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Quality Improvement Framework for Integrated Services for Children, Young People and Their Families

Scottish Executive, Children and Families, March 2006

A. Background

In 2001, For Scotland's Children ¹ highlighted the weaknesses prevailing at that time in the provision and delivery of services to Scotland's children, young people and their families. It also described examples of good practice and made recommendations for the improvement of services. Much has been done since then at both national and local levels to put the focus on delivering improved outcomes for children, young people and their families ², building on strengths and tackling weaknesses and working to deliver an integrated approach.

Since the publication of For Scotland's Children, a number of national developments are underway to help improve outcomes for all children and young people, including:

• Scottish Ministers have articulated a vision that all Scotland's children and young people should be safe, nurtured, healthy, achieving, active, respected and responsible, and included and a shared ambition for children and young people that will enable them to develop their capacities as successful learners, confident individuals, responsible citizens and effective contributors to society and work
• Implementing the vision through supporting all professionals working with children and young people to work together effectively to plan and deliver top quality services which overcome traditional service-sector boundaries and focus on meeting the varied needs of children and young people. The vision described here provides a unifying purpose for all those involved in delivering services for children.
• Recognising the importance of a collective approach to the planning and delivery of services, the Local Government Act (2003) places a duty on local authorities and their partners to develop Community Plans that bring together the delivery of local services. It also introduced a statutory duty by local authorities to achieve Best Value by improving the quality and effectiveness of services.
• Complementing this approach, in November 2004 the Executive issued the Integrated Children's Services Planning guidance to local authorities, NHS boards and other planning partners asking them to draw together their separate plans and priorities for school education, children's social work, child health and youth justice into integrated Children's Services Plans from April 2005. It also stated that the plans should reflect local activity to mainstream equality and diversity for children, young people and their families.
• The discussion and consultation paper Making Services Better for Scotland's Children, launched at the Services for Children Seminar in November 2004, presented an overview of how inspection of services for children and young people needed to evolve to take account of developments in policy and changing practices in the delivery of services on the ground. In particular, the paper addressed the need to design more comprehensive and co-ordinated arrangements for the inspection of services for children and young people.
• The consultation exercise on Getting it right for every child sets out the Executive's aim to develop the Children (Scotland) Act 1995 and to place new statutory duties on agencies.
• The Joint Inspection of Children's Services and Inspection of Social Work Services Act received Royal Assent in February 2006. This provides the statutory framework to enable inspectorates to conduct joint inspections of children's services and in so doing to share information.

This Quality Improvement Framework aims to develop a coherent and sustained approach by inter-agency children's services partnerships to raising quality across all services for children and young people to achieve this shared vision. The Framework aims to achieve this by:

• supporting a focus on those services and areas of improvement, which cannot be achieved by one agency alone;
• helping local partners achieve the overall aim for Integrated Children's Services Plans, which we described in the Integrated Children's Services Plans' guidance as " the primary focus and content of plans should be to establish an agreed description, table or display of local partners' agreed improvement objectives for services and support for children and young people with, for each of these, clear strategies for delivery, outcomes, measures of performance and timescales";
• providing a starting point for the agencies involved in planning and delivering children's services, to come together to develop a coherent and consistent approach to monitoring, reviewing, evaluating and adapting their services to meet the needs of all children and young people; and
• complementing and building on, but do not replace, existing frameworks such as the schools improvement framework, to facilitate integrated working.

Consultation took place on the draft Quality Improvement Framework over the autumn of 2005 and these aims were fully supported by respondents. However, while they considered that it was a useful starting-point, local children's services partnerships appear to be unanimous in identifying considerable scope to develop a more streamlined and proportionate approach to the reporting of performance improvement. The Executive agrees this is desirable and will be discussing with children's services providers how this can be progressed during 2006.

B. Nature and purpose

Achieving progressive and sustainable improvements in the quality of children's services will depend on service-providers having robust and systematic approaches to satisfying themselves that their service provision is of good quality ("quality assurance systems"). Such systems are in place to varying degrees in the different sectors which provide services for children and young people, but there is scope for more consistency and coherence across children's services.

Respondents to the consultation are in full agreement with the view that a new and single quality improvement system for services for children and young people would not be appropriate. Rather, what is required is a framework that supports the better integration of services, within which service-providers can both develop their existing quality improvement systems or frameworks, and work collaboratively with their partners to ensure the effectiveness of quality improvement processes across service-sector boundaries.

Different quality improvement systems are used in the different sectors which provide services to children and young people. Even within the same sector, there can be variations in approach. The depth of experience of using quality improvement systems and the consistency with which they are applied also varies across providers of children's services.

Together with local developments by local children's services partnerships and the introduction of the Joint Inspection of Children's services by 2008, this Quality Improvement Framework is designed to promote the necessary consistency and coherence of quality improvement processes within and across services for children and young people. It should also contribute to the development of a shared culture of quality improvement and a shared language for discussing issues of quality amongst all professionals.

This Framework has been completed following consideration of the first year of the three year planning cycle of Integrated Children's Services plans, 2003-2007. It should therefore contribute to an area's self-evaluation of the quality of its children's services; the setting of improvement objectives in future plans and to each area's preparations for joint inspection of services for children.

C. The Six Elements of the Quality Improvement Framework.

At the heart of the quality improvement framework is the effective use of self-evaluation, complemented by independent joint inspection which moderates and verifies self-evaluation.

The six elements should characterise how children's services work together to raise the quality of the services they provide in partnership. These elements are:

1. To articulate clearly the desired outcomes for children and young people;
2. To determine challenging targets and improvement objectives for achieving successful outcomes for all children and young people;
3. To have, within and across services, effective arrangements for evaluating systematically and rigorously, whether successful outcomes are being achieved;
4. To ask demanding questions about the performance of services for children and young people;
5. To use the information from evaluation to make continuous and sustained improvements to achieve successful outcomes;
6. To determine leadership and accountability roles for achieving improved outcomes.

1: To articulate clearly the desired outcomes for children and young people.

Action to improve quality of services will be severely hampered without a clear vision of what services for children and young people should deliver. As noted in Section 1, Scottish Ministers have said that their ambition for children and young people is that they will all become successful learners; confident individuals, responsible citizens and effective contributors to society and at work. If these aspirations are to become reality our children and young people need to be: safe, nurtured, healthy, achieving, active, respected & responsible and included. This national vision needs to be complemented by clear statements of vision at the local level. The Integrated Children's Services Plans guidance published in November 2004 sets out the vision in more detail. www.scotland.gov.uk/about/ED/CnF/00017842/Planning.aspx

2: To determine challenging targets and improvement objectives for achieving successful outcomes for all children and young people.

This clear vision of what services should do for children and young people is a pre-requisite for setting measurable outcomes. Where these outcomes are not being achieved, it will be necessary to set improvement objectives for services. Establishing improvement objectives within and across integrated services requires clear and common understandings about standards of quality, how improvements can be worked towards and success measured. It is unlikely that appropriate objectives can be set without the involvement of children and their families or without an understanding of their experience and expectations of services.

Annex D of the Integrated Children's Services Plans guidance was a compilation of national data and performance measures that were then in place. The Executive recognised that this was not complete and that further work was required to distil this list into a set of indicators that would be helpful in assessing the extent to which the desired outcomes for children and young people are being achieved through the delivery of integrated services. Annex A sets out the key performance indicators that the Executive is proposing and relates them to the vision for children and young people using these criteria:

• The indicators are unlikely to be achieved by one agency alone - success is dependent on shared and collective responsibility
• The indicators aim to be largely outcome-focussed - but some do measure process. In the latter case, the measure should provide partners with at least part of the answer to whether outcomes are being achieved, in the absence of sufficiently robust outcome measures.
• The indicators are based, largely, on existing measures. We recognise that local partnerships are partway through their three year plans and a new set of indicators would not be helpful. The key change is to focus on specific areas and to distil down the number of measures that are currently used. Inevitably, over time, new and improved measures will need to be developed in partnership with local areas and relevant agencies.
• These indicators should provide local partners with a challenging, but manageable set of performance measures that matter to the Executive and which will be taken into account when evaluating at a national level, whether outcomes are improving for Scotland's children and young people. They should form a starting-point, but not an exclusive list, for establishing local improvement objectives and the local targets and indicators that will measure progress towards these.

Service-providers should note that the Executive is not setting national targets at this stage, unless these are already established. The intention is to give providers time to develop and build on their baselines for these national indicators. During year 3 of the children's services plans, over 2007-08, the Executive will take stock of the evidence being provided and consider whether more specific targets are required.

Annex A also contains references to relevant underpinning quality improvement documents, national standards and data sources.

Responses to the consultation welcomed linking the key performance indicators to the vision and rationalising the number of indicators used to assess improvement. Respondents are firmly of the view that there is scope to reduce and rationalise the number further. This also needs to be supported by a rationalised approach to the collection of information by the Executive. This will be one of the areas that the Executive concentrates in the following year.

3: To have, within and across services, effective arrangements for evaluating, systematically and rigorously, whether successful outcomes are being achieved.

The primary responsibility for assuring the quality of services provided to children and young people lies with the service providers themselves. Organisations and individuals that work with children and young people need to have evidence-based internal evaluation systems and processes for evaluating all aspects of their work; for evaluating the quality of the outcomes achieved by and for children and young people and how improvements can best be achieved. For example, the framework of the National Priorities in Education, as well as drawing on a wide range of qualitative and quantitative indicators to enable authorities to report on their service, incorporates self-assessment using inspection tools.

To complement their own self-evaluation systems, as part of the development and review of their integrated children's services plans, service providers will need to work collaboratively to develop means of evaluating the combined effect of their services on the quality of outcomes for children and young people. They will also need to have robust evidence-based processes in place and demonstrate they use this evidence to improve services.

A consistency in approach can be achieved by using both the national performance indicators (at Annex A) for integrated services for children to assess and evidence performance improvement and the relevant quality indicators for self-evaluation, which will be finalised following consultation on joint inspection of children's services; together with the process of self-evaluation that asks the same six key questions that will be used by the Joint Inspection Team for the joint inspection of services for children.

4: To ask demanding questions about the performance of services for children and young people.

As said above, self-evaluation should be at the heart of quality improvement for children's services. To achieve the aim of consistency and coherence, we recommend that the local approach to self-evaluation is the same as that which has been adopted by the Joint Inspectorates for the Joint Inspection of Services for Children.

Making Services Better for Scotland's Children ³ stated that inspection should evaluate three levels of service provision:

• impact and outcomes for children and families;
• strategic leadership and direction; and
• operational management processes.

In addressing these three levels, inspectors and agencies will seek answers to the following six questions:

1. What key outcomes for children, young people and their families have we achieved?
2. What impact have we had in meeting the needs of our stakeholders?
3. How good is our strategic leadership?
4. How good is our operational management?
5. How good is our delivery of key processes?
6. What is our capacity for improvement?

Robust self-evaluation by local partnerships, underpinned by this framework, will be the most crucial element in improving the quality of services for children and young people. In time, joint inspection of services for children will also provide the essential function of moderating and validating self-evaluation. It will also enhance public accountability.

5: To use the information from evaluation to make continuous and sustained improvements to achieve successful outcomes.

To achieve continuous improvement in quality, the results of evaluation (internal and external) must be used to identify where improvements need to be made and to take action to make these improvements. This requires that:

• Service-providers have a robust understanding of what children, young people and their families have experienced in using their services and of how services could be improved for them.
• Service-providers, individually and collectively, have well-developed systems for continually monitoring and improving the quality of their work with children and the outcomes achieved by and for children, young people and their families. This includes having monitoring arrangements which ensure that improvement objectives, once identified, are actually achieved.
• Individuals working with children and young people are clear about what they personally need to do to improve the quality and impact of their work.
• Support is available when organisations or individuals have difficulty in making improvements to the quality of their work.

Making available the information gained from self-evaluation to relevant stakeholders, including children, young people and their families, is an important element in creating a culture of improvement through self-evaluation. There are examples of good practice of reporting on the progress of the integrated children's services plan and using these events to secure involvement in their further development. Children, young people and their families will have a key role to play in improving services, by being better informed of what they should expect and by providing feed-back to service-providers about the quality of service they have experienced. It is therefore essential to include these users of services in the process of evaluation and continuous improvement.

6: To determine leadership and accountability roles for delivering improved outcomes.

A resolute and systematic approach to quality improvement requires leadership, and it is important in each context to determine who should provide the necessary leadership and how that leadership should be exercised. This is particularly important where the provision of services is shared across a number of partners.

Accountability for the improvement of services begins with an individual professional's responsibility to provide appropriate agreed support and services to the child or young person. It extends to all of the chief officers of all the relevant agencies who are signatories to an area's Integrated Children's Services Plan and to the improvement objectives that they are committed. It is shared by all managers of services being accountable for the achievement of improvement objectives which fall in their domains. Particularly within the context of better integrated delivery of a wide spectrum of services, it is essential that everyone is clear about what aspects of the improvement objectives he or she is responsible for achieving and how they can exercise their accountability effectively.

Less formally, the responsibility of working towards the achievement of the highest levels of quality of service for children and young people is something which lies with all engaged in the planning and delivery of these services. A culture of commitment to quality improvement will thrive in an environment where there is a deep-seated belief and commitment amongst all who work with children and young people that what each individual does can make a difference to the quality of outcomes for children and young people. The creation and nurturing of such an environment and culture is one of the hallmarks of effective leadership.

D. Conclusion

Children's Services Partnerships are at an early and varying stage of development across Scotland. Despite this, they have made considerable progress in developing a unified plan for the development and improvement of children's services in their area. Many have begun the process of identifying high level improvement objectives and set out how they will measure whether these have been achieved.

The responses to the consultation on the draft Quality Improvement Framework suggest that it is welcome and that it will be helpful in the development of inter-agency approaches to achieving improvement in children's services. The responses have also identified the challenges for the Executive in developing more streamlined approaches to evaluating progress. The Executive will produce proposals for achieving this during this year and ensure that they complement the development of the methodology for the Joint Inspection of Services for Children.

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