Assessors’ lack of social work experience among criticisms of CQC council checks in damning review

Care Quality Commission (CQC) assessors’ lack of social work experience was among criticisms of the regulator’s approach to assessing English local authorities shared with a damning review of the regulator.

In the final report of her review of the CQC, Dr Penny Dash listed a number of concerns about its local authority assessment system, introduced last year, which had been shared with her by councils that had been through the process and by sector leaders.

Dash’s interim report, published in July, which focused much more on the commission’s assessments of care providers than of councils, found the regulator could not effectively judge the quality of services, including because of a lack of inspections and of inspector expertise.

Regulator ‘not fit for purpose’

This prompted health and social care secretary Wes Streeting to declare the CQC “not fit for purpose”, triggering an overhaul of the regulator, including the appointment of a new chief executive – Julian Hartley – more government oversight and increased numbers of staff and inspections.

The regulator also commissioned a separate review of its single assessment framework (SAF) by its former chief inspector of hospitals, Mike Richards, the report of which was also published yesterday, alongside Dash’s final report.

The SAF, introduced last year to provide a single framework covering all the health and social care services the CQC regulates, was heavily criticised in Dash’s interim report, including for inadequately setting out what good or outstanding care looks like.

These criticisms were echoed in both Dash’s final report and Richards’, with the former chief inspector concluding that the SAF was “certainly not proving to be beneficial” in adult social care.

Reintroduction of local authority assessments

On the back of the Health and Care Act 2022, the CQC reintroduced assessments of local authorities in December last year, after a 13-year gap, with a plan to assess all 153 councils over two years on their performance of their Care Act 2014 functions.

The policy sparked significant concerns from councils about the additional burdens it would place on them and the validity of giving them single-word ratings – outstanding, good, requires improvement or inadequate – as required by the Department of Health and Social Care (DHSC).

So far, the CQC has fully assessed nine councils, six of whom have been rated good and three requires improvement. All of these authorities shared their experience of the process with Dash, as did sector bodies.

Overall, they said that both the assessment process and CQC’s reporting of it could be improved and compared it unfavourably to Ofsted’s inspection of local authority children’s services.

Perceived lack of assessor expertise

She said there was “a perception among some local authorities that the assessment teams lacked the expertise and insight into how local authorities work in adult social care”, including that “very few had social work experience”. The CQC has a dedicated team of about 14 people carrying out the local authority assessments, about 40% of whom are expert external reviewers, according to Richards’ review of the SAF.

Councils and sector leaders also questioned the small number of cases reviewed by the CQC, with assessors tracking, typically, six cases, compared with an average of 5,600 people receiving long-term care and support in each authority. Although Ofsted also primarily focuses on six cases in its inspections of council children’s services, it also looks at a sample of other cases.

While some respondents to Dash’s review praised the level of engagement they had received from CQC assessors, others said there was insufficient opportunity to discuss the regulator’s findings during the assessment, resulting in a missed opportunity for learning.

Dash reported that the CQC recognised that it needed to do more to build relationships with councils and was considering introducing relationship owners and annual engagement meetings, in addition to current feedback meetings following an assessment. Ofsted holds an annual engagement meeting with every council in relation to its children’s services.

Insufficient focus on commissioning 

Councils and sector representatives also criticised the lack of focus on authorities’ commissioning role in the assessment, despite ministers having intended for the CQC to do this.

Of the nine quality statements against which councils are judged, one relates directly to their commissioning functions: “We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.”

“It is not clear from current assessments how comprehensibly commissioning functions are assessed, which misses an opportunity to improve commissioning capabilities and, as a result, quality and efficiency of care,” Dash concluded.

Councils and sector representatives also said there were insufficient descriptors of what good or outstanding performance looked like in the CQC’s assessment framework, making it difficult for authorities to know how to improve.

Inspectors criticise scoring of councils

Richards’ review of the SAF made limited reference to local authority assessments, concluding that it was “still too early to assess how well these assessments [were] working or the value of the reports”.

However, he did say that assessment teams had criticised the process of scoring councils, from 1-4, on their performance against each of the quality ratings, as well giving them an overall rating.

Richards said the feedback from staff had been that scoring can “drive towards a rating that is not felt to be appropriate”.

Among seven recommendations made in her review, Dash called on the CQC to consider the feedback it had received about local authority assessments, including her findings, to improve the assessment process, its robustness and councils’ experience of it.

In response, the CQC said: “Local authority assessments will continue with ongoing improvements and continued engagement with the health and care sector. In line with changes to the assessment framework, CQC will make scoring of evidence more transparent, and will strengthen its focus on nationally agreed priorities.”

Council heads working with CQC to ‘refine assessments’

For the Local Government Association, community wellbeing board chair David Fothergill said: “Given the ongoing rollout of CQC local authority assessments, we are keen to ensure there is adequate time for CQC, DHSC and local government to learn and reflect on the process so far, to help make sure adult social care assurance is fair and proportionate.”

The Association of Directors of Adult Social Services said it was continuing to “work closely with the CQC to improve and refine the assessment of local authority social care departments”.