The Care Quality Commission (CQC) has set out lessons from the first tranche of assessments of local authority adults’ services since it resumed performance checks in December 2023.

It said that support for carers was in need of improvement, while authorities also needed to enhance their understanding of population equality and diversity issues and use of data, though reablement was an area of strength.

CQC deputy directors Amanda Stride and Lella Andrews made the comments in a presentation to a Local Government Association webinar on its assessment system for councils in England.

Need to improve support for carers

Stride and Andrews said support for unpaid carers was an area of improvement identified by the CQC’s assessments to date.

This included improving the identification of carers, the range and capacity of services for them, the timeliness of assessments and the personalisation of support, based on the age and needs of the person being cared for.

The conclusion reflects the results of a recent Carers UK survey, which found that over half of carers felt they required more recognition of their needs from councils, with some reporting long waits for assessments or support.

The CQC officials also pointed to understanding of population equality and diversity issues as an area for improvement, and said councils’ inconsistent use of data made it harder for them to effectively plan and monitor services.

Challenges with recruitment and transitions

Transitions for young people to adults’ services were often challenging, especially if they did not start early, while councils faced ongoing recruitment pressures, particularly in relation to occupational therapists.

However, reablement was an area of strength, with the CQC having seen good practice in its use to support people to regain independence, said Stride and Andrews.

They added that, while the CQC’s assessment methodology would not change, it was working with sector bodies to make improvements, including in how it gathers evidence of lived experience and collects provider views.

Councils ‘want to work with the CQC to improve process’

In response to the findings, the chair of the LGA’s community wellbeing board, David Fothergill, said: “Councils are keen to learn and improve services. Identifying common themes is essential not only for addressing challenges but also for sharing what works well.

“We want to work with the CQC to ensure the assurance process is productive and valuable, helping councils build on strengths as well as tackle areas for improvement.”

He pointed to the LGA’s work, with the Association of Directors of Adult Social Services (ADASS), through the Partners in Care and Health sector-led improvement initiative, which “plays a key role in supporting the sector to continually drive progress”.

Partners in Care and Health has published guidance for councils on learning from CQC assessments carried out to date, including reflections on the process from adults’ services directors in authorities that have been assessed and an analysis of what it takes to get a good rating, based on the first set of reports.

The Care Quality Commission has issued the first outstanding rating for a council since it resumed assessing local authority adult social services at the end of 2023.

The London Borough of Camden earned the accolade after the regulator found that it was offering “exceptional levels of service”, with no waiting lists across key services and a strong focus on tackling inequalities.

Camden is the 26th of the 153 councils in England to receive an assessment from CQC since its so-called local authority assurance process started in December 2023.

Of the others, 14 have been rated good, 11 requires improvement and none inadequate.

High scores across all areas assessed

Alongside their ratings, councils are given a score out of 100 indicating how well they performed against the nine quality statements that make up the assessment, for which the authorities are awarded a mark of 1-4.

Camden’s score was 89 – 11 more than the next best performer so far – thanks to it receiving the top score of 4 – which denotes an “exceptional” standard – in five of the quality statements. These were equity in experience and outcomes; partnerships and communities; safe pathways, systems and transitions; governance, management and sustainability, and leadership, improvement and innovation.

It was scored a 3 for the other four statements: assessing needs; supporting people to lead healthier lives; care provision, integration and continuity, and safeguarding.

Other councils encouraged to learn from borough

James Bullion, chief inspector of adult care and integrated care, CQC

The CQC’s chief inspector for adult social care and integrated care, James Bullion, said that Camden provided “high-quality and person-centred support”, underpinned by “strong partnership working, a commitment to equity and a focus on prevention”.

“Overall, Camden should be extremely proud of this assessment and the outstanding care they’re providing to people,” he added.

Other local authorities should look at this report to see if there’s anything they can learn.”

No waiting lists in key areas

In recent years, councils have struggled to manage demand without waiting lists for assessments and support, prompting the previous government to make cutting waiting times a priority.

However, the CQC found Camden had no waiting lists for care assessments, hospital discharge, care home placements, home care services, reablement, Deprivation of Liberty Safeguards assessments and safeguarding cases.

This was on the back of “significant action to reduce waiting times”, aided by the borough investing in 12 additional social worker and occupational therapy posts as part of a recent restructure.

Though there were high numbers of reviews overdue, this had reduced since October 2023, with partners praising the timeliness of reviews.

‘A prevention approach’ and meeting non-eligible needs

“A prevention approach was evident at all levels of the local authority,” the CQC found.

Camden uses the ‘three conversations’ model, under which practitioners seek to connect people with community sources of support and only determine if they are eligible for care and support if these do not resolve the challenges and risks that they face.

The CQC found that family group conferencing was also used effectively to support people without eligible needs to make decisions and link them with community groups.

There were also “many examples” of the council commissioning charities and social enterprises to provide services such as befriending, transport and shopping, as well as mental health and housing.

A higher proportion of older people discharged from hospital (4.7%) received reablement services than the national average (2.9%), with a higher proportion (87.2%) still at home three months after a discharge than average (83.7%), while feedback on reablement services was positive.

Equity ‘at the heart of services’

The regulator said it found that Camden had placed equity “at the heart of its adults’ services”, with the authority using data analysis to “identify and reduce inequalities in people’s care and support experiences and outcomes”.

This included plans to improve health and social care outcomes for the borough’s Bengali and Somali communities through the Better Care Fund in 2024-25.

The authority had also prioritised accessibility and inclusion arrangements for autistic adults and people with learning disabilities, sensory loss, multiple disadvantages, autistic adults or interpretation requirements.

‘Proactive’ monitoring of service quality

The London borough proactively monitored the quality of commissioned services.

This involved regular quality assurance visits, involving resident and carer feedback and analysis of CQC provider reports, and action plans to support those rated requires improvement by the regulator.

The council also took steps to ensure care staff in provider services were paid the London Living Wage plus travel and had appropriate working conditions.

Though adult social care vacancy levels across the borough in 2023-24, at 16.8%, were double the national average 8.1%, turnover rates were lower (10% vs 25%).

The CQC said Camden had “effective systems processes and practices to make sure people were protected from abuse and neglect”. This included having no waiting lists and an effective multi-agency safeguarding hub, through which all referrals were routed.

Rating is ‘testament to staff dedication, compassion and expertise’

Camden’s cabinet member for health, wellbeing and adult social care, Anna Wright, said the rating was a “testament to the dedication, compassion, and expertise of our adult social care staff”.

“The report highlights Camden’s positive and inclusive culture and our willingness to innovate and to test and learn,” she added. “It’s great to see the report also highlights the strong partnerships that we have built – with providers, health services, and our wider community – to deliver the best possible outcomes for our residents.”

She added: “We know that there are more improvements we must make, and I want us to build on this success and keep developing our services to ensure that people in Camden can rely on the best possible care and support.”

Celebrate those who’ve inspired you

Photo by Daniel Laflor/peopleimages.com/ AdobeStock

Do you have a colleague, mentor, or social work figure you can’t help but gush about?

Our My Brilliant Colleague series invites you to celebrate anyone within social work who has inspired you – whether current or former colleagues, managers, students, lecturers, mentors or prominent past or present sector figures whom you have admired from afar.

Nominate your colleague or social work inspiration by filling in our nominations form with a few paragraphs (100-250 words) explaining how and why the person has inspired you.

*Please note that, despite the need to provide your name and role, you or the nominee can be anonymous in the published entry*

If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

The Care Quality Commission has awarded good ratings to the first three councils it assessed under its new adults’ services performance regime.

Hertfordshire, Hounslow and West Berkshire all gained the second top rating – behind outstanding – in assessments under the CQC’s local authority assurance system, published last week.

The CQC also awarded each authority a score out of 100 indicating how well they performed against nine quality statements, for which the authorities were awarded a mark of 1-4.

Hertfordshire’s 78 score indicates that it was close to getting an outstanding rating, for which a score of 80 is required. Hounslow scored 70 and West Berkshire 64, just above the boundary between requires improvement and good (62).

The overall ratings are in line with those for five pilot assessments carried out last year, for which four authorities were graded good and one requires improvement.

They were based on feedback from people who receive care and support, including self-funders, carers, voluntary and community groups and staff, including the principal social worker (PSW), director of adult social services and social workers; analysis of performance data on, and surveys of staff, carers and people accessing care and support, and studies of a sample of cases.

Hounslow (good, 70)

Hounslow was awarded a 3 for all but two of the nine quality statements, receiving a 2 in the others.

Assessors praised the council’s use of short-term care and reablement to promote people’s independence. Data showed that 86% of people who received a short-term service in the borough did not require ongoing support, while 84% of older people were still at home 91 days after discharge from hospital to a reablement service, exceeding the England average in both cases.

Tackling inequalities

The CQC also praised the authority’s work in tackling inequalities between groups in access to social care, saying it had “invested significant time and resources” in listening to different communities. This included talking to people from a well-established Traveller site using a representative group and existing connections within the council to identify barriers they faced in accessing adult social care and design a plan to tackle these.

The report was also positive about aspects of commissioning practice, particularly how the authority had minimised the use of long-stay or secure settings for people with mental health and substance misuse needs who would not typically accept help. This involved designing a service that felt like a hotel but was secure and through which people could access supportive in-reach services.

And the regulator hailed social workers’ strengths-based approach to to practice, with assessments and care planning reflecting what people wanted to achieve and how they wished to live their lives.

People with care and support needs could easily access services and waiting times were generally low for initial assessments and care planning, with staff triaging cases based on risk and putting in place interim care arrangements before completing assessments when people required urgent support.

Criticisms of carer services

However, assessors were critical of Hounslow’s service to carers. Relatively few received an assessment last year, though despite this waiting times averaged 24 days. Staff attributed this to “a relatively weak offer” for carers, with most such provision being for the person they were caring for, rather than the carer themselves.

Carers also reported poorer than average outcomes, based on responses to the national survey of adult carers in the borough.

Only 27% of carers felt they had encouragement and support and 44% of carers were not in paid employment because of caring responsibilities, significantly below the England average of 28%.

Performance was mixed in relation to safeguarding. Most concerns were triaged in a timely manner and there were clear standards and quality assurance arrangements for enquiries under section 42 of the Care Act. However, the specialist safeguarding team had reduced in size, adding pressure to workloads and putting Hounslow’s ability to deliver on its section 42 obligations at risk.

The council’s cabinet member for adult social care, public health and transformation, Samia Chaudhary, said the CQC’s assessment underscored “the unwavering dedication and tireless commitment demonstrated by our staff and partners on a daily basis as they strive to provide crucial support to some of our most vulnerable”.

She said the authority recognised the “imperative to continuously enhance [its] services” and would continue to do so through its improvement agenda.

Councils need more funding to manage the impact of Care Quality Commission (CQC) performance checks of adults’ services, sector leaders have warned.

The Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) issued the call with the rollout of assessments of England’s 153 authorities due to start imminently.

This follows pilots of the system in five areas, which resulted in the CQC giving four authorities (Birmingham, Lincolnshire, North Lincolnshire and Suffolk) an indicative rating of good and one (Nottingham) a grade of requires improvement.

But despite the positive performance, the process added significantly to pilot authorities’ workloads at a time of severe pressures on adult social care, said ADASS joint chief executive Cathie Williams.

Process taking ‘huge amount of time and energy’

“The pilots have shown the assurance process takes up a huge amount of time and energy within local authorities, at a time when social care teams are already under pressure with growing numbers of people needing care and support, budgets under severe strain and high levels of vacancies,” she said.

The process involves three phases: evidence gathering, an on-site visit and follow-up.

During the first phase, the CQC gave pilot councils three weeks to submit documents under 48 categories, some of which required multiple submissions, found LGA research with the authorities.

Councils also had to provide the regulator with 50 cases for it to track retrospectively, and submit reflective logs for 10 of them, the LGA said.

‘Immense workload’

Based on its research with the pilot councils, the association advised other authorities that the workload for assurance was “immense”, and they needed a full-time, dedicated team to co-ordinate the work.

The Department for Health and Social Care handed each council a £27,000 flat-rate payment to prepare for their first assessment.

However, the LGA and ADASS said authorities needed more to deal with the additional burdens the process was imposing on them.

‘More funding needed’

“To ensure assurance doesn’t take away from support going to people who need social care, the government must provide local authorities with additional funding and resource to carry this out,” Williams added.

“The added workload these assessments are causing for councils must be addressed and councils should be given appropriate additional funding and support in order to participate in them effectively,” said the chair of the LGA’s community wellbeing board, David Fothergill.

Speaking yesterday at the National Children and Adult Services Conference (NCASC), CQC chief inspector of adult social care and integrated care James Bullion said the regulator had been made aware of the concerns.

James Bullion, chief inspector of adult social care and integrated care, CQC

“It’s not our role in CQC to solve that problem but we will be helpful in seeing what we are seeing,” he said. “Some of the messages we’ve heard is that pilots have had to invest in teams. I know there’s been some compensation but I understand it’s not been enough.”

Councils ‘must be forewarned about CQC checks’

Bullion told the conference that the CQC was expecting to start assessments this month, pending official sign-off from care minister Helen Whately.

In the light of that, the LGA said councils in the first tranche to be assessed needed to be informed of this fact as soon as possible “given the significant amount of preparatory work required in advance of assessment team on-site visit”.

Speaking at NCASC on the same day as Bullion, Whately said she recognised the concerns but did not pledge any more funding.

Minister for care Helen Whately (Credit: Department of Health and Social Care)

“I know some local authorities have been concerned about this and I know about the wider financial pressure you are facing. But this assurance is really important and I genuinely believe it is a good thing for social care teams in local councils.

Assurance ‘will boost transparency’

“Right now, if you are doing a great job in social care, do people really know that? I actually don’t think so. If you ask around, people will tell you all about the problems in social care, but they won’t tell you about the councils who are doing a great job investing in social care, helping their care market, supporting people to live at home.

“And on the other hand, if there is unmet or under-met need or carers are not being supported and the care market isn’t being supported, that needs to be known about. Too much of what we know about social care is anecdote.”

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.

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.”

Councils in England will share £4m to help them prepare for assessments of their adult social services by the Care Quality Commission (CQC).

The Department of Health and Social Care is giving each of the 153 authorities a £26,730 one-off payment to help familiarise themselves with the process and effectively engage with their first assessment.

The regulator is currently testing its approach to assessing adults’ services with five authorities: Birmingham, Lincolnshire, North Lincolnshire, Nottingham and Suffolk.

This has involved requesting information on how they are carrying out their adult social care functions and then carrying out on-site visits. The CQC has also tested how it gathers feedback from providers, people receiving services and other stakeholders, and how it involves experts by experience in its assessments.

Each of the pilot councils will receive a report of its assessment, an indicative score, of 1-4, for each of nine quality statements and an indicative overall rating (‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’), all of which will be published.

It will start its formal assessments of local authorities later this year and is currently working out which councils it will evaluate first.

The CQC expects to take two years to assess all of the 153 councils, each of which will receive an overall, single-word rating, as well as scores against the quality statements.

‘Failing’ local authority adults’ services will not be turned over to independent trusts, the government has confirmed.

Ministers will have the power to direct authorities to take actions to improve services or to take over specific council functions, but will not remove services from authorities and transfer them to other bodies, as they have the power to do in children’s services.

The plans were set out in an intervention framework published this month by the Department of Health and Social Care, part of the DHSC’s new system of ‘assurance’ of local authority adults’ services.

It accompanies the reintroduction this year of Care Quality Commission (CQC) assessments of council adults’ services, which will involve each of the 153 authorities receiving a single-word rating – outstanding, good, requires improvement or outstanding – over the next two years.

The DHSC’s new powers – brought in through an amendment to the Care Act 2014 last year – are designed to respond to situations where an authority is failing to discharge its duties under the Care Act 2014 to an acceptable standard.

Sector-led improvement

Under the DHSC policy, statutory interventon is the third and final stage of actions taken to support councils to improve where there is evidence – principally from CQC assessments, but also from published service data – of performance issues.

The department said it would “support authorities to lead their own improvement wherever possible” including through accessing sector-led support, whether through regional networks of authorities or the national DHSC-funded partners in care and health programme (PCH).

Delivered by the Association of Directors of Adult Social Services (ADASS) and Local Government Association (LGA), PCH provides advice and support on issues including improving social work practice, safeguarding, assessments, commissioning, providing information and advice and financial management.

Enhanced support and monitoring

Where there are “serious and persistent failures”, the DHSC said it would 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. This is similar to the improvement notice process used by the Department for Education (DfE) with struggling children’s services.

“The improvement adviser will provide support, guidance and challenge to the authority to develop and deliver a robust improvement plan,” the DHSC framework said.

Improvement plans should generally be shared with the DHSC and CQC within three months and contain prioritised actions and outcomes, with named individuals and realistic timeframes against each, arrangements for monitoring and scrutinising progress and costings.

The DHSC will publish details of the support and monitoring these authorities are receiving and councils will also be expected to publish their improvement plans and report to the department on progress.

Authorities that demonstate sufficient improvement, as judged by improvement advisers, CQC and the DHSC, will be removed from support and monitoring.

However, where this does not happen and the DHSC has “limited confidence in the authority’s ability to improve”, it may escalate to statutory intervention.

Statutory intervention plans

The department said this was “a very significant step” and would “generally be used only in the most serious cases and where an authority does not have capacity to lead its own improvement”.

Before taking this step, the DHSC will send – and publish – a letter to the council, setting out its proposals and reasoning for statutory intervention and inviting them to make representations.

As in children’s services, interventions will consist of statutory directions to the council and often involve the appointment of commissioners, either to direct improvements or take over some or all of the authority’s adult social care functions.

Councils will be expected to provide the commissioner with all of the resources and support required to perform their role and the commissioner will, in turn, report to the DHSC on progress.

This, along with other sources of evidence, such as the CQC, will inform the DHSC’s decision on whether to continue, revise or revoke directions.

No removal of services to independent trusts

However, the DHSC stressed that councils would not have their services transferred to another organisation.

“Unlike interventions in children’s social services, there is no power to set up independent trusts,” it said.

In response to the proposed framework, ADASS joint chief executive Sheila Norris said: “The framework clearly sets out what will happen if improvements are needed, and it’s good that, in the most cases, councils will get the support they need to lead improvements in care themselves.”

However, she said the association remained concerned about the CQC issuing councils with single-word judgments, adding that this would be “unhelpful and [would] not do justice to the broad range of responsibilities and services that make up adult social care.”

The Care Quality Commission’s (CQC) new system for assessing council adults’ services’ performance of their Care Act 2014 duties will be piloted by three councils over the coming months.

The regulator’s work in Birmingham, Lincolnshire and Nottingham councils, which starts this month, will inform its rollout of its local authority assurance system this autumn.

Inspectors will assess the authorities using its draft local authority assessment framework  and will also study a sample of people’s cases. This will result in a report including scores against nine quality statements and an overall rating ranging from ‘inadequate’ to ‘outstanding’.

The CQC stressed the pilots’ ratings would just be indicative, with formal scoring starting from the rollout of the system later this year.

Alongside the pilots, the regulator will carry out desk-top reviews of performance information for all 153 councils in relation to two areas: assessing needs and care provision, integration and continuity.

The pilots come amid longstanding concerns from council leaders that the system risks setting councils up to fail because of what they see as inadequate levels of funding. These have intensified since the Department of Health and Social Care told the CQC to produce single-word ratings of authorities.

Councils’ concerns about performance checks

The concerns were raised with Michelle Dyson, the DHSC’s director general, adult social care, at a meeting last week of the Local Government Association’s community wellbeing board, which comprises 23 councillors from around the country and focuses on adult social care and health-related issues.

“Money flowing into the system being less than expected alongside a new assurance system does risk CQC finding local authorities are not meeting their statutory duties,” said the LGA’s director of policy (people), Sally Burlington.

“Having a framework saying you’re not doing well without the resource to improve it is challenging to say the least, said one member of the community wellbeing board, while another added that single-word ratings “could make things a lot worse than they already are”.

In response, Dyson said: “I know there are a lot of local authorities who are really worried about [the assurance system]. I was in Solihull the other day and, while they were worried, they saw it as an opportunity.”

Pilot councils welcome CQC checks

All three pilot areas said they welcomed the chance to have their performance assessed by the CQC.

“We see the CQC assurance process as something that will add value to our existing ambitions of continuous improvement in generating even better outcomes for the people who need our advice and support,” said Lincolnshire’s executive director for adult care and community wellbeing, Glen Garrod. “As well as reviewing our own work in this area, people’s experience of care and feedback from our partners will also help CQC to inform their independent assessment of local authorities.”

Nottingham’s director of adult health and social care, Sara Storey, said she hoped the process would “identify areas for further development and provide important feedback on things we can start to do differently to support our residents”.

And Birmingham’s cabinet member for health and social care, Mariam Khan, added: “There have been really positive changes in adult social care in the city over recent years but we know there is still more to do and we are open to learning from others as we all work together to ensure people get the support they need and deserve.”

The government has told the Care Quality Commission to rate local authorities on their performance in adult social care under its new assessment system, launching later this year.

The regulator will give each council an overall score – ‘inadequate’, ‘requires improvement’, ‘good’ or ‘outstanding’ – underpinned by scores of 1-4 against each of nine quality statements authorities will be judged on.

This will also generate an overall score that will indicate where the authority stands within its performance band, for example, whether it is ‘good’ bordering on ‘outstanding’, or ‘requires improvement’ tending towards’ inadequate’.

Ratings approach similar to children’s services

The ratings approach is similar to that taken by the CQC in relation to adult social care providers, and Ofsted in relation to council children’s services. However, many directors of adult social services favoured the regulator providing them with a “narrative” judgment, without an overall rating.

The decision to rate was taken by the Department of Health and Social Care (DHSC) which, under the relevant legislation (section 46A of the Health and Social Care Act 2008), must approve the CQC’s approach to assessing councils.

The regulator set out its approach to assessments in interim guidance published this week.

As Community Care reported last month, the CQC’s system for assuring the performance of local authorities will be rolled out from next month, but it said this week it would only start formally assessing councils from September.

How assessment of councils will be rolled out

From April until then, it will review data and published performance evidence across England’s 152 councils, with a particular focus on two of the nine quality statements: assessing needs and care provision, integration and continuity. It will also look at issues relating to the workforce, personalisation, access to services, market shaping and commissioning.

The regulator will publish information from this nationally, not at a local authority level, though will also do up to five pilot assessments of authorities during this first phase.

From September to December, the CQC plans to fully assess 20 councils, and will continue to so in 2024, working with councils and the DHSC on how to publish its findings.

ADASS welcome for staged introduction

The Association of Directors of Adult Social Services (ADASS) welcomed the approach set out by the CQC.

Joint chief executive Sheila Norris said: “We called for a delay to introducing the assessments this year so that adult social care services could focus their resources on supporting people during the winter crisis rather than preparing for assessments in these first few critical months of the year.

“The staged approach with five pilots this summer and a first group of 20 assessments in the autumn should help with this and enable the CQC to test and learn from their approach.”

However, while she welcomed the regulator’s commitment to work with authorities on the best way to publish findings, she raised concerns about the prospect of single-word ratings for each council.

Warnings over single-word ratings

“Directors of adult social services indicated in our reform report last summer that they think narrative reports would provide the most useful and balanced picture of the quality of services,” she added.

“Though the government wants individual ratings for each council, it’s important that any single word rating is presented very clearly alongside narrative and potentially sub-ratings across the seven theme areas that the CQC will be assessing, like care provision, access and personalisation.

“A single-word rating alone wouldn’t show the public how good different parts of the service are, and experience from Ofsted’s inspections of children’s social care shows the detrimental impact a negative single judgement can have on retaining vital staff.”

For the Local Government Association, community wellbeing board chair David Fothergill also raised concerns about the prospect of single-word ratings. He said the LGA did not think they could “adequately reflect how a council is performing across the wide spectrum of services that comprise adult social care or adequately reflect the local context”.

‘Extremely challenging context’

He also said the assessment process needed to take into account the “extremely challenging context councils are operating in”.

“The introduction of assurance of adult social care comes at a time when both councils and social care providers face significant financial and capacity challenges with rising costs and demand and significant levels of unmet and undermet need,” he said.

“Councils will want to work with CQC and government to make the most of the opportunities that assurance will bring including improving the experience of care and support for people who draw on it and further evidencing the scale of the challenges facing the sector. In order to do so it will be crucial that councils have the time and space necessary to learn from the initial pilot assessments.”

“We’re also keen to work with the Department of Health and Social Care on what support will be available for councils following assessments, as that will be vital in maximising the impact of this new assessment programme.”

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.

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.