Care Quality Commission (CQC) assessments of local authority adult social services are still due to start in a matter of weeks despite the process for doing so not having been agreed.
The Department of Health and Social Care (DHSC) confirmed that the adults’ assessments were still on course to commence at the start of April.
This means it has not bowed to calls from council leaders for a delay, to help them deal with current pressures on services, including severe shortages of care staff, long waiting times for assessments and care and high levels of delayed discharges from hospital.
Return of CQC assessments after 13-year gap
The government legislated last year, through the Health and Care Act 2022, to place a duty on the CQC to carry out and report on reviews of councils’ performance of their Care Act 2014 duties.
The legislation also provides for the DHSC to intervene and, if deemed necessary, direct improvements at authorities found to be failing, in a similar regime to that currently operating in children’s services.
The CQC and its predecessors assessed council adults’ services until 2010, with the then coalition government justifying its removal on the grounds that it would be replaced by a “more proportionate and constructive system” of sector-led improvement.
However, in its 2021 adult care white paper, the DHSC said “the full spirit of the Care Act [was] not currently being met”, and the ability to assess council performance was key to delivering its vision of improved independence, choice and control for older and disabled people and support for the workforce and unpaid carers.
“These assessments will provide a greater understanding of practice and provision at local level, making it easier to see what is working well, and make good practice, positive outcomes and outstanding quality easier to spot and share nationally,” it added.
Councils’ call for delay
However, bodies including the Association of Directors of Adult Social Services (ADASS), County Councils Network and the Local Government Association have raised concerns about the April 2023 start date, given the severe pressures on services.
In a report last year, ADASS said a delay would enable councils to “focus on winter and reduce expenditure on inspection preparation and processes”, releasing money to improving care and support and tackling unmet need.
The CQC tested a methodology for the assessment process in Hampshire and Manchester councils last year. The authorities were assessed in relation to four themes:
- Working with people, including assessing needs and supporting people to live healthier lives.
- Providing support, encompassing care provision, integration and continuity of care, and partnership working.
- Ensuring safety, incorporating safeguarding and safe systems, pathways and transitions.
- Leadership and workforce, including improvement, innovation, governance, management and sustainability.
How councils found testing CQC checks
Hear how Hampshire and Manchester councils found testing the CQC’s approach in the December 2022 edition of the regulator’s podcast.
Under each theme, it proposed a number of quality statements, setting out what councils should be seeking to achieve, and what people should expect of the support they receive. These were underpinned by best practice guidance and indicators setting out the evidence councils would need to provide to demonstrate their performance.
Assessment process not agreed
The CQC submitted a draft methodology to the DHSC in early November but, six weeks out from the scheduled start of assessments, this has not been agreed.
A DHSC spokesperson said: “These assessments will enable people to hold their local authority to account and, ultimately, give them access to the consistent, high-quality care and support they deserve.
“We are finalising the local authority assessment framework which we expect to roll out from April 2023 and will announce further details in due course, including information on the methodology.”
In a statement issued last month, a CQC spokesperson said it was expecting it was expecting the system to start in April and was “currently working with the Department of Health and Social Care to finalise what our approach to assessments will involve”.
One area the DHSC is yet to determine is whether councils will be rated on their performance, as is the case in Ofsted judgments of local authority children’s services.
ADASS said last year that directors’ preference was for authorities to receive a narrative judgment, rather than a rating.