Failing social services may be going unchallenged, warns CQC chief

David Behan doubts ability of sector-led performance regime to deal with underperforming adult social care departments successfully because councils are too competitive with each other.

Failing adult social services departments may be going unchallenged under the sector-led improvement regime brought in to replace annual assessments by the Care Quality Commission, the CQC’s chief executive has warned.

David Behan told Community Care that councils who were underperforming were unlikely to be open to fellow councils identifying their failings and offering support and challenge to improve, as councils were too competitive with each other.

Under sector-led improvement, councils voluntarily subject themselves to peer reviews by staff and councillors from elsewhere and authorities work together regionally to support each other. Behan said the system was working “really well” for higher-performing adult social services departments and those in the middle of the performance spectrum, but questioned its value for those at the bottom.

Failing councils ‘may not be open to support’

“People can share information, intelligence and learning and that can help improvements take place,” he said. “What I’m less clear about is for those authorities who are failing or at risk of failing how open they are to help from outside.”

He said in the past failing councils had faced intervention from a regulator, under systems in which their performance was assessed every year and their social services departments were inspected regularly. However, annual performance assessments and routine inspections were scrapped by the government in November 2010, to be replaced by sector-led improvement.

Behan added: “I’m not sure I would be confident that [a failing authority] would be open to another local authority coming along to them and saying ‘I don’t think you’re getting it right, can we help you?’.

Councils ‘too competitive with each other’

“That’s the ultimate test for sector-led improvement, not that the good get better but can those who are less effective be helped to improve. I think local authorities can be too competitive.” However, he stressed that “there are some very good things going on”, under sector-led improvement.

The sector-led improvement process is overseen by the Towards Excellence in Adult Social Care (TEASC) programme board, which is led by the Association of Directors of Adult Social Services (Adass) and Local Government Association (LGA), but also includes representation from the CQC.

TEASC has just had its funding from the Department of Health increased from £500,000 in 2012-13 to £800,000 in 2013-14, which the board sees as the first full year of delivery for its sector-led improvement model. The model includes:

  • Peer challenge – reviews of a councils’ performance in adult safeguarding, use of resources or overall effectiveness in adults’ services, commissioned voluntarily by the councils themselves and conducted by staff and councillors from other authorities;
  • Local accounts by councils of their performance in adult social care, published annually, ideally with strong input from local service user-led organisations, such as the local Healthwatch;
  • Support for councils to improve, brokered by regional Adass branches;
  • The identification of councils at risk of failure and the provision of support for them to improve.

Protocol on managing under-performance

TEASC published a protocol on managing the risk of under-performance last year. This places an expectation on directors of adult social services that they will be self-aware about their authority’s level of performance, will use data to benchmark their performance against others and consider seeking challenge and support from peers.

Where an Adass regional branch identifies under-performance in a member it should arrange offers of support, subject to available resources. Where failings continue or are significant this will be reported to regional LGA principal advisers, whose role it is to identify councils performing poorly. They would be expected to assess the prospects for improvement and identify further support needs.

The protocol also envisages Adass regional chairs and principal advisers sharing information with officials from the Department of Health, which is also represented on the TEASC board.

CQC’s power to intervene

Under section 48 of the Health and Social Care Act 2008, the CQC has reserve powers to carry out an investigation into a failing adult social services department, and can also be directed to do so by the secretary of state for health. No such investigation has taken place since the abolition of annual performance assessments in 2010.

The protocol states: “Ultimately ministers retain the right and statutory powers to intervene however, it is important that the sector should be provided with an opportunity to address any concerns about a particular council before any form of intervention is invoked, however, there may be circumstances where intervention is determined as urgent and necessary.”

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