The Care Quality Commission (CQC) has rated most councils as good in pilot assessments for its new system of appraising the quality of local authority adults’ social care.
Four of the five authorities tested – Birmingham, Lincolnshire, North Lincolnshire and Suffolk – received a good rating, the second highest grade below outstanding, following assessments carried out over the summer and autumn.
Nottingham council was rated as requires improvement, the second lowest of the four grades, though the CQC said the ratings for the five authorities were indicative, due to the pilot status of the assessments.
First adults’ services ratings since 2010
The reports mark the regulator’s first published assessments of local authority adults’ services performance since 2010, when the previous ratings system was scrapped by the coalition government.
The ratings were underpinned by scores of 1 (indicating significant shortfalls in performance) to 4 (an exceptional standard) across nine quality statements designed to capture how well the councils were performing their Care Act 2014 responsibilities: 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.
Get up to speed with CQC assessments
Community Care Inform Adults users can get up to speed with how CQC assessments of adults’ services by listening to our podcast on the topic, with the regulator’s director of adult social care, Mary Cridge, and deputy director for delivery of local authority assessments, Amanda Stride.
Lincolnshire performed best in this regard, gaining 3s across the board, suggesting it performed to a good standard in all areas. It was followed by North Lincolnshire (eight 3s and one 2), Suffolk (seven 3s and two 2s), Birmingham (six 3s and three 2s) and Nottingham (three 3s and six 2s).
CQC’s judgments were based on, among other sources, feedback and surveys of people receiving care and support, carers and staff, the views or providers and relevant community groups, analysis of performance data and studies of a sample of cases.
Though assessors did not directly observe the quality of frontline practice, the commission reported on the calibre of social work across the five authorities.
Lincolnshire (indicative rating: good)
In the context of high and mounting waiting lists for assessments across the country, the CQC found these were low in Lincolnshire. No one was waiting to be seen by mental health or learning disability teams, with waiting lists of less than 100 for the other teams, who managed them in a risk-based way.
The regulator also praised the county council for a strengths-based approach, which had been embedded in practice through a training programme over the past year.
This was part of a “real focus on prevention, independence and maintaining and developing people’s own skills to prevent and delay the need for more formalised care and support”. Lincolnshire also had much higher rates of direct payments than the national average.
Improvement areas flagged up by the CQC included transitions to adulthood, for which some young people were allocated to a generic social worker rather than one with specialist skills and knowledge, and the lack of a team specifically to support autistic people.
Wendy Bowkett, executive councillor for adult care and public health, said the assessment outcome “vindicates all the hard work and commitment that our staff and partners put in on a daily basis to support those who need it to keep people as independent, fit and healthy as possible”.
“I’m particularly pleased that they highlight our workforce as being fully committed to understanding people’s needs, reflected in what people told them,” she added. “It is especially encouraging to see that people using services spoke highly of individual staff, with effective assessment and support planning and minimal waiting times for assessments and support.”
North Lincolnshire (indicative rating: good)
As with Lincolnshire, assessors praised North Lincolnshire for its relatively high rates of direct payments, strengths-based approach to practice and lack of waiting lists for assessments, though the CQC said some people were waiting for annual reviews.
People using care and support praised the quality of their relationships with social workers and said they felt involved in their assessments. Practitioners, in turn, felt able to be creative in care and support planning, supporting people from ethnic minority communities to access culturally appropriate services.
However, the CQC said the authority needed to do more to engage with groups defined as harder to reach. Though frontline teams strove to engage with communities, the regulator found “no strategic oversight to ensure that all voices were heard, and communities felt able to access services”
Richard Hannigan, deputy leader and cabinet member for adults and communities at North Lincolnshire, said: “It is pleasing to get the external sense check on the standards of care and support and while challenging, the team has welcomed the process and most importantly the opportunity this has brought to learn.
“The pilot has highlighted best practice which we now need to replicate elsewhere. We know where we can get better and are determined to continue our focus on the needs of our residents.”
Suffolk (indicative rating: good)
At Suffolk, the CQC found that staff were “overwhelmingly positive about working for the local authority” in relation to learning, development and career progression opportunities.
Practitioners also praised the authority’s decision to bring mental health services back in-house, from the local NHS trust, in 2022, which they reported had enabled them to provide people with more holistic support.
People receiving care and support were generally positive about their care and praised the quality of their relationships with frontline staff.
However, some reported delays in contacting the authority’s contact centre, with waits of over 40 minutes for calls triaged as lower risk. At the time of the CQC’s fieldwork visit, over 500 people were waiting for an occupational therapy assessment and 400 for a financial assessment, though the authority had effectively reduced waits for reviews by using a peripatetic team.
Beccy Hopfensperger, cabinet member for adult care, said she was “delighted” by Suffolk’s good rating, adding: “I am especially pleased to see areas like safeguarding rated as good, this is a real acknowledgement of the hard work Suffolk County Council and partners have put in place over the last few years to learn from every incident and work closely together as a system to ensure the safety of the most vulnerable in our community.”
Birmingham (indicative rating: good)
The regulator found that Birmingham’s leaders were driving a “shift in practice” towards a strengths-based approach, which was well embedded in community teams.
It found that assessments and reviews were “person-centred”, with practitioners building good relationships with people and, as appropriate, those who were important to them.
However, some social work teams, including mental health and transitions, were overstretched due to recruitment difficulties, resulting in waiting lists for assessments or reviews.
Also, as of September 2023, there were over 250 safeguarding referrals that met the threshold for an enquiry under section 42 of the Care Act that had been waiting between five and six months to be allocated.
While initial efforts to tackle this had led to high caseloads, the council now had a plan to eliminate the backlog by December 2023 by adding capacity to the safeguarding team.
Birmingham’s cabinet member for health and social care, Mariam Khan, said: “It is really encouraging to see we have been given a rating of ‘good’, confirming citizens have access to a good standard of adult social care and support.
“Of course, there is always more to do, and we are committed to continuous improvement and will use the feedback from the pilot to continue to build on the improvement activity already underway.”
Nottingham (indicative rating: requires improvement).
Due to past financial failings, Nottingham has been overseen by a government-appointed improvement and assurance board since 2021, and the CQC said its improvement plan included having a stronger focus on delivering its Care Act duties.
The regulator found people were positive, overall, in their feedback about frontline staff, who they said were responsive and with whom they had good relationships.
It also found practitioners were “clearly passionate and committed to providing the best care and support possible” and that support for newly qualified social workers was described as “excellent”.
However, while some teams said they were well supported, others reported having high caseloads and low morale.
The CQC also found a “common theme” of delayed care assessments, with staff reporting significant waits for people to access the contact centre and the regulator finding high waiting times for occupational therapy and Deprivation of Liberty Safeguards assessments.
Linda Woodings, Nottingham’s portfolio holder for adult social care and health, said: “We’re pleased that the CQC has recognised key areas where the council are working well to support local people and we will use the areas identified for development to inform our ongoing improvement work.”
Roll-out of CQC assessments due to begin
Based on the pilots, the CQC said it was planning to make changes to the assessment process, including:
- Simplifying the information return it asks councils to fill out.
- Reviewing its process of tracking cases to make this more efficient.
- Further developing the way it engages with the public through community and voluntary groups.
The regulator said it was now planning to roll out a national programme of assessments of local authorities from next month, subject to Department of Health and Social Care approval. The process of appraising all 153 councils likely to take two years.
The DHSC has previously said it has reintroduced performance assessments of adults’ services to boost transparency, local accountability and the quality of care, and to identify councils that need further support.
Such authorities will, in the first instance, be supported by fellow authorities in their region, as well as a DHSC-funded programme delivered by the Local Government Association and Association of Directors of Adult Social Services.
Where there are “serious and persistent failures”, the DHSC has said it will offer “enhanced support and monitoring”, a non-statutory form of intervention that may involve the department appointing, and funding, an improvement adviser to work with the authority.
In the most serious cases, where the council appears to lack the capacity to improve, the DHSC may intervene to direct the authority or take over specific functions, usually through an appointed commissioner.
However, ‘failing’ services will not be turned over to independent trusts, as in children’s services.