Doubts over viability of new adult care inspection regime

Government plans to overhaul the performance assessment of adult social care in England could be endangered by under-resourcing and a lack of expertise, sector heads have warned.

The proposals, unveiled last week, are designed to make councils accountable downwards to users and the public for performance, rather than upwards to government.

Out will go government-set performance indicators and data requirements for councils; in will come a smaller set of outcome measures and a national data set, the content of which will be negotiated between councils and government, and will not be used for national target setting.

Out will go the annual performance assessment of councils by the Care Quality Commission; in will come local annual reports by councils, which would vary from area to area and be reviewed by other councils and user-led organisations.

Compulsory annual quality ratings for providers will also disappear. They will be replaced by an excellence standard which providers will have to apply to be assessed against by the CQC and other bodies.

The reforms have been warmly welcomed by local government leaders, who have been calling for a locally led approach for years.

Andrew Cozens, adult care lead at the Local Government Association, said the old system provided a false sense of security by collecting a lot of data, most of which had no relevance in establishing whether services were improving.

However, concerns have been raised about the government’s plan to “place local people in the lead role for holding organisations to account” through user-led bodies.

At the heart of this will be HealthWatch England, a “consumer champion” to be created within the CQC in 2012 as part of the government’s health White Paper reforms, and its local offshoots, which will replace existing Local Involvement Networks (Links). Links are currently commissioned by councils to provide user scrutiny of health and social care services and it is anticipated that the same will apply to local HealthWatch bodies.

Unrealistic expectations

However, Malcolm Alexander, chair of the National Association of Links Members, said it was unrealistic to expect HealthWatch bodies to take on this role in performance assessment when council funding from central government to fund Links – £84m from 2008-2011 – was not being renewed in April 2011.

Alexander said resources were also needed to engage those outside of the Link who used services but were not as fully engaged with the policy agenda to assess performance. But he said projects such as asking services users to keep diaries on their experiences of social care were expensive to administer.

In the absence of a nationally published narrative that compares councils against each other, as published currently by the CQC, service user organisations will also require resources to analyse data, he said.

There is also set to be great local variation in the quality of scrutiny, said Alexander. “It isn’t stuff that volunteers could easily do unless they have previously had careers in social care,” he said, adding that such people were more easily found in affluent areas.

Enabling the public and service users to hold services to account requires focusing on performance at a very local level, below that of the council, says Georgina Owen, assistant director at consultancy iMPOWER.

“To drive improvement ‘local’ needs to mean much smaller geographical areas – whatever might make sense to the community, but probably of the order of 1,000 households or smaller,” she says.  “At this level of localisation there is a real sense of community, a prerequisite to drive the empowerment that the Department of Health would like to create.”

While the performance framework published last week is expected to dovetail with equivalent frameworks for the NHS and public health, there will not be one overarching assessment system.

However, both Cozens and Richard Humphries, senior fellow in social care at think-tank The Kings Fund, said a single framework would do more to help the public to understand what was being measured and account for the different factors that influence outcomes for service users.

“The practical reason for doing this is that, otherwise, agencies slip back into thinking about service performance rather than their part in improving the wider picture, and we want them to feel they have an overall responsibility,” said Cozens.

The CQC will be able to inspect councils when there are risks to safety and service quality in an area, including at the request of the relevant local HealthWatch.

Currently, councils are inspected routinely, rather than on risk grounds.

Cozens said it was best that inspection resources were focused where they were needed most, when money was scarce.

However, with the triggers for inspection yet to be determined, Humphries warned that the plan lacked a clear early warning system to sound the alarm when councils were struggling to maintain standards.

Transparency in Outcomes: a Framework for Adult Social Care is under consultation until 9 February 2011.

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