Government to revive CQC ratings of council adults’ services after more than decade-long gap

Councils found to be failing on adults’ services by inspectorate would face government intervention, along similar lines to children’s services, under NHS White Paper reforms

Image of computer key marked 'assessment' (Credit: momius / Adobe Stock)
(Credit: momius / Adobe Stock)

The government plans to reintroduce inspections of local authority’s adult social care functions by the Care Quality Commission, with councils being potentially subject to government intervention for failings, it announced last week.

In its NHS reform White Paper, the government proposed to introduce a duty through a planned Health and Care Bill, in which the CQC would be responsible for assessing local authorities’ delivery of their adult social care duties.

CQC annual assessments of local authorities were scrapped by the government in 2010, at the same time as the CQC stopped carrying out inspections of local authorities, which then focused on adult safeguarding.

Since then, councils have worked together to support their own performance through “sector-led improvement”, typically on a regional basis and involving sharing information and data, and teams of council practitioners and managers conducting peer reviews of other authorities.

New power of intervention for government

Running alongside the CQC assessment proposal are plans to introduce a new power for the health and social care secretary to intervene where it’s considered that a local authority is failing to meet its duties.

“Any intervention by the Secretary of State would be proportionate to the issues identified and taken as a final step in exceptional circumstances when help and support options have been exhausted,” the White Paper said.

It plans to “secure these provisions in primary legislation at a high-level”, prior to working with government partners and the sector on detailed system design and practice, to provide consistent oversight and reduce the variation in the quality of care.

The system would put adults’ services on a similar basis to children’s services, in which local authorities are subject to regular inspection by Ofsted and government intervention if they are deemed ‘inadequate’.

Proposals ‘do not address wider social care challenge’

In response to the proposals, Ian Hudspeth, chairman of the Local Government Association’s community wellbeing board, said: “We understand the desire for greater transparency in social care, but councils need to be an equal partner in the design of any national oversight.

“This must build on existing sector led improvement work, recognise local democratic accountability and give a voice to people who use and work in social care. It is helpful the white paper recognises the pressures facing social care and makes clear the government remains committed to reform, but action is needed and proposals must be brought forward as a matter of urgency.

“These proposals do not address the need to put social care on a sustainable, long-term footing, nor the wider changes needed to ensure care and support can best enable people to live the lives they want to lead.”

Changes to NHS bodies

The biggest part of the government’s proposals is to scrap clinical commissioning groups (CCGs) and set up integrated care systems (ICS) on a statutory basis to plan health services in their areas. ICSs, which currently exist on a voluntary basis, cover larger areas than CCGs, typically encompassing multiple local authorities, who would have representation on ICS boards.

Separate ICS Health and Care Partnerships, on which councils would also be represented, would plan health, social care and public health services in their areas,

The proposals would see NHS bodies and local authorities placed under a new duty to collaborate, replacing existing duties to co-operate.

The government is “exploring ways to enhance the role of CQC in reviewing system working”, the White Paper said.

Hopsital discharge fines to be scrapped

Meanwhile, measures are due to be brought forward to facilitate smoother discharge by putting in place a legal framework for a ‘discharge to assess’ model.

This would allow NHS continuing healthcare (CHC), NHS-funded nursing care (FNC) assessments and Care Act assessments to take place after an individual has been discharged from acute care, replacing the existing legal requirement for all assessments to take place prior to discharge.

As a result, the system of councils being fined for delayed discharges that they are responsible for – introduced in 2004 – would be scrapped.

Government to make direct payments to providers

Additionally, the White Paper sets out plans that would allow the government to make direct payments to adult social care providers rather than having to give grants to local authorities to then distribute to services.

This is based on the experience of the challenge of getting funds to providers as required during the pandemic.

The paper also proposes a new data collection system across health and social care, which would include the collection of information on people who self-fund their care and the hours and costs of care per person.

“We need to make changes to the data we collect and the frequency with which we collect it; not just for central government assurance and oversight, but so that local authorities, providers and consumers can access the data they need, while minimising the burden on data providers,” the White Paper said.

This social care data will be linked up to people’s health data to improve understanding of the lifetime costs of care, it added.

White Paper should be seen as ‘first step’

Association of Directors of Adult Social Services president James Bullion welcomed the White Paper, but said it should be seen as the “first step in an important journey over the coming months”.

“We note that the white paper reaffirms that proposals to reform social care will be published later this year, these must incorporate all outstanding issues, including a workforce plan to put social care staff on an equal footing with workers in the NHS, greatly improved support for family carers and a commitment to long-term funding to develop the kind of care and support that will enable us all to live the lives we want in the place we want to be.”

7 Responses to Government to revive CQC ratings of council adults’ services after more than decade-long gap

  1. Mark February 15, 2021 at 3:34 pm #

    This is fantastic news. I worked in Children’s Services for a long time and then found it completely bizarre when I moved to Adult Social Care that there was no external oversight or inspection. Whilst I see some very good practice, equally I see some really worrying practice. I hope there is an emphasis upon needs assessments and assessments of capacity and best interests decision making. This would give managers the impetus they need to properly scrutinise these documents and ensure that their own audits are in line with the law and professional regulation, and to take proper action to improve practice. At the moment because there is no external oversight, practitioners and managers know that the only time their practice will ever be scrutinised is if something goes wrong, so many cut corners and interpret the law to suit their own needs. I know, I’ve seen it over many years and it needs to stop. Regulation of adult social care services by the CQC is long overdue and it will only benefit service users and help to improve practice!

  2. Jan Parkin February 16, 2021 at 10:13 am #

    And miraculously those comparatively ‘rich’ Tory-led Boroughs will do magnificently, while cash-starved Councils in areas of high need will struggle to meet the test. And divert precious resources towards trying to look good. Been there – experienced that awful feeling of getting beaten twice. Once for not being able to do my job because the funding isn’t there – and again because the scores tell us we must do better. Another way to kick northern Councils. I am passionate about quality and holding services to account – but the playing field is not level, and the motive is not about quality or people. Fix the system first – then see how well we perform.

  3. Monoca February 16, 2021 at 11:08 am #

    Oh the horse has bolted, hurry close the gate.

    • Harvey Campbell February 17, 2021 at 1:23 pm #

      Tend to agree, doubt if the the inspection framework will be set against a financial back drop of 50% plus cut in local government fund in the past 10 years?

  4. Berni February 19, 2021 at 3:05 pm #

    What a mess , could we at least sort out the problems we have before creating new problems .

    In the brief few years I have been doing this great job I have seen NHS reorganisation a new social care Act , CCG s getting prominence and by the back door privatisation of health services .

    I have also seen a massive reduction in all staff and all services no matter the area and yes in the North we have taken a kicking since the cons ( intentional mis spell ) have been back in .

    Go anywhere in adult social care and ask the people on the ground how it is just make sure you have a drink and something to eat because the work force does not stop and works as hard as anyone .

    Why does the government not love the social care sector , I do what a great hard working bunch of people .

  5. Malcolm February 19, 2021 at 10:47 pm #

    The reintroduction of inspections for Adult Services should be welcomed by all staff – no hiding behind budgets / local ‘interpretations’ of the Care Act and less focus on Children’s services because they ‘have to’ pass Ofsted inspections. They also need to legislate that all DAS posts must be a qualified SW so they at least are professionally responsible for their actions.

    The removal of the CCGs is a good thing – they never worked properly, but unfortunately it will inevitably lead to a merry go round of senior health staff. A decade ago health staff took redundancy payments on a Friday and joined the new organisations on the Monday ………

  6. Chris Sterry February 21, 2021 at 11:01 am #

    Worrying times for many reasons, lack of sufficient finance, but that is nothing new, Government interventions and again nothing new.

    I agree with jan, fix the system first, for the system has to be flexible to meet all needs, while currently it is far from it. persons with needs have to fit the system, while it should be the system fitting the person. All persons are individuals with having many interwoven factors, so what is perhaps correct for one, may not be for another who appears to be displaying similar needs.

    Social care has never been sufficiently funded and 10 years of austerity cuts by Conservative Governments has caused untold damage and then we have the costs related to COVID. Here the Government promised to cover these costs, but to date the funding supplied is falling way short, causing cash strapped councils even more funding problems.

    Social care like health care is not cheap and it should not be run on a ‘shoestring’, for to not provide sufficient social care is storing more problems to be catered for under health, like it or not health and social care are instinkingly interwoven.

    So, get the funding correct and then work to get the system fixed.

    More powers are to be given to the CQC, but again they are kept short of funding and getting good and consistent good quality costs, so, for them to get anywhere near to monitoring quality then they also need to be sufficiently funded.

    Neither social care, health care or checking on quality should be used as a ‘political football’ in that funding is given, restricted, etc on the whims of Governments. Within that funding staff care has also to be a priority, for there is much clamour for sufficient wages for health staff, do you notice it is always referenced to nurses and doctors, when there are a multitude of others within health and none can work without the others, for it is as a team that health is provided. An unclean area, will be detrimental to health carer no matter how good the nurses and doctors are.

    This is the same in social care, where pay is abysmal, especially to those who deliver direct care, care work is a skilled employment for it is not just preparing meals, toileting, personal hygiene,etc, for while important, it has to be done in conjunction with emotional care, financial care, safeguarding, and many others, which are far from easy to place a monetary cost on for time is the main factor. Short calls 2 or 3 times per day are not the answer, for these do not allow sufficient time for the recognised care, toileting, dressing, meal preparation, etc, so no time for the other aspects.

    So funding is way short even for the recognised care, let alone a pay rate for care workers to recognise the skills they should have and this all adds to quality of care, less time and money reduces quality, no matter how good the care workers are.

    This Government has throughout COVID spent money here and there without looking to see if they have the funding to do so, but, in reality, no funding for social care. It is as though this and previous Governments do not see the ne4ed for social care and this needs to change, for if it does not the outlook for social care is not good.

    Many are looking to the new White Paper, Integration and innovation: working together to improve health and social care for all, https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-html-version, as a possible saviour, but that has to be seen. On face value, it appears to have some good points, but within are some that are not so good. The reduction from 135 CCGs to 42 ICSs could well be not a good point, that is not that the existing CCGs were good, for they did have their faults,as to how many, that depended on who you were asking.

    So, the White Paper needs to be looked at very carefully.

    Will Social Care survive, now that is the question?

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