The Performance Management System

Frameworks for performance management and continuous improvement

Managing quality

Monitoring casework

Business planning

Management information

Setting targets

Performance measures - measuring what matters

Reporting performance

Responding to external scrutiny

Financial management

Integrating performance management

Frameworks for performance management and continuous improvement

Councils should develop a coherent framework for performance management which meets the requirements of the Government's 'Best Value' initiative and their own local needs. They can develop their own bespoke system tailored to meeting their specific needs and circumstances or they can utilise a number of performance management models and tools to develop their framework. To be successful, frameworks have to:

• Demonstrate a clear direction and linkages between corporate objectives and the jobs people do in the organisation - so that individuals know their contribution to achieving the broader goals of the council, and those relating to social services in particular
  
• Explain what Social Services is wanting to achieve in simple terms to staff, partners, service providers and (most importantly) service users
  
• Form objectives, and force any potential conflicts between objectives into the open, to enable the organisation to be managed better
  
• Play a part in changing culture and behaviour - using the system can encourage people to work differently, with the result that they see the outcomes and potential benefits

The Commission has developed a model for performance 'breakthroughs':

EXHIBIT 3 Audit Commission - 'A model for Performance 'Breakthroughs'

Source: Audit Commission

There are a number of factors that prevent frameworks from working well:

• A lack of clarity about the framework and what you want it to do
  
• Not tailoring an 'off the shelf' system to your organisation
  
• Focusing too much on the mechanics of the system, rather than its purpose which is to help improve services for service users
  
• A lack of discipline about information collected - only collect the information necessary to run the organisation effectively
  
• Making the framework too complicated
  
• Applying the framework inflexibly
  
• Expecting the framework to do the analytical thinking - it should only provide you with the information to enable analysis
  
• Not ensuring the framework is properly implemented - with too little planning, too little training, and failing to review whether the framework is operating in the way intended
  
• Failing to involve staff, service users and other partners

There are a number of models and tools available to councils to support performance management, and these can be used as the basis for their framework or to support their own approach. These models and tools can be used in different ways to support a council's approach, and it is possible to utilise all of them to support different aspects of the performance management system because of their different characteristics and purposes.

When selecting which model or tool will be used it is necessary to be clear about what you are trying to achieve and why. In particular, the following need to be considered:

• What are you aiming to change or improve?
  
• Does the improvement need to be holistic covering all of the organisation's activities, or designed for a specific task, service or area of activity?
  
• What is the timescale for change?
  
• What resources are available?
  
• To what extent do you want to involve staff in the changes?

The Audit Commission and the Improvement and Development Agency (IDeA) have a joint project - 'Performance management - measurement and information' (PMMI) - which has reviewed a number of models and tools and identified relative strengths and implementation issues of each of them - Read More
Information is provided below about those models and tools most frequently used by councils in their social services:

Models:
Models provide a holistic framework designed to give structure and rigor to an organisation's performance management approach.

EXHIBIT 4 The Basic Building Blocks for a Performance Management Model

Source: Audit Commission and IDeA project - performance management measurement and information

All models aim to address one or more of the following objectives with the aim of improving performance:

• Provide a structured approach to strategic management
  
• Create links between individual, service and corporate objectives
  
• Translate strategy into performance measures and targets, and in doing so rationalise performance information
  
• Help demonstrate individual staff contributions to organisational objectives
  
• Identify strengths and areas for improvement
  
• Help organisations become more results orientated
  
• Aid internal and external communication
  

Aims:

• To give a comprehensive overview of organisational health
  
• Provide evidenced levels of achievement that can be used for year on year assessment
  
• Facilitate comparison with a range of private and overseas organisations
  
• Provide an opportunity for achieving a nationally recognised quality award
  
• Aid internal communication and staff contribution to improvement

European Foundation for Quality Management (EFQM) - the 'Business Excellence model'

The 'Business Excellence Model' has been developed by the European Foundation for Quality Management and is widely used in major UK and European organisations as a means of reviewing performance against internationally recognised best practice. The model allows organisations to use a structured self assessment approach to support continuous improvement.

Continuous improvement in organisations can be seen as including four key elements:

• Define: Using internal planning processes and management information to define the direction of travel for the organisation - what you want to achieve
  
• Assess: Assessing where you are currently against your desired aims
  
• Prioritise: Agree expectations over a desired timescale and the improvements you desire. Develop and agree performance improvement plans to support the process
  
• Deploy: The actions you intend to take and the resources to be invested to achieve the improvements

The 'Excellence' model is based upon nine elements, five of which are classified as 'Enablers' of excellence which in turn drive excellence of achievement in the four other 'Results' elements. The nine elements are:

Enablers:

• Leadership: Is leadership effective?
  
• People: Are people in the organisation well managed?
  
• Policy and Strategy: What is the direction of travel, and how will we get there?
  
• Partnership and Resources: Is best use made of partnerships and resources?
  
• Processes: How well are things done?

Which lead to:
Results:

• People Results: Are people motivated and performing well?
  
• Customer Results: Are customers satisfied?
  
• Society Results: What is the contribution to the local community?
  
• Key Performance Results: Are targets being achieved?

Because of the broad structure of the model, it is possible to incorporate other quality models to support the Excellence Model. For example, Investors in People can be used to provide the evidence for the people elements of the model.

The 'Balanced Scorecard'

Provides a multi-dimensional framework for managing vision and the strategies for delivering that vision by linking objectives, initiatives, targets and performance measures across four key corporate perspectives:

• Financial perspective
  
• Learning and growth perspective
  
• Customer perspective
  
• Informal process perspective

Aims: to achieve a balanced set of performance measures and targets that allow managers to track progress in key areas.
It is used to:

• Formulate and refine strategies
  
• Communicate strategies and priorities throughout the organisation
  
• Link strategic objectives to long-term targets and budgets
  
• Monitor progress and introduce initiatives to improve performance
  

Scorecards can be cascaded to the various levels in the organisation, with scorecards for the senior management, service unit, and individual levels. The balanced scorecard approach can be used to support other performance management models and tools such as EFQM self assessment and Investors in People self assessment

EXHIBIT 5 'The Balanced Scorecard' approach

Source: Jane Shuttleworth Consultancy and Training

Tools:

The following tools aim to improve the efficiency of organisations.

Investors in People

A national standard for improving organisational performance by training and developing people to achieve organisational goals - Read More. The standard is based upon four key principles:

• Commitment to invest in people to achieve business goals
  
• Planning how skills, individuals and teams are to be developed to achieve these goals
  
• Action to develop and use necessary skills in a well defined and continuing programme directly tied to business objectives
  
• Evaluating outcomes of training and development for individuals' progress towards goals, the value achieved and future needs
  

It also has four other objectives:

• Provide business benefits
  
• Provide a framework for workforce development
  
• Improve motivation, morale, job satisfaction and retention
• Increase skill levels of staff

The approach can be used incrementally across services or departments, or a council-wide approach can be taken. Implementation is usually handled by a council's human resources department.

Chartermark

Chartermark is the government's national standard and quality improvement scheme aimed at improving customer service in the public sector. The scheme focuses on results (namely, the service the customer actually receives).

Aims:

• To drive customer focused quality improvement programmes and a culture of continuous improvement
  
• Improve the quality of service the customer is receiving
  
• Provide a recognised standard that users and customers will equate to quality services
  
• Communicate more effectively with customers and service users, and respond to their needs

ISO 90001 (2000)

This is a global standard and approach for quality management systems. It focuses on the management of processes and documentation in order to meet customers' needs and expectations.

Aims:

• To establish excellent working practices through effective processes
  
• To document processes in order to improve understanding among staff

Once a system is in place and established, the organisation can seek independent assessment by the UK Accreditation Service (UKAS) which is recognised by the Department of Trade and Industry. Only organisations accredited by UKAS can use the national accreditation mark.

Managing Quality

Quality Standards

Quality standards should be set for all services provided by social services and must apply equally to services provided in-house by councils or commissioned from the voluntary or private sectors under contract. Standards should be set for all aspects of the work of social services which have a direct impact on service users. This will include:

• Services which relate to the care management processes, such as the processes for assessment and care planning. Standards should be clear about user involvement, timescales and process
  
• Directly provided and commissioned services, which are delivered either by the council or under contract with a voluntary sector organisation or independent sector provider
  
• Support services directly affecting service users, such as arrangements for charging and financial assessments, and for handling complaints
  
• All services which are delivered jointly with other agencies, where quality standards should be produced which apply to all agencies in the partnership

There are a number of factors which need to be considered when setting quality standards:

• They should be developed with the involvement of service users and frontline staff
  
• They should be written in plain English and in a form which is meaningful to service users
  
• They should be measurable. Standards have to be set in a way which enables service users and social services managers to monitor whether the standards are being met
• They should be made available to all service users and frontline staff, and in different formats to meet the needs of individual users and carers
  

Quality Assurance

Having set the quality standards for services, councils should ensure that all of the business processes related to the delivery of services should help ensure that those standards are delivered comprehensively and consistently. All aspects of service planning and delivery should be focused on quality assurance (Exhibit 6):

EXHIBIT 6 Quality Assurance - The processes for ensuring quality standards are achieved

Source: Joint Reviews

Strategic Commissioning (See Commissioning module):

Arrangements for commissioning services at a strategic level must ensure that potential service providers are able to meet the standards for the service:

Care needs to be taken to ensure that the forms of contracts chosen do not have an adverse effect on the provider's capacity for meeting the standards. While, for example, spot contracting has attractions for the council in that it allows it to purchase only the service needed, it can make it more difficult for the service provider to anticipate and plan for the number of service users to be supported. This, in turn, can create problems for recruiting, retaining and training suitably skilled staff.

Ensure the timescales set for contracts enable service providers to develop and sustain the capacity in their organisations to meet the standards.

Ensure that arrangements for re-letting contracts do not have an adverse impact on the quality of services provided. Careful consideration needs to be given to the problem of balancing the need to get the best price in the contract with the impact that changing service providers will have for service users. If it is decided to change a service provider, this will need to be planned carefully to ensure that users are not disadvantaged and that standards are still met.

Social Services need to be clear about their future purchasing intentions, and then design their commissioning arrangements around this expected level of activity. This may include using a mix of contract arrangements to deliver a service.

Contract specifications and monitoring (Read More):

Contract specifications and conditions should include the quality standards for the service, all other requirements expected in the delivery of a quality service, and the arrangements for monitoring compliance. This should include:

• A full service specification to support the contract that includes the quality standards and all other requirements laid down by social services to ensure a quality service such as minimum staffing requirements, staff skills and qualifications, and the availability of the service
  
• Operational processes to clarify the expectations social services have of contractors in the day-to-day delivery of the service. This would include such issues as having to notify social services about any changes in the circumstances of users, varying the agreed level of service in emergency or one-off situations
  
• The arrangements and timescales for implementing a new contract. This would recognise the initial investment needed to support effective implementation and the potential to stage the implementation over a period of time
  
• The expectations in respect of collecting information from users about their satisfaction with the service, and arrangements for managing complaints
  
• The arrangements for contract monitoring should include the frequency of monitoring meetings, who should represent both of the parties involved in the contract, and the arrangements for dealing with poor performance
• The management information required from service providers and the frequency with which it is required, to support the contract monitoring and quality assurance processes
  

Accreditation of service providers:

Accreditation of service providers is an important way for social services to satisfy themselves that a prospective service provider has the capacity to provide a particular service. This is most important if a spot contract approach is to be adopted, as it provides a mechanism for a council to be satisfied about the provider's ability to deliver the contract ahead of services being commissioned. It is also a means of limiting the organisations involved in tendering for 'block' or 'cost and volume' contracts, by restricting applicants to those that have already been accredited.

An accreditation process would need a service provider to demonstrate that:

• It has the ethos and values required to deliver the services being commissioned
  
• It has the ability to meet service standards and contract conditions
  
• It has managers with the experience and track record of delivering the service
  
• It has the numbers of staff with the necessary skills and qualifications
  
• It has the ability and systems to ensure the quality of its services and meet such things as health and safety requirements
  
• It has a sound financial standing

A number of factors need to be considered in relation to any process of accreditation:

• The relationship between the accreditation process and the requirements of the regulatory body for social services (the Commission for Social Care Inspection (CSCI), which assumes responsibility from the National Care Standards Commission [NCSC] on 1st April, 2004). NCSC currently has responsibility for registering organisations involved in the provision of a range of services including residential services, home care services and foster care
  
• The process has to be consistent and fair across all providers. Failure to ensure this would leave the council vulnerable to challenge from organisations that had failed to be accredited
  
• Whether the council would be prepared for providers to advertise the fact that they had 'accredited' status as a way of attracting other business
• The process and circumstances for withdrawing accreditation status from a provider, any appeals process, and its relationship with findings of the external regulatory body
  

Management information:

The availability of accurate and timely information about the quality of services delivered either directly by the council or by voluntary or private sector providers is a key part of gathering evidence to enable monitoring of quality in service provision - Read More

Too frequently, management information is seen as the gathering of statistical data and the quantitative input to monitoring and measuring performance. Not enough attention is given to gathering qualitative information to ensure standards are being met. In order to gather qualitative management information, councils need to ensure that qualitative standards are expressed in ways which are measurable to enable management. For example, a quality standard for home care of 'providing a timely and reliable service for users' could be supported by measurable outcomes such as:

• The number of occasions when new carers arrive without the service user being informed
  
• That all carer visits should have a specified time, and information is provided about the number of occasions when visits are made outside of that specified time (within a given tolerance)

Regulation (external registration and inspection processes):

Managers need to ensure that information from agencies responsible for the regulation and inspection of social services is available to them and is used to monitor the quality of the services being delivered, whether in-house or by voluntary sector or private sector providers. Close working relationships with the inspectorates need to be developed to ensure that appropriate responses are made to the findings of inspectors and to ensure that the council's responsibilities to service users are met through action taken to deal with findings of poor performance - Read More

Case reviews:

Reviewing care plans makes a major and often under-estimated contribution to ensuring quality services are delivered for service users. Review processes should ensure that the needs of users are re-assessed and services changed to reflect the most up-to-date position, and that care plans adequately address these needs. The needs of users and carers cannot be assumed to remain static. Review processes should ensure that users and their carers are actively engaged in the process, including being given the opportunity to comment on the standards of the services they have been receiving.

Failure to regularly review cases can cause drift and an inability to ensure that the response to previous assessed needs is having the desired impact. It can also result in over-provision of services as needs change and this can waste valuable resources.

In spite of this, performance in this area of care management has been patchy. In adult services, there has been a slow improvement in performance from a very low base reaching only 51.4 per cent of users receiving a scheduled review or re-assessment in 2002/3. The best councils achieve results in excess of 90 per cent.

Supervision and case file audits:

Staff supervision and other casework monitoring arrangements are an essential means of ensuring the quality of services - Read More on Staff Supervision or Casework Monitoring.

Feedback from users and carers:

Processes to encourage and act on user and carer feedback are a critical part of any quality monitoring system. Information from user sources needs to be systematically recorded to provide an overview of performance against quality standards - Read More

Monitoring casework

The quality of casework and caseloads should be regularly monitored through routine casework supervision, supported by a systematic process for auditing case files. Supervision should monitor the quality of the casework, support and record decisions about the future direction of the case, and monitor whether previous decisions and actions have been followed through. Overall, case files should be reviewed to establish whether they provide a coherent and comprehensive record of the casework and there has been an effective response to meeting user needs - Read More about what needs to be put in place to ensure an effective staff supervision system

Case file audits:

Arrangements for auditing case files should explicitly be put in place. This can be undertaken through the supervision process, independently of that process, or preferably through elements of both approaches. Separate mechanisms for audit allow managers to assess the quality of supervision as well as providing a check on the quality of direct work. A systematic approach to auditing files will also provide collective hard data for management about how key elements of casework activity are being delivered. This can give an overall picture of performance within a council as well as a quality assurance check on the individual case.

To support this systematic approach, councils should develop a checklist of essential requirements to support the audit process. This will ensure consistency of approach and enable comparisons across locations, teams and trends over time.

Each council wants to put together its own requirements but information about key national priorities and indicators should form part of the audit and be included in the checklist. Some of the core elements that should be included in a checklist are shown below (Exhibit 7):

EXHIBIT 7 Checklist of essential requirements

Source: Joint Reviews

Business planning

Business planning forms the link between the broad policy objectives for social services, both national and local, and the delivery of day-to-day support to vulnerable people. It is the bedrock of effective performance management. Business planning, therefore, ranges between an overarching strategic plan for social services (or separately for children's services and services for adults), through to specific service plans (for example for older people or people with a learning disability), through to plans for teams or service delivery units. The actual structure of business planning should match the organisational structure for social services within a council, or with partner organisations. An effective mechanism for connecting plans up, down and across the organisation, within a common framework, is critical. In some councils, processes are too cumbersome and can create the impression of serving the needs of the top of the council rather than the front line.

EXHIBIT 8 Service plans should lead the planning process

Source: Joint Reviews

Management Information

The availability of accurate and timely management information is central to any performance management system. However, this task often presents serious problems for social services. Arrangements frequently fail to produce the information necessary to run services well and cost effectively; consequently, managers are ill equipped to manage performance and make evidenced-based decisions. Managers can also struggle to provide accurate information for national, as well as local, scrutiny and monitoring purposes. Too often, the cause of the problem is cited as information technology when in reality there is lack of clarity as to what information is required to support good management.

Nevertheless, the nature of the task is complex. Some of the challenges are caused by:

• The number and complexity of individual transactions that have to be tracked. For example, an older person may have a weekly home care package but the precise nature of the service provided may change frequently due to the user's changing circumstances, for example visits to family and friends, or ill health and hospital visits. These changing dynamics can be replicated across large numbers of service users creating a significant number of changes that have to be tracked
  
• The complexity of the definitions of some data sets. For example PAF indicator C28 (BVPI 53) for intensive home care requires those individuals who receive more than 10 contact hours of home care and 6 or more visits a week to be separately identified
  
• Information systems (mainly IT systems) that are too inflexible and cumbersome to respond to changing information and business process needs
  
• Data is often held on more than one system making reconciliation difficult
  
• Capacity problems on councils IT networks. Often, new social services systems are implemented without a thorough analysis of the impact on the council's network
  
• Under capacity results in slow response times. Frustrated staff then develop paper systems. This duplicates data collection and requires the data to be input at a later date, increasing the risk of error
  
• Administrative and business processes are often not organised or configured to support IT systems (ie the system software assumes that data will be handled in a particular way but the processes are organised differently)
  
• Responsibility for data management is usually spread among many staff in the organisation and through different management streams, with little clarity about the accountabilities of individual members of staff or managers
  
• Frequently, there is no one manager in the organisation who has the ultimate responsibility for ensuring the production of accurate and timely information
  
• The staff responsible for inputting data are usually not the same staff that have to use the data. This means that those responsible for input are often unaware of how critical their work is to the organisation or of the needs of managers and other staff who need the data. Equally, those who use the data can be ill informed about the problems and difficulties faced by those staff responsible for data collection.
  
• Administrative staff who are usually key to effective data collection and management are often seen as a low priority in organisations
  
• Problems of reconciling finance and activity data prevent managers and councillors from being clear about the cost implications of decisions regarding services and so undermine efforts to improve efficiency

EXHIBIT 9 Management Information is central to effective performance management in Social Services

Source: Joint Reviews

There are a number of key issues for social services managers to address if these problems are to be avoided (see good practice tips). Primarily though, there needs to be a culture in place that sees information as central to the management task. Councils that are information conscious and evidence driven are more likely to solve the day-to-day practical problems that thwart access to good information. 'The more you use it the better it will get'. See Good Practice - Derbyshire County Council - Devolving Responsibility for Performance

Setting targets

Targets should be set in order to drive improvement and meet service development objectives. Targets need to stretch the organisation at all levels, but also recognise the constraints that the organisation is working under and the resource capacity it has to support the desired improvements and developments. A small but well selected set of targets is much preferable to a target for everything! Targets should always be:

SPECIFIC
MEASURABLE
ACHIEVABLE
REALISTIC
TIME BOUND

Performance measures - measuring what matters

Performance measures or indicators should be designed to inform how well the organisation is performing against key national and local policies and objectives. They should facilitate progress in tackling service weaknesses and the tracking and monitoring of improvement. There are some important issues to be considered when deciding what information needs to be collected and what areas of performance need to be measured, but generally it is better to focus on fewer, better quality outcome measures - Read More

Reporting performance

Councils need to create a framework for reporting on performance in social services. Reporting should be comprehensive and give a rounded, recognisable view of progress in terms of outcomes. A comprehensive approach should include, for example, not only bald performance indicators but also:

• Performance against quality standards
  
• Compliments and complaints
  
• Outcomes from staff appraisal processes
  
• Outcomes from staff training and development programmes
  
• Recommendations from inspectorates, regulators and independent people or bodies.
  

Finance and service reporting needs to connect in a way that shows how money is being spent and to what effect.

It is sensible to develop a coherent structured approach to who needs what information and how often. For example:

• Reporting to the Mayor, Cabinet or Executive on matters of corporate and strategic importance to the council would focus on areas of major financial and service risk and overall performance in social services
  
• Senior management in social services would require more detailed focus on progress against strategy for each of the major user groups. Information on activity, cost and performance should be integrated to form an overall picture of the state of services. Routine monitoring of PAF indicators would be part of this, especially those which reflect current national priority areas. See Good Practice - Derbyshire County Council - Devolving Responsibility for Performance
  
• First line management and middle management levels would require differentiated information relevant to their responsibilities. This should support comparisons with others and drive adjustments that further the achievement of team or service objectives
  
• At an individual level performance reporting should be through supervision and staff appraisal processes
  
• Key stakeholders require access to reports on performance in respect of service interface issues, for example, delayed discharges from hospital. Where more formal partnerships are in place, there needs to be joint agreement about performance measures and reporting. In respect of service providers matters, the outcome of contract monitoring arrangements would need reporting
  
• Users and carers too, through the formal machinery that is put in place for engagement and consultation, need to see feedback on how services of relevance to them are doing
  

Responding to external scrutiny

Councils need to work with the external bodies responsible for the regulation and inspection of social services and use feedback from independent sources as a further way of validating progress and good practice, identifying weakness and making improvement.

The main regulatory bodies whose responsibilities have a direct bearing on the provision of quality social care services are:

The Commission for Social Care Inspection:

This new inspectorate has been formed to take over responsibilities from:

• The Social Services Inspectorate, which has had responsibility for the overall assessment of a council's performance in the delivery of social services leading to its star rating. SSI has undertaken the inspection of broad areas of service delivery. It has taken part in joint inspections with other inspectorates for example, OfSTED and CHAI
  
• The National Care Standards Commission, which has had the responsibility for the registration and inspection of individual service providers covering a range of social care services such as residential care units, home care and foster care
  
• SSI/Audit Commission Joint Reviews which have had responsibility to undertake a comprehensive assessment of a council's delivery of its social services functions, including whether it secures 'value for money' in its provision of those services

The Audit Commission:

Provides assessment of councils through its Comprehensive Performance Assessment process. It provides an 'external auditor' to ensure probity and propriety particularly in respect of the council's arrangements for:

• performance and risk management
  
• procurement of services
  
• securing value for money
  
• sound finances

The Health and Safety Executive:

Ensures that services provided by the council or by independent providers meet all health and safety requirements.

Financial management

Councils need to ensure their performance management and financial management systems are well integrated. There are a number of aspects to integration which councils need to address - Read More on Budget Setting or Unit Costs

Integrating Performance Management

Councils need to understand the performance management arrangements in place in Hospital and Primary Care Trusts. Some integration of performance management is necessary if joint or related services are to be effectively delivered and monitored. For example, performance monitoring of intermediate care services would want to track user outcomes in terms of re-admissions to hospital and residential care.

The integration of performance arrangements is most likely to be achieved if there is explicit agreement on joint objectives and targets and a mutual understanding of the framework in which respective organisations operate.

Learning how to operate in this partnership context is important as integration is a trend that will continue. Councils are currently planning their response to the Government's requirement for Children's Trusts to be established by 2006. In adult services, use of the flexibilities allowed under the Health Act 1999 has meant that there are an increasing number of integrated joint management arrangements with some moving to full Trust status. For further information see the Partnership module.

While systems and approaches to performance management in the Health Service and local government are different, there are also similarities which need to be developed and built upon:

• Each sector has targets, performance indicators and star ratings
  
• Both have formal systems of self review, Best Value and clinical governance
  
• Activities in both are scrutinised by elected members and non-executives

There are a number of issues which need to be addressed by agencies involved in these joint management arrangements:

• Integration should merge and transform systems, rather than allow duplication
  
• There needs to be a greater concentration on outcomes for users and carers, rather than on the inputs to or outputs from processes
  
• Performance management processes must be orientated towards action (they are a means to an end and not an end in themselves)
  
• Frontline staff working together in joint teams should find the performance management processes both motivating and supportive. New arrangements need to ensure that potential tensions between the performance requirements and the data collection systems of the participating agencies are tackled

While there are some PAF indicators which are interface indicators monitoring performance at the interface between social care and health, there are currently no joint indicators. A performance development group has been established by the Department of Health to look at how to develop and implement joint performance indicators for services where staff from the two organisations already work closely together, such as in community mental health teams, or in multi-disciplinary teams in children's services. In the latter case, emphasis will be placed on the five broad outcomes identified in the Green Paper 'Every Child Matters'.