Guidance

The adult social care outcomes framework: handbook of definitions

Updated 19 December 2024

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 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 sets priorities for the sector focused on how well services help adults with care needs and unpaid carers achieve outcomes across 6 key areas:

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

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 the 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. To note, several of the ASCOF measures are used by other programmes, such as by the Better Care Fund (BCF), to set and monitor objectives.

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 the adult social care outcomes frameworks 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 adult social care outcomes frameworks 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 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 data source - SALT to CLD

The short and long term (SALT) data collection was an annual data return from local authorities comprised of a set of measures describing their adult social care activity. The final year of the SALT collection was April 2023 to March 2024. From April 2024, the adult social care client level data (CLD) collection has replaced SALT as the primary source of information about local authority adult social care activity.

As outlined in the ASCOF 2023 to 2024 handbook of definitions, there are 6 metrics which were previously derived from SALT that will be derived from CLD from 2024 to 2025 onwards. The last ASCOF publication using SALT data was in December 2024. The metrics affected by the change in data source are:

• 2A - the proportion of people who received reablement 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
• 3D - the proportion of people using social care who receive self-directed support, and those receiving direct payments

CLD became mandatory for local authorities from April 2023 and therefore remains a relatively new data source. Given this, and as outlined in DHSC’s approach to using the data (see Annex D), the department is committed to working with local authorities and the wider sector to refine the methods for the ASCOF measures and ensure the data is used and interpreted appropriately. In addition, all metrics derived from CLD will be designated as ‘official statistics in development’. This label is to reflect the transition to a new data source, including new methodologies for using record level data and associated data quality challenges.

DHSC has adopted the following principles when developing metrics from CLD for use in the ASCOF:

1. Definitions and rationale: the definition and rationale for each metric is outlined in this handbook. Any changes from the definitions set out in the 2023 to 2024 handbook have been discussed with the local authority CLD reference group, the Data Delivery Action Group, the Data and Outcomes Board - ASC data governance groups which include representatives from local authorities, providers, CQC and NHS England, Skills for Care, and other sector representatives.

2. Methodology: the principles and definitions in this handbook are final, but the detailed methodology (data processing steps and code) for calculating the figures may be refined further after the handbook is published, before the metrics are published at the end of 2025. This allows time to fully test the methodologies with local authorities, acting on sector feedback to refine the exact data processing steps. We intend to publish the final detailed methodologies and code in early 2025.

3. Data quality: the quality of the data will be considered when refining the methodologies and at the time of publication. Information about data quality issues that affect the measures will be communicated clearly to users alongside the publication of the data. Data quality is being assessed throughout the development of the underlying methods and simplifications and amendments are made where possible to reduce the impact of data quality issues. DHSC is also working with local authorities to improve the quality of their data, particularly for areas of activity where we are aware of significant challenges.

Four of the metrics (2A, 2B, 2C and 3D) will retain the same definition for 2024 onwards as previous years, but the methodology will be adapted to use CLD.

Metric 2D - ‘the proportion of older people (65 and over) who were still at home 91 days after discharge from hospital’ - cannot be recreated from CLD. DHSC has developed a replacement metric, aligned with the intention of the previous metric. This is experimental and defined as: ‘the proportion of people aged 65 and over discharged from hospital into reablement and who remained in the community within 12 weeks of discharge’.

Metric 2E - ‘the proportion of people who receive long-term support who live in their home or with family’ - was intended to cover all clients regardless of primary support reason when moving to CLD as the source. Based on sector feedback, this metric will be split into 2 parts:

• part 1 - clients with a learning disability aged 18 to 64
• part 2 - all clients disaggregated by age group: 18 to 64 and 65 and over

For all the metrics listed above, except metric 2D, NHS England has developed and published central transformation principles for reproducing these using CLD. To test these with all local authorities, DHSC applied these principles using CLD submissions covering April 2023 to March 2024 and produced indicative figures for the 5 metrics.

In August 2024, these were shared with each local authority, providing them with an opportunity to review their own ASCOF figures and submit feedback. The feedback received is directly informing the refinement of the data processing steps for these metrics for 2024 to 2025. We will continue to work with local authorities to refine the detailed methodologies, publishing the final versions by April 2025.

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, age distribution of the local population or levels of care 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 100,00 population)). This metric is presented as 2 separate metrics, one covering those aged 18 to 64 (2B), and the other covering those aged 65 and over (2C).

This age breakdown reflects that the likelihood of long-term support needs requiring residential care increases with age. 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 partly 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 has only been applied when it is judged that 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 to others serving populations with similar populations can be undertaken for benchmarking purposes.

This handbook sets out suggested factors which could be explored for the risk adjustment of metrics. For example, levels of income and wealth in the local population could affect the proportion of people who fund their own care, which could affect measures 2A, B, C and D. 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

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) equals 0

Some needs met (3rd answer option) equals 1

Needs adequately met (2nd answer option) equals 2

No unmet needs (1st answer option) equals 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

Table 1 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.

Table 1: the responses of 145 users who answered questions 3a to 9a and 11

Question identifier	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) equals 3
• needs adequately met (2nd answer option) equals 2
• some needs met (3rd answer option) equals 1
• no needs met (the last answer option for each question) equals 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 [(568 multiplied by 3) plus (385 multiplied by 2) plus (150 multiplied by 1) plus (57 multiplied by 0)] equals 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 quantifies the impact of social care on the quality of life of people who draw on social care. It 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 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 or 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

Risk adjustment is applied to this metric by estimating the impact of external factors such as age and self-reported health, and then subtracting them from the Utility Weighted Indicator.

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) equals 2
• some needs met (2nd answer option) equals 1
• no needs met (the last answer option for each question) equals 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

Table 2: the responses of 105 carers who answered all 6 questions

Question identifier	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) equals 2
• some needs met (2nd answer option) equals 1
• no needs met (the last answer option for each question) equals 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 [(308 multiplied by 2) plus (226 multiplied by 1) plus (96 multiplied by 0)] equals 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 ASCS 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, 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 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 ASCS.

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] equals 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.

The outcomes in this section have been developed to measure outcomes at a population level. We recognise that in some cases the measures may not reflect the best outcome for an individual, particularly if that individual has escalating or complex care needs. It is for this reason that the outcomes should be interpreted at a population rather than an individual level.

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

Rationale

The aim of reablement is to support people to regain independence that may have been reduced or lost through illness or disability. This metric will provide evidence of a good outcome in terms of maximising independence and delaying dependency on, reducing and preventing further care needs. This is relevant for quality of life but not adequately captured in the headline quality of life metric.

As well as measuring a domain of user quality of life (independence), it also captures efficiency (as using an earlier, lower cost intervention to also prevent or reduce future need for a costlier long-term service).

Definition and interpretation

This metric measures the proportion of completed episodes of reablement provided to new clients aged 18 and over during the year, where the sequel was either no ongoing support or support of a lower level.

In this context, reablement is defined as ‘short-term support which is designed to maximise independence’. It captures services provided which are intended to be time limited and provided in the home, for the purpose of maximising the independence of the individual and reducing or eliminating their need for ongoing support by the local authority. It therefore excludes carer contingency and emergency support.

This measure only includes reablement that is solely or jointly provided or arranged by the local authority and reported in the local authority’s CLD submission. CLD does not include intermediate care provided by the NHS. In some areas, these health-funded services may represent a substantial proportion of post-discharge intermediate care.  

This metric, along with all metrics derived from CLD, will be designated as ‘official statistics in development’. This label is to reflect the transition to a new data source, including a new methodology for using record level data and associated data quality challenges.

Alignment

ASCOF only measure.

Risk adjustment

This metric only includes services which were arranged or provided by the local authority. It therefore does not identify outcomes for all individuals who, after receiving reablement, later self-fund and organise their own long term care. Such individuals will be most prevalent in local authorities with higher levels of income and wealth which may affect these local authorities’ results.

Formula

The formula is x over y multiplied by 100.

Where the numerator X is: the number of new clients who had reablement where after the reablement they received ongoing low-level short term support, other short term support, information, advice or signposting, or where no services were provided.

Unlike with SALT, sequels are derived from CLD by linking event records to determine the event chronology and from the ‘event outcome’ field.

Source: CLD.

And the denominator Y is: number of new clients who had reablement.

Source: CLD.

Exclusions

Those who after their reablement went on to self-fund their own care, declined support, received 100% NHS funded care or who died are excluded from both the denominator and numerator.

Source: CLD.

Disaggregation

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

Frequency of collection

CLD is collected quarterly.

Data source

CLD.

Return format

Percentage.

Decimal places

One.

Further guidance

The specification and collection guidance for CLD can be found on AGEM’s website.

We are working with local authorities to refine the detailed methodology (data processing steps and code) for this metric, and all other CLD metrics in the ASCOF. We intend to publish final methodologies by April 2025.

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 on long-term support. Research suggests that, where possible, people prefer to stay in their own home rather than move into residential and nursing care.

For some people drawing on care, an admission to a residential or nursing care home can represent an improvement in their situation and for this reason the measure should be interpreted at a population rather than an individual level.

This indicator also captures efficiency. Residential and nursing care are often the most expensive forms of interventions. Interventions that prevent, reduce and delay care need and subsequently help people be independent for longer can result in cost savings.

This metric includes adults aged 18 to 64, new admissions for adults aged 65 and over are captured separately in metric 2C. The rationale for measuring the 2 age groups separately 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 younger adults whose long-term support needs are met by admission to residential and nursing care homes relative to the population size. The measure compares council records on numbers admitted to residential or nursing care with population figures based on ONS population estimates.

People counted in this measure include:

• users admitted to residential or nursing care which was provided or arranged by the local authority
• users where the local authority makes any contribution to the costs of care, irrespective of how the balance of these costs are met (including full-cost clients) or location of residential or nursing care

Only new admissions are counted in this measure, where a person was not previously in residential or nursing care. A new admission can follow any of:

• a request for support
• care needs assessment or review
• a period of short-term support
• a period of long-term support in the community
• an NHS provided service
• depleted funds for self-funders

Identifying whether an admission is new depends on historical data being available in CLD. In addition, CLD does not differentiate between permanent and temporary residential stays, therefore some temporary admissions may be included.

Individuals who self-fund their care and whose funds become depleted are included in this metric, since CLD only captures services that are arranged or provided by the local authority. If these individuals previously had a 12-week period of disregard or deferred payment agreement and the local authority arranged the residential or nursing service which is captured in CLD, then they would be counted.

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 partly separate age as a factor from other factors, including the contribution of local authority services to prevent or reduce future care needs. The 2-part measure will also help highlight, both nationally and locally, the separate issues that exist for younger adults and for older people.

This metric, along with all metrics derived from CLD, will be designated as ‘official statistics in development’. This label is to reflect the transition to a new data source, including a new methodology for using record level data and associated data quality challenges.

Alignment

ASCOF only measure.

Risk adjustment

Analysis identified age as a factor that influenced the rate of admissions. Instead of applying more complex risk adjustment, the measure has been separated for those aged 18 to 64 years, and those aged 65 years and over are covered by the metric 2C.

This metric only includes services which were arranged or provided by the local authority, and therefore does not capture individuals (typically aged over 65) who self-fund and organise their own care. Such individuals will be most prevalent in local authorities with higher levels of income and wealth which may affect these local authorities’ results.

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 an admission from the community to residential and nursing care during the year (not counting transfers between residential and nursing care).

Source: CLD.

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

Source: ONS.

Exclusions

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

Disaggregation

Not applicable

Frequency of collection

CLD is collected quarterly.

Data source

CLD, ONS.

Return format

Rate per 100,000 population.

Decimal places

One.

Further guidance

The specification and collection guidance for CLD can be found on AGEM’s website.

We are working with local authorities to refine the detailed methodology (data processing steps and code) for this metric, and all other CLD metrics in the ASCOF. We intend to publish final methodologies by April 2025.

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 on long-term support. Research suggests that, where possible, people prefer to stay in their own home rather than move into residential and nursing care.

For some people drawing on care, an admission to a residential or nursing care home can represent an improvement in their situation and for this reason the measure should be interpreted at a population rather than an individual level.

This indicator also captures efficiency. Residential and nursing care are often the most expensive forms of interventions. Interventions that prevent, reduce and delay care need and subsequently help people be independent for longer can result in cost savings.

This metric includes adults aged 18 to 64; new admissions for adults aged 18 to 64 are captured separately in metric 2B. The rationale for measuring the 2 age groups separately 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 older adults whose long-term support needs are met by admission to residential and nursing care homes relative to the population size. The measure compares council records on numbers admitted to residential or nursing care with population figures based on ONS population estimates.

People counted in this measure include:

• users admitted to residential or nursing care which was provided or arranged by the local authority
• users where the local authority makes any contribution to the costs of care, irrespective of how the balance of these costs are met (including full-cost clients) or location of residential or nursing care

Only new admissions are counted in this measure, where a person was not previously in residential or nursing care. A new admission can follow any of:

• a request for support
• care needs assessment or review
• a period of short-term support
• a period of long term support in the community
• an NHS provided service
• depleted funds for self-funders

Identifying whether an admission is new depends on historical data being available in CLD. In addition, CLD does not differentiate between permanent and temporary residential stays, therefore some temporary admissions may be included.

Individuals who self-fund their care and whose funds become depleted are included in this metric, since CLD only captures services that are arranged or provided by the local authority. If these individuals previously had a 12-week period of disregard or deferred payment agreement and the local authority arranged the residential or nursing service which is captured in CLD, then they would be counted.

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 partly separate age as a factor from other factors, including the contribution of local authority services to prevent or reduce future care needs. The 2-part measure will also help highlight, both nationally and locally, the separate issues that exist for younger adults and for older people.

This metric, along with all metrics derived from CLD, will be designated as ‘official statistics in development’. This label is to reflect the transition to a new data source, including a new methodology for using record level data and associated data quality challenges.

Alignment

ASCOF only measure.

Risk adjustment

Analysis identified age as a factor that influenced the rate of admissions. Instead of applying more complex risk adjustment, the measure has been separated for those aged 65 and over, and those aged 18 to 64 years are covered by the metric 2B.

This metric only includes services which were arranged or provided by the local authority, and therefore does not capture individuals (typically aged over 65) who self-fund and organise their own care. Such individuals will be most prevalent in local authorities with higher levels of income and wealth which may affect these local authorities’ results.

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 an admission from the community to residential and nursing care during the year (not counting transfers between residential and nursing care).

Source: CLD.

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

Source: ONS.

Exclusions

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

Disaggregation

Not applicable.

Frequency of collection

CLD is collected quarterly.

Data source

CLD, ONS.

Return format

Rate per 100,000 population.

Decimal places

One.

Further guidance

The specification and collection guidance for CLD can be found on AGEM’s website.

We are working with local authorities to refine the detailed methodology (data processing steps and code) for this metric, and all other CLD metrics in the ASCOF. We intend to publish final methodologies by April 2025.

2D The proportion of people aged 65 and over discharged from hospital into reablement and who remained in the community within 12 weeks of discharge

Rationale

Not being admitted into long-term residential and nursing care is a good measure of maximising independence and delaying dependency on long-term support. 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, admission to residential or nursing care homes can represent an improvement in their situation.

Reablement seeks to support people by maximising their level of independence and minimising their need for ongoing social care support and dependence on public services. The inclusion of this metric is important for understanding the outcomes of those discharged from hospitals. The metric supports the integration of local health and social care services, by working together to have effective discharge and reablement processes after hospital and reducing avoidable admissions.

Definition and interpretation

This metric is new for 2024 to 2025. The previous metric ‘the proportion of older people (65 and over) who were still at home 91 days after discharge from hospital’ was derived from SALT and cannot be replicated from CLD. While this metric is aligned with the intention of the previous metric - in other words, to measure outcomes for people who have received reablement after hospital - it is a distinctly different metric and thus not comparable with previous statistics.

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

2D Part 1:

The proportion of new clients aged 65 and over who were discharged from hospital into reablement and who remained in the community within 12 weeks of discharge.

For the purposes of this metric, people are counted as remaining in the community if:

• they were not admitted to long-term residential or nursing care and
• they were not readmitted to hospital and
• they did not die over these 12 weeks

Here ‘new clients’ is defined as anyone not in receipt of long-term support arranged or provided by the local authority at the point when they were admitted to hospital.

2D Part 2:

This is a contextual measure describing the proportion of people, including new and older clients aged 65 and over, who were provided with reablement services following discharge from hospital.

The rationale for a 2-part measure is to capture provision of reablement as well as the outcome of the reablement service offered. The part 2 measure provides additional context to the part 1 measure about how many people are provided reablement.

Where reablement services are provided only for a very small proportion of people, people may be selected on the basis that they have a high chance of successful reablement, and the service may not be providing potentially beneficial access to those with a less certain outcome.

The part 2 measure does not capture the following: those who are not provided reablement because they chose not to receive it, did not require it, or were not provided the option. This metric includes reablement services which take place across the 12-month period of the financial year.

The numerator for this contextual measure (part 2) differs slightly from the denominator for the headline measure (part 1) in that it includes existing as well as new clients. This is because it is compared to a denominator including everyone aged 65 and over who was discharged from hospital based on hospital episode statistics (HES), where prior receipt of social care support (existing clients) cannot be separately identified.

In this context, reablement is defined as services which are intended to be time limited and provided in the home, for the purpose of maximising the independence of the individual and reducing or eliminating their need for ongoing support by the local authority. It only includes reablement which is solely or jointly provided or arranged by the local authority and reported in the local authority’s CLD submission. CLD does not include intermediate care services that are funded by the NHS. In some areas, these health-funded services may represent a substantial proportion of post-discharge intermediate care.

In relation to the outcome of remaining in the community, this measure only includes admissions to residential or nursing care arranged or provided by the local authority. It does not capture admissions of individuals who have self-funded and arranged their own long-term care.

This metric describes outcomes for individuals within a 12-week window after discharge from hospital. This time allows for the period of reablement support to have ended and subsequent assessments to be carried out and services put in place if required. People who died within 12 weeks of hospital discharge are included in the metric since excluding this group could result in selection bias and distort comparisons between areas with different discharge policies and criteria for accessing reablement.

This metric, along with all metrics derived from CLD, will be designated as ‘official statistics in development’. This label is to reflect the transition to a new data source, including a new methodology for using record level data linked across multiple datasets and associated data quality challenges.

Alignment

These measures are shared with measure 3.6i (the proportion of people aged 65 and over discharged from hospital into reablement and who remained in the community within 12 weeks of discharge) and measure 3.6ii (the proportion of people aged 65 and over, who were provided with reablement following discharge from hospital) in the NHS Outcomes Framework.

Risk adjustment

Age is a factor influencing the rate of admissions to long-term residential and nursing care, readmissions to hospital and likelihood of death. Instead of applying full risk adjustment, the measure looks at people aged 65 years and over.

CLD only includes services which were arranged or provided by the local authority, and therefore does not capture individuals who go on to self-fund and organise their own care following reablement. Such individuals will be most prevalent in local authorities with higher levels of income and wealth which may affect these local authorities’ results.

This measure describes whether a person was admitted to long-term residential or nursing care over the 12 weeks after their discharge from hospital. For this reason, people are only included in this measure if they were not already in long-term support at the time of their admission to hospital - in other words, the measure is restricted to new clients. This ensures any admission into residential or nursing care after reablement is a new admission.

This measure describes whether someone dies within 12 weeks of discharge, meaning variations in mortality risk across different areas will influence the results. Rather than adjusting for this, a breakdown of the different outcomes (hospital admission, care home admission, and death) will be provided for additional insight.

Formula

The formula is x over y multiplied by 100.

Where, for 2D part 1 (outcomes after reablement):

The numerator X: the number of people (new clients aged 65 and over) discharged from hospital into reablement who met all 3 of the following criteria within 12 weeks following discharge. They did not:

• receive local authority arranged or provided long-term residential or nursing care
• have an emergency (unplanned) admission into hospital
• die over this period

This should only include those cases referred to in the denominator.

Source: CLD linked to HES and ONS mortality data, individual records linked by NHS number.

The denominator Y: the number of people (new clients aged 65 and over) discharged from hospital where reablement services were provided.

Source: CLD linked to HES, individual records linked by NHS number.

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

The numerator X: the number of people (all clients new and existing aged 65 and over), discharged from hospital where reablement services were provided.

Source: CLD linked to HES, linked by NHS number

The denominator Y: total number of hospital discharges, for people aged 65 and over discharged alive from hospitals in England. This includes all specialities but excludes patients with a zero-length stay in hospital. Data for geographical areas is based on usual residence of patient.

Source: HES

For both parts people may be counted more than once within the year if they had 2 separate hospital discharges and received 2 separate reablement services.

Disaggregation

Outcomes - part 1 only: the total number of reablement episodes after hospital discharge, for new clients aged 65 and over, will be disaggregated by whether the person entered long-term support (residential or nursing), was readmitted to hospital or was no longer alive.

Frequency of collection

CLD is collected quarterly, HES is updated monthly and ONS mortality data is updated monthly.

Data source

CLD.

Return format

Percentage.

Decimal places

One.

Further guidance

The specification and collection guidance for CLD can be found on AGEM’s website.

We are working with local authorities to refine the detailed methodology (data processing steps and code) for this metric, and all other CLD metrics in the ASCOF. We intend to publish final methodologies by April 2025.

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

Rationale

Measuring whether someone lives in their home is another way of measuring independence and delaying dependency on long-term residential or nursing care. In addition, research suggests that, where possible, people prefer to stay in their home.

From 2024 to 2025, this metric has been expanded into 2 parts:

• part 1 - the proportion of people who received long-term support with a primary support reason of learning disability, who live in their home or with family (people aged 18 to 64)
• part 2 - the proportion of people who received long-term support who live in their home or with family (all clients, disaggregated by age: 18 to 64 and 65 and over)

Part 1 is intended to improve outcomes for adults with learning disabilities. Evidence shows that the nature of accommodation for people with a primary support reason of learning disability has a large impact on their quality of life and social inclusion.

Part 2 is intended to improve outcomes for all adults, regardless of primary support reason. This will include people with a learning disability also included in part 1. This metric is disaggregated into 2 age groups: 18 to 64, and 65 and over. The separation reflects differences in these populations, since older people are less likely to reside in their own home or with family.

Definition and interpretation

The measure shows the proportion of all adults who received long-term support arranged or provided by the local authority and who are recorded as living in their home or with their family. It counts people who received long-term support within the reporting period 1 April of the relevant year to 31 March the following year.

‘Living in their home 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. While this may apply to older people living in residential or nursing homes, they are not considered as living in their own home for the purpose of this metric to measure independence. This includes the following accommodation statuses in CLD:

• owner occupier or shared ownership scheme
• tenant
• tenant - private landlord
• settled mainstream housing with family and/or friends
• supported accommodation or supported lodgings or supported group home
• Shared Lives scheme
• approved premises for offenders released from prison or under probation supervision
• sheltered housing or extra care housing or other sheltered housing
• mobile accommodation for Gypsy/Roma and Traveller communities

This metric, along with all metrics derived from CLD, will be designated as ‘official statistics in development’. This label is to reflect the transition to a new data source, including a new methodology for using record level data and associated data quality challenges.

Alignment

ASCOF measure only.

Risk adjustment

None.

Formula

The formula is x over y multiplied by 100.

Where:

Where, for 2E part 1 (people aged 18 to 64 with a learning disability):

X: all people within the denominator who are ‘living on their own or with their family’ as per the definition above, aged 18 to 64.

Source: CLD.

Y: the number of people aged 18 to 64, who have received long-term support for learning disability during the year. All support settings are included (for example, residential, nursing and community settings but excluding prisons).

Source: CLD.

Where, for 2E part 2 (all people regardless of primary support reason, by age: 18 to 64 and 65 and over):

X: all people within the denominator who are ‘living on their own or with their family’ as per the definition above.

Source: CLD.

Y: the number of people who have received long-term support during the year.  All support settings should be included (for example, residential, nursing and community settings but excluding prisons).

Source: CLD.

Disaggregation

Equalities: gender, age (18 to 64, 65 and over for part 2 only).

Frequency of collection

CLD is collected quarterly.

Data source

Client level data.

Return format

Percentage.

Decimal places

One.

Further guidance

The specification and collection guidance for CLD can be found on AGEM’s website.

We are working with local authorities to refine the detailed methodology (data processing steps and code) for this metric, and all other CLD metrics in the ASCOF. We intend to publish final methodologies by April 2025.

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

People have better outcomes when they have control over their care and support and when services are personalised and tailored to their needs. This outcome is  measured by asking whether people provided care and support feel in control of their daily lives.

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 ASCS 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] equals 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

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 measures the extent to which carers feel they have been involved or consulted about the person they care for in the last 12 months.

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. 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 can only be fully realised where information is accessible, timely and meaningful for local populations.

Definition and interpretation

This measure is in 2 parts and uses questions in the ASCS and SACE.

The question from the ASCS 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 ASCS 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 The 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, as they allow people to personalise their care and support. Self-directed support provides people with increased choice and control over their care, therefore improving outcomes.

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. These individuals will have the right, in most circumstances, to request this as a direct payment. This metric provides an insight into the personalisation of services.

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 clients and carers receiving self-directed support as a percentage of all clients receiving community-based services and carers receiving carer specific services.^{[footnote 3]}

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, a direct payment, or a combination of these approaches)

3D part 1:

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

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.

For 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.

Full cost clients - in other words, those that pay the full direct costs of the services they receive but whose support is arranged by the council with adult social services responsibility (CASSR) which includes, for example, regular reviews or support planning - 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 part 1. 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.

This metric, along with all metrics derived from CLD, will be designated as ‘official statistics in development’. This label is to reflect the transition to a new data source, including a new methodology for using record level data and associated data quality challenges.

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 receiving self-directed support)

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

Source: CLD.

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

Source: CLD.

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

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

Source: CLD.

Y: the number of carers (caring for someone aged 18 or over) receiving carer-specific services delivered via a) direct payment, b) CASSR managed personal budget or c) CASSR commissioned support only in the year to 31 March.

Source: CLD.

Where, for 3D part 2a (adults receiving direct payments)

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

Source: CLD.

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

Source: CLD.

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

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

Source: CLD.

Y: the number of carers (caring for someone aged 18 or over) receiving carer specific services delivered via a) direct payment, b) CASSR managed personal budget or c) CASSR commissioned support only in the year to 31 March.

Source: CLD.

Disaggregation

Equalities: age (clients: 18 to 64, 65 and over; carers: 64 and under, 65 to 84, 85 and over).

Frequency of collection

CLD is collected quarterly.

Data source

CLD.

Return format

Percentage.

Decimal places

One.

Further guidance

The specification and collection guidance for CLD can be found on AGEM’s website.

We are working with local authorities to refine the detailed methodology (data processing steps and code) for this metric, and all other CLD metrics in the ASCOF. We intend to publish final methodologies by April 2025.

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

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 ASCS 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

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 the 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 2,150

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

As such the denominator is 2,310.

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 ASCS 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 SACE 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 the ASCS.

Biennial for SACE.

Data source

ASCS and 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.

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 equals 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 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.

Dormant locations are not included within this metric.

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 divided by 94) multiplied by 100, which equals 4% were rated ‘Outstanding’.

(76 divided by 94) multiplied by 100, which equals 81% were rated ‘Good’.

(13 divided by 94) multiplied by 100, which equals 14% were rated ‘Other’.

And (1 divided by 94) multiplied by 100, which equals 1% have not yet been rated.

Therefore, the proportion of care homes rated outstanding or good in Northumberland is 85%.

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

CQC.

Return format

Percentage.

Decimal places

One.

Longer-term development options

Not applicable.

Further guidance

For further guidance on the CQC data underpinning this metric, see the CQC’s Using CQC data page.

Appendix 1: adult social care outcomes framework - 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 people aged 65 and over discharged from hospital into reablement and who remained in the community within 12 weeks of discharge
• 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 using social care who receive self-directed support, and those receiving 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.

Metric 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 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 EuroQol website. ↩

3. 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. ↩