The Care Quality Commission has given its initial verdict on council adult social care services under its new local authority assurance system.
The regulator included findings from an analysis of data and other published performance information from all 153 councils in its annual State of health and social care report, published last week.
The assessment covered two of nine quality statements against which the CQC will be assessing authorities: care provision, integration and continuity, and assessing needs.
It raised concerns about inadequate support for carers and a lack of published strategies to develop the social care workforce, despite councils recognising the significant challenges they faced in this area.
The CQC also flagged up councils’ reports of there being shortages of care in their areas for people with more complex needs.
About the CQC’s local authority assurance system
- All 153 councils will be assessed once during a two-year period.
- The system is currently being piloted in five councils: Nottinghamshire, Lincolnshire, Birmingham, North Lincolnshire and Suffolk.
- Councils will each receive an overall rating on the same four-point scale Ofsted uses for children’s services and the CQC uses for care providers: ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’.
- Councils will also receive a score of 1-4 for each of nine quality statements on: assessing needs; supporting people to live healthier lives; equity in experiences and outcomes; care provision, integration and continuity; partnerships and communities; safe systems, pathways and transitions; safeguarding, and governance, management and sustainability. These scores will inform the single-word rating.
- The CQC’s assessments will involve a combination of desk-based checks and visits to the council concerned.
- Sources of evidence will include: feedback from people who receive care and support, including self-funders, carers, voluntary and community groups and staff, including the principal social worker, director of adult social services and social workers; analysis of performance data; surveys of staff, carers and people accessing care and support, and studies of a sample of cases.
- There will be no observation of practice by social workers or other professionals, such as occupational therapists.
- As well as assessing individual authorities, the CQC will also draw on data and performance information to track and report on national trends, as it did in the State of care report.
Growing pressures on carers but lack of support in some councils
The regulator’s analysis of national information identified that the number of carers was increasing, they were caring for longer – in terms of hours per week and the duration of time in the role – and they were looking after people with increasingly complex needs.
However, it found clear variations across authorities in relation to the number of carers getting timely support and levels of satisfaction with support.
Most councils had not published a recent carers strategy and authorities were often basing their plans on data from the 2011 census, rather than the 2021 one.
The CQC’s findings on carers chime with recent studies into carers’ experience.
Carers were more stressed, less able to take breaks and less supported by paid services, found a 2021-22 survey of over 40,000 by NHS Digital (now part of NHS England).
Separate University of Manchester research found that reductions in support to carers during the pandemic indicated “a high risk of instances where statutory duties under the Care Act towards carers were not met – including for assessment, provision, communication, and reviews”.
In the rest of the State of care report, the CQC referenced how growing inequalities in access to were placing added pressures on carers.
‘Too often, carers starved of support’
The chief executive officer of charity Carers Trust, Kirsty McHugh, said: “As [the CQC] report recognises, local authorities have a clear legal duty to identify, assess and support unpaid carers. Too often, however, carers are being starved of vital support and access to care because of vast differences in carer strategies across the country.
“It is absolutely vital that the needs of this country’s unpaid carers are properly addressed and those responsible for supporting them are held to account.”
For the Association of Directors of Adult Social Services, president Beverley Tarka said: “Families up and down the country are facing constant struggles to get the support they need to care for loved ones.
“The government has committed to offer more support for carers through its reform funding and there are new rights for unpaid leave in the new Carer’s Leave Act, but that won’t be enough. We need to do more to end this unfairness by striking a new deal for unpaid carers.”
Lack of workforce strategies
Against the backdrop of longstanding concerns about social care staffing shortages, the CQC found very few councils had published workforce strategies, with even fewer having plans that covered the entire health and social care system.
While the regulator said effective workforce planning required collaboration, a survey of providers found that just 18% said their local authority consulted or engaged with them completely, with a further 44% saying their council did so to an extent.
Positive practice included councils working with providers to set up academies to develop staff and skilling up care staff to work with people with more complex medical needs.
As well as giving an overview of performance in certain areas, the CQC also shared councils’ reports on the challenges they faced.
Gaps in care for people with more complex needs
Authorities reported gaps in care for people needing specialist dementia care, autistic people, those with learning disabilities and people with mental health needs.
There were shortages of nursing home beds for those with complex needs, and increased demand for home care, amid workforce shortages.
Councils were responding to these pressures by planning investment in early intervention, prevention and reablement, as well as extra care and supported housing provision.
However, overall, the CQC said authorities’ plans were short-term.
The findings came with the regulator completing pilot assessments of five local authorities (see box above), whose findings it said it would publish shortly.
In relation to the wider rollout of local authority assessments, a CQC spokesperson added: “We will be providing more information on our approach to formal assessments including when we expect to start assessments in the coming weeks.”