This Performance Monitoring Framework (PMF) is the Partnership’s system for collecting, reporting and scrutinising performance information for continuous improvement of the services we deliver. This document sets out our principles for monitoring performance as well as the structures and processes in place that allow us to be a high-performing organisation and ensure decisions are made based on evidence of our performance.
The Edinburgh Integration Joint Board (EIJB) was established in 2016 to bring together the planning and operational oversight for a range of NHS and Local Authority services. This was intended to improve overall health and wellbeing through the delivery of more efficient and effective health and social care services, while transforming health and social care provision into a sustainable model for Edinburgh. The Edinburgh Integration Scheme details the governance, scope and operation of the EIJB, including the responsibilities that are delegated by NHS Lothian and the City of Edinburgh Council.
As set out in the Integration Scheme, the EIJB is responsible for the strategic direction of the functions delegated to it, and as the EIJB is the only forum where health and social care functions for the Edinburgh area are governed by members of both NHS Lothian and CEC, it is the primary focus for performance management in respect of delivery of the delegated functions. Within the EIJB, the scrutiny of performance information is delegated to the Performance and Delivery Committee. Other Committees, particularly Clinical and Care Governance, also scrutinise performance information for particular services or functions as part of their remit.
The EHSCP is the operational delivery arm of the EIJB and is led by an integrated Executive and Senior Management team. While we manage services citywide, we continue to report and review needs and service delivery through the four Edinburgh localities: North East (NE), North West (NW), South East (SE) and South West (SW). This fulfils the legislative requirement to work at locality level, and also supports us in shaping services more responsive to the different characteristics and needs of our distinct Edinburgh Communities. We also host services on behalf of other partnerships.
We aim to be a high-performing organisation through a culture of continuous improvement. Our Strategic Plan sets an ambitious direction of travel, which seeks to build on our strengths, identify those areas where we need to improve and work together with partners to provide the best possible health and social care outcomes for the citizens of Edinburgh.
The PMF is underpinned by a few key principles of how we intend to manage performance.
Performance Monitoring Principles
- EHSCP aims to have a high-performing culture, supported by the use of evidence and data in decision making.
- Data and performance information should be used across the organisation to generate insights and inform evidence-based decision making.
- The purpose of performance monitoring is continuous improvement, not blame for underperformance.
- Everyone has a responsibility to support robust performance and in particular, managers and leaders are responsible for setting up robust performance monitoring in their areas.
Performance information can be any information that is used to help us understand how our services are performing and whether or not we are achieving against our strategic plan. Often data is collected as part of the day-to-day running of our services, but in aggregate form can be used to understand the overall performance of the service. Performance information can be either quantitative (based on numbers and calculations) or qualitative (based on descriptive, narrative information). Performance information can be used to monitor one of four aspects:
- Inputs These are the resources used to deliver a service, such as finance and staffing.
- Processes These are the pathways people follow when they use services. Sometimes this is described as a person’s ‘journey of care’ or how people ‘flow’ through the health and social care services.
- Outputs These are the services delivered to people as a result of the inputs and processes. For example, an output may be counting the number of people who have used a service.
- Outcomes These are the end experiences of people and communities resulting from the inputs, processes and outputs delivered.
Performance data needs to be available on each of these aspects to ensure a well-rounded picture of performance.
Performance information of different types is needed at different times and at different places within the Partnership and EIJB. Although it is more of a spectrum than clearly divisible categories, there are three levels at which performance information is scrutinised and acted on in the organisation.
| Strategic | Information that tells us if we are going in the right direction to meet our strategic objectives and informs decision making with regard to the long-term direction of the Partnership. Typically, this is quarterly or annual information that executive management and board members use to consider the direction of the organisation over the medium to long term. At this level, we focus on measuring the outcomes of our service provision. |
| Operational | Information that informs decision making in the short to medium-term by providing information on whether services are meeting required performance standards and operating in a way that supports the strategic direction. This information is typically used by senior management. At the operational level we mainly measure inputs, processes and outputs, but we must do so in a way that aligns with outcomes. |
| Tactical | Information, used primarily by managers involved in the delivery of services, that informs the day-to-day running of a service. At this level, managers focus on measuring the inputs, processes and outputs of the services we deliver. |
Strategic Information
At the strategic level, our performance information monitors our performance against the achievement of the strategic objectives set out in the EIJBs Strategic Plan. This is updated every three years, with an updated plan scheduled to be published in 2024.
The Strategic Plane will be monitored through a suite of strategic Key Performance Indicators (KPIs) focused on whether we are achieving change against these high-level goals. Given the nature of these strategic objectives, many of these KPIs are focused on long term change and may not see much movement in the short term. The Strategic KPIs will be supplemented by performance information on progress we are making with strategic change initiatives. The strategic KPIs and associated information will be monitored on a quarterly basis.
Operational information
At the operational level, performance reporting is focused on ensuring that we deliver services that are efficient, effective and in line with the strategic objectives of the EIJB. This level of information is predominately reported to the Operations Senior Management Team, alongside other management teams responsible for the operational delivery of services. Work is underway to ensure a comprehensive suite of service specific operational reporting is put in place to cover key services and ensure management teams and committees have the information needed to monitor overall operational performance. This will be supported by greater management accountability that includes detailed narrative from responsible managers explaining poor performance and actions for improvement.
Tactical information
Tactical performance information is used by our front-line teams on a day-to-day basis to support the smooth operation of services. It is vital to ensure that the performance information used at these levels aligns with the operational and strategic information used at senior management/governance levels so that the delivery of services aligns with our operational standards and strategic objectives. Work is underway to review and improve the delivery of data at the tactical level to support front line teams to use this to improve service delivery.
National performance indicators
As well as the performance information we use locally at each of these three levels, the partnership is required to report performance against a range of national performance indicators. We also submit data nationally that is used for benchmarking against other partnership areas. These national indicators may be included in our suite of strategic and operational KPIs, though there may be instances when improving the indicator is not a local priority, typically because we are already performing well on the measure. These measures are still reported against in our Annual Performance Report but will not form part of regular reporting against our KPIs.
National Health and Wellbeing Outcomes and indicators
The Public Bodies (Joint Working) (National Health and Wellbeing Outcomes) (Scotland) Regulations 2014 sets out nine national health and wellbeing outcomes which apply across all integrated health and social care services. These outcomes are linked to the EIJB’s strategic objectives within our Strategic Plan, showing how performance against our strategic objectives contributes to improving the National Health and Wellbeing Outcomes.
Underpinning the nine wellbeing outcomes sits a core suite of integration indicators, which all HSCPs report their performance against. These national indicators have been developed from national data sources to ensure consistency in measurement. There are 23 indicators developed by the Scottish Government for use by all Health and Social Care Partnerships but four of them (indicators 10, 21, 22 and 23) have not yet been finalised for reporting.
National indicators (NI) 1 to 9 are based on the Scottish Health and Care Experience Survey (HACE) commissioned by the Scottish Government every two years. The primary source of data for national indicators 11 to 20 are Scottish Morbidity Records (SMRs) which are nationally collected discharge-based hospital records and other national returns from NHS Boards and local authorities.
Ministerial Strategic Group (MSG) Indicators
In February 2017, the Ministerial Strategic Group (MSG) asked Integration Authorities to set trajectories for progress against six key areas of health and social care.
These performance indicators give a view of how HSCPs are progressing against a range of whole system level measures. The performance indicators are largely based on hospital sector data due to routine availability of national data. While similar to some of the core indicators, these figures are calculated in slightly different ways so are not comparable.
Data dictionary
A comprehensive data dictionary is being created which includes all of the Key Performance Indicators at the strategic and operational level. This will outline for each indicator:
- The measure wording
- Data source
- Where the indicator is reported
- The indicator definition
- Details of how the indicator is calculated
- Key services/change initiatives that support performance under the indicator
We are required to report on a number of indicators externally. We also report performance information at a range of levels in the organisation as shown below. Where relevant and available, reporting on performance information should include benchmarking information to allow us to assess performance compared to other similar partnerships.
| Level | Who | What | When |
| Strategic | Public | · Annual Performance Report covering progress against strategic objectives (Strategic Plan KPIs) and strategic change initiatives
· Strategic Performance Report showing progress against strategic objectives (Strategic Plan KPIs) |
Annually Quarterly |
| Strategic | EIJB | · Strategic Performance Report showing progress against strategic objectives (Strategic Plan KPIs) | Quarterly |
| Strategic | Performance and Delivery Committee | · Progress against strategic objectives (Strategic Plan KPIs)
· Progress against nationally reported indicators (core and MSG indicators) · Progress against key operational areas that are strategically important (Operational KPIs) |
Quarterly |
| Strategic/
Operational |
Executive Management Team | · Progress against strategic objectives (Strategic Plan KPIs)
· Progress against nationally reported indicators (core and MSG indicators) · Exception reporting on key operational areas |
Quarterly |
| Operational | Senior Management Teams | · Progress against nationally reported indicators where relevant
· Key performance indicators across operational areas |
Monthly |
| Tactical | Managers and teams | · Information that supports day-to-day management of services
· Locally relevant key performance indicators across operational areas |
Daily or weekly |
Annual Performance Report
The Annual Performance Report (APR) is a legislative requirement for IJBs, with the information to be included in the report set out by the Public Bodies (Joint Working) (Scotland) Act 2014. The report covers the April to March financial year and includes reporting progress against the nine Health and Wellbeing outcomes as well as the strategic objectives from the EIJB Strategic Plan.
Quarterly Performance Reports
Every three months a performance report is produced for the Performance and Delivery Committee with an update on strategic KPIs and nationally reported indicators. This allows the Committee to scrutinise our strategic performance and ensure service delivery is on track, in line with the strategic objectives in our Strategic Plan. This strategic performance report will also be sent to the EIJB for noting and made available to the public. Operational KPIs will also be reported to the Performance and Delivery Committee where strategically relevant and necessary to provide assurance to the committee on operational performance. This will be supported by deep dives into areas of performance as requested by the committee.
Partner Performance Reports
The Executive Management Team meets regularly with senior managers from our partner organisations, City of Edinburgh Council and NHS Lothian, to collaboratively review performance. This covers nationally reported indicators as well as key strategic projects of interest to all partners.
While the EIJB remains the primary focus for performance management in respect of delivery of the delegated functions, the EHSCP also provides performance information for partner performance reporting to Council or Health Board committees as requested.
Other performance reports
To support operational and tactical performance monitoring, a range of daily, weekly and monthly reports are produced. These cover a range of services and are produced using a variety of data systems. Some of these are managed by the central performance team, while others are created and maintained within operational teams. We are working to improve this reporting across teams and ensure it aligns with the strategic KPIs for the organisation.
Everyone in the partnership has a responsibility to support robust performance monitoring and contribute to a continuous improvement and a high-performing culture in the organisation.
EIJB and Executive Management Team
The EIJB has overall responsibility for the strategic and operational performance of the organisation, supported by the scrutiny and assurance functions of the EIJB committees and the Executive Management Team. The Performance and Delivery Committee has delegated responsibility to provide advice and assurance to the IJB on the effectiveness of operational and financial performance of the EHSCP. This is the main committee for discussion of organisational performance, with a focus on the delivery of the EIJB’s Strategic Plan.
Other committees also use performance information in the exercise of their functions. The Clinical and Care Governance Committee is responsible for monitoring the quality of care to the local population, specifically in relation to safety, quality of access and clinical effectiveness and experience. This often necessitates access to performance information to gain assurance in relation to particular functions or services. The Audit and Assurance Committee may also utilise performance information in order to provide assurance to the IJB on the EHSCP’s provisions for governance, risk management and internal control. The Strategic Planning group may also use performance information and contextual data to support the strategic planning process.
Managers across the organisation
Senior managers from the wider leadership team have a responsibility for putting in place structures to facilitate the collection and reporting of data and actioning measures to address poorer than expected results. On a day-to-day basis service managers are responsible for reviewing performance information to help manage their service and highlighting any areas of concern or success.
Performance and Evaluation Teams
The Performance and Evaluation team within EHSCP is responsible for the overall performance framework in the EIJB and ensuring teams have the tools, skills and information they need to evaluate performance information and use it for continuous improvement of services. This team also collates and reports performance data to the Executive Management Team, the Performance and Delivery Committee and the EIJB.
We receive valuable support with performance and analytics from our partners in the City of Edinburgh Council (CEC), Lothian Analytical Services (LAS) and the Local Intelligence Support Team (LIST) within Public Health Scotland.
With CEC, there is a focus on the social care information held within the social care and care home databases and the team produce many of the regular performance reports used by our social care operational teams. The LAS and LIST teams offer support with nationally available datasets and access to the Trak system to pull reports and analyse NHS Lothian healthcare data. The team can also provide in-depth analysis into particular areas on our behalf, drawing on a range of advanced analytical skills.
Change Programme Initiatives
A key plank of our Strategic Plan is the Innovation and Sustainability Portfolio, a collection of strategic change projects that will support us to achieve our strategic objectives. Progress and performance of the portfolio is part of our strategic performance information and should be captured as part of these performance reports. The portfolio will be measured at both the aggregate level, showing collective benefits from the portfolio, and through benefits measurement for individual projects. Progress with the projects is monitored through the Strategic Change Board and reported to the EIJB and committees when appropriate to each project.
Financial information
Financial information is a key part of our performance framework, providing data on the inputs to the delivery of our services and how these are used. Budget holders receive regular reports in their spend against budget, and aggregate reports are provided to the Executive Management Team and Performance and Delivery Committee quarterly. The Performance and Evaluation Team is working closely with the Finance team to bring our financial and non-financial reporting closer together. This is important so that managers can understand, not just whether their spend is within budget, but the outputs and outcomes they are achieving within this budget. This is particularly important in the context of current financial challenges, which mean that we need to ensure we balance improving performance with maintaining financial sustainability.
Quality Improvement
At the heart of a robust performance culture is a commitment to continuous improvement. Our Quality Improvement team is implementing a Quality Management System (QMS) that seeks to embed quality improvement across the partnership. Using quality improvement methodology can promote a robust performance culture, both within specific change projects and through application to our wider performance monitoring.
Contract Monitoring
As much of the delivery of our services is commissioned from external partners in the third and private sector, the performance of these contracts is an important part of ensuring we deliver against our strategic objectives. Contract management enables parties in a contract to meet their obligations to deliver the outcomes required from the contract.
Contracts have different values and varied risk profiles meaning that the resources required to manage these relationships can and will differ. We have a Contract Management Framework in place that supports the management of these contracts, including using data and measures to track the realisation of benefits in terms of quality, quantity, price, timeliness and satisfaction.
Directions
Directions are the means by which the EIJB directs NHS Lothian and The City of Edinburgh Council on which services are to be delivered using the integrated budget. Directions provide the mechanism for delivering the strategic plan, for conveying the decisions of the EIJB, clarifying responsibilities between partners and improving accountability. The EIJB Directions Policy makes provision for the monitoring of directions through the Performance and Delivery Committee and a Directions Tracker has been developed as a specific tool to assist with this.
This performance framework will be implemented through planned activity to improve our performance processes and information. There are a range of next steps planned to progress this work, with some taking place in the short-term and others extending over a slightly longer time period as we work to embed the performance framework throughout the organisation.
We have invested in our performance and analytical resource in the last two years, creating a dedicated Performance and Evaluation Team that provides support with data across the organisation as well as developing a network of analysts from across our partner organisations. We are continually improving our use of data to support decision making and alert us to performance issues, but we still have much to do to develop the performance culture, skills and data needed to meet the ambitions of the Performance Monitoring Framework.
A Digital and Data Strategy will be produced, which will outline our ambitions for the use of data to support the management and delivery of our services. This will be accompanied by a Data Strategic Implementation Plan, setting out the steps we need to take to improve how we manage, analyse, share and act upon our data.
Our work to improve our performance monitoring and use of data will also take a holistic look at datasets and reporting across our services to ensure we are collecting and reporting on the data we need to robustly inform performance monitoring and service improvement, rationalising the information collected where appropriate. This will include mapping out the data collected and reported in each part of the business to ensure robust performance monitoring is in place at each layer of our performance framework.
As part of our workforce strategy, we will look to develop training opportunities for our staff to improve their awareness and use of data. We will also improve our use of reporting and dashboard tools that can provide visual and easy-to-use reports to support the better use of data across the organisation.
More detail on the activities to improve our performance reporting will be captured within our Data Strategic Implementation Plan, currently under development.