied by 100] which equals 55.8%.

Data weighted to reflect the stratified sampling technique that has been used when conducting the survey.

3C Part 2 (carers)

The number of respondents to the SACE who select the responses ‘very easy to find’ or ‘fairly easy to find’ was 93.

The total number of users who responded to the question was 220 of whom 8 gave a response of ‘I have not tried to find information or advice in the last 12 months’.

The score for the SACE is [(93 divided by (220 minus 8)) multiplied by 100] which equals 43.9%.

Disaggregation

Primary support reason (all ages):

• physical support
• sensory support
• support with memory and cognition
• learning disability support
• mental health support
• social support
• carers

Please note that some of the disaggregations listed above are not published as part of the adult social care outcomes returns; however, they are part of the publication of the original data source.

Frequency of collection

Annual (ASCS).

Biennial (SACE).

Data source

Adult Social Care Survey (ASCS) and Survey of Adult Carers in England (SACE).

Return format

Percentage.

Decimal places

One.

Longer-term development options

Not applicable.

Further guidance

Guidance on both surveys can be found through the NHS England website.

3D Proportion of people using social care who receive self-directed support, and those receiving direct payments (formerly metric 1C)

Rationale

Studies have shown that direct payments increase satisfaction with services and are the purest form of personalisation^{[footnote 4]}.

The Care Act 2014 requires that all local authorities inform those using services and their carers of their personal budget, which will set out the cost to the local authority of meeting their needs. They will have the right, in most circumstances, to request this as a direct payment. This metric will most directly assess how personalisation of services is reflected in the ASCOF.

Definition and interpretation

This is a 2-part measure which reflects the proportion of people using services who receive self-directed support (3D part 1), and the proportion who receive a direct payment either through a personal budget or other means (3D part 2), for users and carers separately.

3D part 1 is presented as the number of adults, older people and carers receiving self-directed support as a percentage of all clients receiving community-based services and carers receiving carer specific services^{[footnote 5]}.

 To be counted as receiving self-directed support, the person (adult, older person or carer) must either:

• be in receipt of a direct payment
• have in place a personal budget which meets all the following criteria:
  • the person (or their representative) has been informed about a clear, upfront allocation of funding, enabling them to plan their support arrangements
  • there is an agreed care and support plan (support plan for carers) making clear the needs to be met and what outcomes are to be achieved with the funding
  • the person (or their representative) can use the funding in ways and at times of their choosing (the options of deploying a personal budget are a budget managed by the local authority or third party (commonly referred to as an individual service fund), a direct payment, or a combination of these approaches

Councils will need to evidence that these criteria detailed in the Care Act and the statutory guidance are met, for example through local monitoring of outcomes and satisfaction.

3D Part 1:

3D part 1a adults aged 18 or over receiving self-directed support

3D part 1b carers receiving self-directed support

The data collections will record for each category:

• people who have been through a self-directed support planning process:
  • people receiving a personal budget in the form of a direct payment for all or some of the package
  • people receiving a personal budget (based on the above definition) and who do not receive a direct payment
• of people who have not been through a self-directed support planning process:
  • people receiving an existing or new direct payment (they may also be receiving other services)

3D Part 2:

3D part 2a adults 18 or over in receipt of care and receiving direct payments.

3D part 2b carers receiving direct payments for support direct to carer.

Those receiving direct payments. The denominator remains the same (that is, all adults and carers receiving community-based services), but the numerator captures only those from part 1 with direct payments.

Interpretation

There are established issues with the data definitions in relation to this measure, which means that care must be taken when interpreting the information for analysis and benchmarking.

Full cost clients will not normally have a personal budget and therefore it may result in a figure less than 100%. However, they can ask local authorities to arrange their care. They can either pay for that care direct or ask for a deferred payment which will see the local authority arranging the care and recovering the costs later. In these circumstances full cost clients will receive a personal budget.

Clients in receipt of an individual service fund (ISF) are in receipt of self-directed support and included in 3D part1. However, they are not included in 3D part 2 (those receiving direct payments or part-direct payments) in line with the Care Act statutory guidance.

Alignment

ASCOF measure only

Risk adjustment

Risk adjustment does not seem appropriate for this measure since the objective is that self-directed support is offered to all users regardless of ages, client group and so on.

Formula

The formula is x over y multiplied by 100.

Where, for 3D part 1a (adults aged over 18 receiving self-directed support)

X: the number of users receiving either a) Direct payment, b) Part direct payment or c) Council with adult social services responsibility (CASSR) managed personal budget at the year-end 31 March

Source: SALT Measure LTS001b Tables 1a and 1b - sum of community columns ‘Direct payment only’, ‘Part direct payment’ and ‘CASSR managed personal budget’.

Y: clients (aged 18 or over) accessing long-term community support at the year-end 31 March.

Source: SALT Measure LTS001b Tables 1a and 1b - sum of clients in community columns headed ‘Direct payment only’, ‘Part direct payment’, ‘CASSR managed personal budget’, ‘CASSR commissioned support only’.

Where, for 3D part 1b (carers receiving self-directed support)

X: the number of carers receiving either a) Direct payment, b) Part direct payment or c) CASSR managed personal budget in the year to 31 March.

Source: SALT Measure LTS003 Table 1a sum of row ‘total carers’ for columns, ‘Direct payment’, ‘Part direct payment’ and ‘CASSR managed personal budget’.

Y: carers (caring for someone aged 18 or over) receiving carer-specific services in the year to 31 March.

Source: SALT Measure LTS003 Table 1a sum of row ‘total carers’ for all columns excluding those headed ‘Where no direct support provided to carer’ and ‘Information advice and other universal services and/or signposting’

3D part 2a (adults receiving direct payments)

X: the number of users receiving direct-payments and part-direct payments at the year-end 31 March.

Source: SALT Measure LTS001b Tables 1a and 1b - sum of columns ‘Direct payment only’ and ‘Part direct payment’

Y: clients aged 18 or over accessing long-term support at the year-end 31 March.

Source: SALT Measure LTS001b Tables 1a and 1b - sum of clients in community columns headed ‘Direct payment only’, ‘Part direct payment’, ‘CASSR managed personal budget’, ‘CASSR commissioned support only’

For 3D part 2b (carers receiving direct payments for support direct to carer)

X: the number of carers receiving direct-payments and part direct payments in the year to 31 March.

Source: SALT Measure LTS003 Table 1a sum of row ‘total carers’ for columns, ‘Direct payment’ and ‘Part direct payment’

Y: carers (caring for someone aged 18 or over) receiving carer specific services in the year to 31 March.

Source: SALT Measure LTS003 Table 1 sum of row ‘total carers’ for all columns excluding ‘No direct support provided to carer’ and ‘Information advice and other universal services and/or signposting’

Worked example

3D part 1a

The total number of people who received self-directed support (existing/new direct payment or personal budget) at the year end 31 March was 600.

The total number of people receiving community-based services was 2,000.

The measure value is [(600 divided by 2,000) multiplied by 100] = 30.0%.

3D part 1b

The total number of carers who received self-directed support (existing and/or new direct payment or personal budget) in the year was 300.

The total number of carers receiving carer-specific services was 3,000.

The measure value is [(300 divided by 3,000) multiplied by 100] = 10.0%.

3D part 2a

The total number of people receiving a direct payment or part direct payment (whether part of a self-directed process or not) is 172.

Then the measure value is [(172 divided by 2,000) multiplied by 100] = 8.6%.

3D part 2b

The total number of carers receiving a direct payment or part direct payment (whether part of a self-directed process or not) is 195. Then the measure value is [(195 divided by 3,000) multiplied by 100] = 6.4%.

Disaggregation

Equalities: age.

Primary support reason (all ages):

• physical support
• sensory support
• support with memory and cognition
• learning disability support
• mental health support
• social support

Please note that some of the disaggregations listed above are not published as part of the adult social care outcomes returns; however, they are part of the publication of the original data source.

Frequency of collection

Annual.

Data source

SALT and CLD.

Return format

Percentage.

Decimal places

One.

Longer-term development options

For 2023 to 2024, this metric will continue to be derived from SALT, with figures derived from CLD also provided for comparison purposes.

From 2024 to 2025, these will be derived from CLD, which will replace SALT as the primary source of information about local authority adult social care activity.

NHSE has developed methods for reproducing SALT and ASCOF metrics using CLD. This work has been carried out in collaboration with local authority and DHSC analysts on our CLD SALT metrics reference group, as well as consulting previous proposals from the pilot phase.

The draft document setting out principles adopted from SALT, describing fields and methods used from CLD to reproduce the existing SALT metrics, and describing known limitations is published on AGEM’s website (see the further guidance box) and all local authorities have been encouraged to comment on the methods.

Further guidance

Guidance on both surveys can be found through the NHS England website.

Guidance for 2024 to 2025 onwards can be found on AGEM’s website.

Objective 4: safety

People have access to care and support that is safe, and which is appropriate to their needs (especially in the use of custody or other secure settings).

4A The proportion of people who use services who feel safe (formerly metric )

Rationale

This measures one component of the overarching ‘social care-related quality of life’ metric, focused on the outcome to safeguard people whose circumstances make them vulnerable and to protect them from avoidable harm.

Safety is fundamental to the wellbeing and independence of people using social care, and the wider population. Feeling safe is a vital part of users’ experience and their care and support. There are legal requirements about safety in the context of service quality, including CQC essential standards for registered services.

Definition and interpretation

The relevant question drawn from the Adult Social Care Survey is Question 7a: ‘Which of the following statements best describes how safe you feel?’, to which the following answers are possible:

• I feel as safe as I want
• generally, I feel adequately safe, but not as safe as I would like
• I feel less than adequately safe
• I don’t feel at all safe

The measure is defined by determining the percentage of all those responding who choose the answer ‘I feel as safe as I want’.

The responses of respondents who were sent the version of the questionnaire for people with a learning disability will be treated in the same way, as this questionnaire has been designed to be equivalent to the non-learning disabilities version.

Interpretation

The measure gives an overall indication of a reported outcome for individuals - it does not, at present, identify the specific contribution of councils’ adult social care towards to feeling safe.

While the measure will focus on those choosing the most positive response - ‘I feel as safe as I want’ - it will be important locally to analyse the distribution of answers across all 4 possible responses. For example, if a council has a relatively high proportion of respondents selecting ‘I feel as safe as I want’ (that is, scores highly on the measure) but also has a relatively high proportion of respondents selecting ‘I don’t feel at all safe’, this could reflect gaps in safeguarding services.

Alignment

ASCOF measure only

Risk adjustment

A range of factors will be considered to adjust the measure to improve comparability between councils. Some examples are:

• age of users
• needs of users
• client groups of users

Formula

The formula is x over y multiplied by 100.

Where:

X: in response to Question 7a, those individuals who selected the response ‘I feel as safe as I want’.

Those respondents who were sent the easy reading version of the questionnaire for will be treated in the same way, as this questionnaire has been designed to be equivalent to the standard version.

Y: all those that responded to the question.

For both the numerator (X) and denominator (Y), weighted data should be used to calculate the measure. The data from the survey will be weighted by NHS England to take account of the stratified sampling technique that has been used when conducting the survey. The weights are automatically calculated within the survey data return along with the ASCOF outcome measures.

Worked example

The number of users who said ‘I feel as safe as I want’ was 214.

The total number of users who responded to the question was 345.

Data weighted to reflect the stratified sampling technique that has been used when conducting the survey.

The measure value is [(214 divided by 345) multiplied by 100] which equals 62.0%.

Disaggregation

Primary support reason (all ages):

• physical support
• sensory support
• support with memory and cognition
• learning disability support
• mental health support
• social support

Please note that some of the disaggregations listed above are not published as part of the adult social care outcomes returns; however, they are part of the publication of the original data source.

Frequency of collection

Annual.

Data source

Adult Social Care Survey (ASCS).

Return format

Percentage.

Decimal places

One.

Longer-term development options

Develop a broader ‘value-added’ measure which quantifies the contribution of social services to people feeling safe.

Further guidance

Guidance on ASCS can be found through the user survey guidance page on the NHS England website.

4B The proportion of section 42 safeguarding enquiries where a risk was identified, and the reported outcome was that this risk was reduced or removed

Rationale

This measures the proportion of Section 42 enquiries concluded within the year following an investigation where a risk was identified, and the reported outcome was that the risk was reduced or removed.

Safety is fundamental to the wellbeing and independence of both people using social care, and the wider population. Safeguarding adults is a statutory duty for councils with adult social services responsibilities in England under the Care Act 2014, to safeguard vulnerable adults from abuse or neglect.

Definition and interpretation

This metric can be used to understand what proportion of safeguarding cases where risk was identified, resulted in reduced or removed risk.

This metric cannot be used to make judgements on how effective local authorities are at keeping adults safe from abuse and neglect. Nor can it be used to benchmark local authorities against each other, due to the different reporting and practices used to discharge their statutory duties.

Alignment

ASCOF measure only.

Risk adjustment

Not applicable.

Formula

The formula is x over y multiplied by 100.

Where:

X: the sum of risk removed, and risk reduced.

Y: the sum of all risk - removed, reduced, and remaining.

Worked example

The number of cases in which risk was reduced following a case being concluded was 1,695.

The number of cases in which risk was removed completely was 455.

As such, the numerator - X, is 2150

The number of cases in which risk remained following a case, was 160.

As such the denominator is 2310.

The measure value is [(2150 divided by 2310) multiplied by 100] which equals 93.1%.

Disaggregation

None.

Frequency of collection

Annual.

Data source

Safeguarding Adults Collection.

Return format

Percentage.

Decimal places

One.

Longer-term development options

None.

Further guidance

Further guidance is available on the NHS England website.

Objective 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.

5A The proportion of people who use services, who reported that they had as much social contact as they would like (formerly metric 1I)

Rationale

There is a clear link between loneliness and poor mental and physical health. A key element of the government’s vision for social care is to tackle loneliness and social isolation, supporting people to remain connected to their communities and to develop and maintain connections to their friends and family. This metric will draw on self-reported levels of social contact as an indicator of social isolation for both users of social care and carers.

Definition and interpretation

The relevant question drawn from the Adult Social Care Survey is question 8a - ‘Thinking about how much contact you’ve had with people you like, which of the following statements best describes your social situation?’

• I have as much social contact as I want with people I like
• I have adequate social contact with people
• I have some social contact with people, but not enough
• I have little social contact with people and feel socially isolated

The relevant question drawn from the Carers’ Survey is question 11 - ‘Thinking about how much social contact you’ve had with people you like, which of the following statements best describes your social situation?’

• I have as much social contact as I want
• I have some social contact but not enough
• I have little social contact and I feel isolated

The measure is defined by determining the percentage of users responding, ‘I have as much contact as I want with people I like’ and carers choosing ‘I have as much contact as I want’. Measures for users and carers will be presented separately. These responses have been chosen to focus the measure on individuals achieving the best outcomes, to allow for better use in benchmarking.

Alignment

This measure is shared with Measure 1.18 (social isolation) in the Public health outcomes framework (page 50).

Risk adjustment

There are a range of factors which are likely to have an impact on this measure, including the:

• severity of needs of users
• amount of care provided by carers

Formula

The formula is x over y multiplied by 100.

Where for 5A part 1 (users):

X: in response to Question 8a of the ASCS, those individuals who selected the response ‘I have as much social contact as I want with people I like’.

Y: all those that responded to the question.

For both the numerator (X) and denominator (Y), weighted data should be used to calculate the measure. The data from the survey will be weighted by NHS England to take account of the stratified sampling technique that has been used when conducting the survey. The weights are automatically calculated within the survey data return along with the ASCOF outcome measures.

For 5A part 2 (carers)

X: the sum of all those who in response to question 11 of the SACE, selected the response ‘I have as much social contact as I want’.

Y: the sum of all those that responded to the above question of the SACE.

Worked example

5A part 1 - users

The number of users who said ‘I have as much social contact as I want with people I like’ was 242.

The total number of users who responded to the question was 548.

Data is weighted to reflect the stratified sampling technique that has been used when conducting the survey.

The indicator value is [(242 divided by 548) multiplied by 100] which equals 44.2%.

5A part 2 - unpaid carers

The number of carers who said ‘I have as much social contact as I want’ was 197.

The number of carers who responded to the question was 420.

Data is weighted to reflect the stratified sampling technique that has been used when conducting the survey.

The indicator value is [(197 divided by 420) multiplied by 100] which equals 46.9%.

Disaggregation

Primary support reason (all ages):

• physical support
• sensory support
• support with memory and cognition
• learning disability support
• mental health support
• social support

Please note that some of the disaggregations listed above are not published as part of the adult social care outcomes returns; however, they are part of the publication of the original data source.

Frequency of collection

Annual for ASCS.

Biennial for SACE.

Data source

Adult Social Care Survey (ASCS) and the Survey of Adult Carers in England (SACE).

Return format

Percentage.

Decimal places

One.

Longer-term development options

This measure focuses on social care users and carers, rather than the broader population. The impact of social isolation and loneliness is much wider than the population currently receiving services, and all parts of the health and care system have a role to play in preventing, and reducing, social isolation and loneliness in the broader population. Work on pursuing a measure of loneliness in the wider population has now concluded having been unable to identify a suitable measure. As such, the development of this measure has been deferred for the foreseeable future. However, we remain interested in exploring more widely how the issue can be measured in a way that will support local authorities.

Further guidance

Guidance on both surveys can be found through the NHS England website.

Objective 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 or trained staff.

6a The proportion of staff in the formal care workforce leaving their role in the past 12 months

Rationale

This indicator is not an outcome but has been included as a proxy for continuity of care. Continuity of care affects care users’ quality of life, and it is only implicitly captured in the headline quality of life metric.

It also represents a saving to the public purse, as there is some evidence on the cost of recruiting and training care workers, and these costs are reduced when turnover falls.
Finally, it represents a proxy for workforce work-related quality of life, as staff are more likely to stay in their role if supported.

Definition and interpretation

This metric is an estimate of the proportion of directly employed staff who left their role in the previous 12 months. It is published at national and local authority level by Skills for Care on an annual basis.

The metric is based on the 1.39 million employees in local authorities, the independent sectors, and those working for direct payment recipients (DPRs). It does not include those delivering social care in the NHS. It is based on directly employed staff only, agency staff are not included in these estimates.

Higher staff leaver rates indicate that a greater share of social care staff have left their roles in the previous 12 months. Higher staff leaver rates can limit continuity of care and lead to higher recruitment costs for providers.

Alignment

This metric is published by Skills for Care as part of their annual workforce estimates. It is also included as one of the Office for Local Government (OFLOG) metrics.

Risk adjustment

In areas or groups where response rates are low, workforce estimates may be suppressed. This is to avoid the potential misrepresentation of the area due to missing values.

Local authority estimates are based on the reported location of providers. Providers may deliver care across multiple local authorities.

Formula

The formula is x over y multiplied by 100.

Where:

X is the number of staff who have a role in any provider or with any DPR in the local authority area in the last 12 months

and

Y is the total number of permanent and temporary staff employed in any provider or by DPRs in the local authority area.

Worked example

The number of filled posts in adult social care in Lincolnshire was 21,000 in 2022 to 2023. 8,410 staff left their post. The leaver rate was 8,410 divided by 21,000 = 40.1%

Estimates of staff leaver rates are published at local authority level by Skills for Care. The metric is taken directly from the tables published by Skills for Care. A more detailed methodology is published by Skills for Care.

Disaggregation

The published tables include breakdowns by sector (all sectors, independent sector, local authority), service type (all services, CQC care home with nursing, CQC care only home, CQC non care home, non CQC provider) and job role - all at local authority level.

Frequency of collection

Skills for Care produce annual workforce estimates derived from the Adult Social Care Workforce Dataset (ASC-WDS). These estimates are published each October and cover the previous financial year.

The ASC-WDS is a live online service which is completed on a voluntary basis by providers. Providers may choose to complete more regularly than annually. It is mandatory for local authorities to complete the service on an annual basis for the local authority part of the sector.

Data source

Adult Social Care Workforce Data Set (ASC-WDS).

Return format

Percentage.

Decimal places

One.

Longer-term development options

Not applicable.

Further guidance

Further guidance is published by Skills for Care and is available at Methodology (skillsforcare.org.uk).

6B The percentage of residential adult social care providers rated good or outstanding by CQC.

Rationale

This indicator complements the headline quality of life metric as it covers the overall quality of residential care available in the local authority, including self-funders and NHS funded clients, which local authority data will not normally pick up.

Definition and interpretation

This metric gives an indication of the quality-of-care provision within the geographical footprint of a local authority. This metric excludes home care as these services often operate across several local authorities. Assigning them to one local authority based on their postcode may be misleading.

This metric cannot and must not be used as a proxy for local authority performance as the quality-of-care provision within the geographical footprint of a local authority but does not necessarily reflect the quality of services commissioned by a local authority. Not all care homes will have local authority funded residents, therefore reducing the local authorities’ ability to promote improvement.

Alignment

This metric is being published as part of OFLOG and should complement the wider CQC work into appraisal of local authorities.

Risk adjustment

Extra care should be taken if using this metric in relation to learning disability services as the geographical footprint of this sector is particularly diverse. We have considered the need for an equality impact assessment; however, it was decided that a note highlighting the need to use extra caution was a more proportionate response.

Where more than 10% of a local authority area’s locations have not yet been rated, the results have been redacted. This is to avoid the potential misrepresentation of the area due to missing values. Please contact DHSC if you would like further information on these areas.

Formula

The formula is x over y multiplied by 100.

Where:

X: is all the unique care homes in a predefined local authority area with a chosen rating:

• outstanding
• good
• other
• not yet rated

and

Y: is the total number of care homes in the same local authority area, including those not yet rated.

Worked example

The number of care homes in the Northumberland County Council Area that were rated outstanding at their last assessment is 4.

The number of care homes in the Northumberland County Council Area that were rated good at their last assessment is 76.

The number of care homes in the Northumberland County Council Area that were rated other at the last assessment was 13, and 1 care home has not yet been rated.

The total number of care homes in the Northumberland County Council area is 94.

(4/94) * 100 = 4% were rated ‘Outstanding’.

(76/94) * 100 = 81% were rated ‘Good’.

(13/94) * 100 = 14% were rated ‘Other’

And (1/94) * 100 = 1% has not yet been rated.

Disaggregation

The outputs in this metric amalgamate the results for ‘Requires improvement, and inadequate’. This breakdown can be provided on request.

Frequency of collection

The CQC dataset is usually updated monthly. However, the ratings within the dataset are not updated at set intervals but rather when inspections take place.

Data source

Care Quality Commission (CQC) directory through the DHSC capacity tracker on a specific date. This metric therefore represents a snapshot of ratings at that date, for adult social care services within the footprint of respective local authorities.

Return format

Percentage

Decimal places

One

Longer-term development options

Not applicable

Further guidance

For further guidance on the CQC data underpinning this metric can be found here.

Appendix 1: adult social care outcomes framework 2023 to 2024 - at a glance

Objective 1: quality of life

Objective statement: people’s quality of life is maximised by the support and services which they access, given their needs and aspirations, while ensuring that public resources are allocated efficiently.

Metrics:

• 1A: quality of life of people who use services
• 1B: quality of life of people who use services - adjusted to account only for the additional impact of local-authority funded social care on quality of life, removing non-service-related factors
• 1C: quality of life of carers
• 1D: overall satisfaction of people who use services with their care and support
• 1E: overall satisfaction of carers with social services (for them and for the person they care for)

Objective 2: independence

Objective statement: people are enabled by adult social care to maintain their independence and, where appropriate, regain it.

Metrics:

• 2A: the proportion of people who received short-term services during the year - who previously were not receiving services – where no further request was made for ongoing support
• 2B: the number of adults aged 18 to 64 whose long-term support needs are met by admission to residential and nursing care homes (per 100,000 population)
• 2C: the number of adults aged 65 and over whose long-term support needs are met by admission to residential and nursing care homes (per 100,000 population)
• 2D: the proportion of older people (65 and over) who were still at home 91 days after discharge from hospital
• 2E: the proportion of people who receive long-term support who live in their home or with family

Objective 3: empowerment

Objective statement: information and advice: individuals, their families and carers are empowered by access to good quality information and advice to have choice and control over the care they access, ensuring that people have a positive experience of care and support.

Metrics:

• 3A: the proportion of people who use services who report having control over their daily life
• 3B: the proportion of carers who report that they have been involved in discussions about the person they care for
• 3C: the proportion of people and carers who use services who have found it easy to find information about services and/or support
• 3D: the proportion of people who use services who receive direct payments

Objective 4: safety

Objective statement: people have access to care and support that is safe, and which is appropriate to their needs (especially in the use of custody or other secure settings).

Metrics:

• 4A: the proportion of people who use services who feel safe
• 4B: the proportion of section 42 safeguarding enquiries where a risk was identified, and the reported outcome was that this risk was reduced or removed

Objective 5: social connections

Objective statement: people are enabled by adult social care to maintain and where appropriate regain their connections to their own home, family and community.

Metrics 5A: the proportion of people who use services and carers, who reported that they had as much social contact as they would like.

Objective 6: continuity and quality of care

Objective statement: people receive quality care, underpinned by a sustainable and high-quality care market and an adequate supply of appropriately qualified and trained staff.

Metrics:

• 6A: the proportion of staff in the formal care workforce leaving their role in the past 12 months
• 6B: the percentage of adult social care providers rated good or outstanding by CQC

Appendix 2: interpretation of metric 1A - quality of life of people who use services

The social care related quality of life score for an individual is a composite metric using responses to questions from the ASCS covering 8 domains:

• control
• dignity
• personal care
• food and drink
• safety
• occupation
• social participation
• accommodation

The ASCOF metric provides a social care-related quality of life score averaged across each of the users who responded to the Adult Social Care Survey (ASCS) in a local authority. It gives an average quality of life score for those that responded to the ASCS.

The score will be influenced by a range of factors, one of which is the services provided by the authority. Some of the other factors that are likely to have had an influence are the needs of individuals, age and whether people receive informal care.

Therefore, in its current form this metric does not solely reflect the impact of social care services but does capture people’s experience in aspects of life relevant to social care.

The social care related quality of life metric tells us about outcomes for social care users but does not isolate the impact that care and support services have on those outcomes. The department commissioned research from the Quality and Outcomes of Person-Centred Care Policy Research Unit to identify a way of generating a social care related quality of life ‘value added’ measure, which would allow us to identify the impact of adult social care on people’s quality of life. NHS England published a working paper which set out how the metric value is calculated for a local authority in 2013 to 2014.

If using the measure for benchmarking, it is important that comparisons are made with authorities that have similar characteristics, otherwise comparisons can be misleading. A starting point might be the standard comparator groups.

At a local level, the score for each of the questions that measures outcomes across the 8 domains could be investigated. Comparing this to a national average or similar councils would help understand whether scores on any of the individual domains are better or worse than would be expected.

Also at a local level, it may be useful to look at the distribution of scores of individuals on the social care related quality of life measure. This would help understand whether most people’s scores are around the average or are distributed widely. This analysis could be repeated based on the characteristics of the person receiving care, or the services being used.

When the survey is repeated, time series comparisons can be made and a change in the level of the measure should be investigated. Reasons for the change in the level of the measure may be a change in the impact of service but could also be related to changes in the needs of the local population, and so on.

However, when making comparisons it’s important to remember that the results are estimates from survey data and so there will be a degree of uncertainty which will be greater as the results are broken down further and therefore based on fewer service users.

The level of uncertainty is commonly represented by a confidence interval which gives a range around the estimate in which you can be reasonably confident that the true figure lies. If you would like more information on calculating confidence intervals see ‘Helping you make better use of the results from user surveys’ on NHS England’s Running and using social care user surveys page.

DHSC funded the development (by ADASS and the University of Birmingham) of Commissioning for Better Outcomes: A Route Map, which supports local authorities to undertake a process of continuous improvement that makes use of commissioning levers to achieved improved outcomes for users and carers.

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1. The ‘ASCOT’ (Adult Social Care Outcomes Toolkit) measure (1A) is designed to capture information about an individual’s social care-related quality of life (SCRQoL). The ASCOT is also the source for many of the questions in the Adult Social Care Survey. Users wishing to make commercial use of any of the ASCOT materials should contact the ASCOT team (ascot@kent.ac.uk), who will then be put into contact with Kent Innovation and Enterprise, as people need to register to use the ASCOT. Also see the ASCOT on the Personal Social Services Research Unit website. ↩

2. EQ-5D™ is a registered trademark of EuroQol. Further details are available from http://www.euroqol.org. ↩

3. This information is not published as part of the adult social care outcomes returns; however, it is part of the publication of the data source. ↩

4. Quoting; Choice and competition in public services: a guide for policy makers (2010, OFT/Frontier Economics) ↩

5. For the purposes of this measure the following age brackets are used: ‘adult’ - aged 18 to 64; ‘older person’ - aged 65 and over; ‘carer’: aged 16 or over but caring for an adult aged 18 or over. ↩