CQC delivers initial verdict on council adults’ services under new assurance system

Regulator raises particular concerns about councils' support for carers and highlights gaps in specialist care, in overview of data and performance evidence from England's 153 authorities

Dial pointing at the word 'performance'
Photo: Coloures-pic/Adobe Stock

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.”

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6 Responses to CQC delivers initial verdict on council adults’ services under new assurance system

  1. Kryssi October 24, 2023 at 9:57 am #

    All that is quoted above looks good on paper but the reality is totally different because actions speak louder than words but all that is done is written actions never take form. We ate fed up of listening! I am a voluntary carer. Why because if you leave it to the so called professionals people will die or not receive the care they need because nobody listens to their needs as most of the support is in AI. Most people who are ill can not use computers or even in some cases the phone if they are at home. If they are placed in a home they take their lives in their own hands. How can we justify 2 carers in charge if 9 people it just does not work!!! As for the CQC it lives in doo doo land pretending to know what is need. They give us the same dribble every year and every year it gets worse. These people need to be regulated more often let alone they regulating others because in reality the CQC do not really have a clue. If they do then they are not acting on anything even if you complain on numerous occasions!!!!!

    • Andrew Z October 25, 2023 at 9:36 am #

      Well said Kryssi, spot on!

  2. Chris Sterry October 25, 2023 at 10:27 am #

    I know too well where Kryyi is coming from for I was a family carer for going on 39 years and so my daughter, my wife and myself were at the centre of the system, or as near the centre of the system that the system allows.

    Most systems are imperfect because they tend to only favour the institution that implements the system and takes no account of anyone who has to use the system, even staff within the institutions let alone who who are not employed by the institutions, but need to engage for a myriad of reasons.

    Any systems should have at its centre the persons it is there to support and that is not the organisation which implements, but those who have to use it.

    So systems and strategies should be done by co-production, not co-production as thought by the institutions but real co-production. Here is what Think local act personal (TLAP) state, (https://www.thinklocalactpersonal.org.uk/co-production-in-commissioning-tool/co-production/In-more-detail/what-is-co-production/),

    There is no point in creating systems or strategies where people who will be using or having to use the systems and strategies are not involved from the very outset and are allowed to be equally engaged. A new concept for many institutions for it requires to some extent a release of what they assume is their power. But by using co-production it could reintroduce some degrees of trust, which due to inappropriate systems has been sadly eroded, even if it was there to start with.

    Trust is so important, the lack of which is so evident in the Hamas/Israel situations.

    My own local authority, (LA) is using co-production to some degree and I am involved with other family carers in some areas of strategy and re-creating systems, but to a large extent the power is still with my LA for they will have the final word. In the co-production we are to some extent working with some senior managers, but not directly with Directors who will have the final say, with the authority of the Chief Executive.

    Some co-production working groups have already been concluded and to a large extent what the co-production working group agreed was implemented for how long who can be sure. For any system implemented needs some degree of appraisal, but here again the original co-production group should be reconvened or if not possible to be as similar as possible. The reasons behind this is because the work produced is owned by the co-production group and not the institution and if possible patented to some extent legally.

    Everyone is an expert to some extent and expertise should be welcomed and utilised but in many instances not, as to look at some systems they appear to have been created with no expert knowledge of how they could work practically only in theory. Theory is great but how it is put in practice is the real expertise for if it is inappropriate then the system will be useless, but useless systems are continued with due to the power, time and expense involved, but practicality should be a prime reason if not the most important.

    Perhaps I live in a cloud or a time still to come, but it is so important that it does.

  3. Helen October 27, 2023 at 9:12 am #

    I work in adult social care,Brighton and Hove.I am also a carer at home. I feel that the lip service for carers and the blame of the economic crisis is what the governments of the day pedal.
    Here at the council staff are working flat out under pressures to cut/ save funds, this year we had to cut 3 million from the budget. Next year we are expected to cut 8.2 million for the council.
    Why? This is due to central government funding being cut. The service is cut to the bone, the work force is under stresses and pressures to find other ways of provision. However the charities that the council use,no longer have capacity top support and there are waiting lists for the charities that we are expected to ref to. ( eg age concern, money advise many others ) long waiting times impacting on the general populace. There is difficulty retaining staff and employing new staff. The government pledge to train more Social workers. However the way the budget is there will be no social care.
    Central Government need to reconsider the amount given to Brighton and Hove to minimise the poverty and loss of services to this whole community. This therefore has the knock on effect of impacting any one that is a carer. Anyone that needs care. The wider community.
    This is my opinion and not the council stance.

  4. Anonymous October 28, 2023 at 6:29 am #

    If I gave you £6 to cook a family meal, you could make something tasty and nutritious, if I give you £3 to make the meal, you could all eat and wouldn’t starve. If I gave you £1 to do the same you would still be hungry. The impact wouldn’t be seen immediately, but over time, the outcomes would be very different.

    Chronic underfunding is destroying our society. Until the whole voting population see that, nothing will change.

  5. Berni October 31, 2023 at 2:24 pm #

    I agree with many of the points raised here and yes with a shrinking budget things deplete further.
    Many councils are doing the work of central government. The more you save each year the more money you lose in the next round.

    Could there be some if not a lot of waste of money generally in councils — yes there is just like the NHS .

    I will not name and shame but a council close where I work put in a cycle path that goes on for some miles, new tarmac , painted and signed.

    Its a great idea , get people out on bikes enjoying the fresh air and keeping fit but is it a priority .

    I agree with the view that co production should be something more prominent but its hit the buffers since you know who has been in power.

    I just wonder what it is going to take for change to happen .

    Its like I have a zombie government ( sorry it is Halloween ) which is breaking down and very short term . I have to agree with the views that nothing ever changes despite all of the reports and all of the findings and it has been this way since the Griffith report some two decades or more ago ( Community care and support ) .

    Nothing ever changes ——— why .