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.
Hertfordshire (good, 78)
Hertfordshire was awarded a score of 3 for eight of the nine quality statements and 4 – the highest level – for the other, partnerships and communities. This was down to its “excellent partnership working” with the NHS, care providers, district council housing services and the voluntary sector, the CQC said.
This included strong links with the Hertfordshire Care Providers Association (HCPA), which all commissioned regulated services are required to join. This meant the council had a good understanding of the challenges facing providers and used this to inform commissioning decisions.
Providers also highlighted the council’s investment in the care workforce, including by funding them to pay above the above the real living wage (currently £12 an hour) and cover holiday pay, sick pay and travel time, thereby boosting recruitment and retention.
Despite this, home care providers faced challenges recruiting in rural areas leading to long waits for services in those localities, with an average wait of 14 days for domiciliary care across the county. The authority was intending to tackle this by recommissioning its home care contract.
‘Impressive’ prevention work
The CQC also praised Hertfordshire’s “impressive” focus on preventing or delaying people’s needs for care and support, as required by section 2 of the Care Act.
This included creating a multidisciplinary ‘gateway team’ last year, to provide an initial assessment and advice to people who approached adults’ services, including signposting them to organisations providing preventive services, and, where they had greater needs, referring them to the local authority’s frontline teams.
“This team clearly had extensive knowledge of what was available in the community and where to signpost people,” said the CQC.
The authority had waiting lists for assessment in all areas, with people waiting an average of 10 days for an initial care assessment with some facing much longer waits.
Mixed picture on waiting times
Despite a 10% rise in requests for support over the previous year, the size of waiting lists had reduced over that time, indicating the success of measures taken by Hertfordshire to deal with them. This included recruiting more people into frontline teams and having an “effective” triage system to assess risk and provide immediate support to people to keep them safe while they waited.
However, the average wait for occupational therapy assessments – half of which were housing related – was 27 days, with some people waiting several months.
The council had a “good offer” for carers, with 37.5% of those surveyed saying they were able to take a break of 1-24 hours at a time, well above the England average of 27.6%. However, a slightly higher proportions than average were not in employment or experiencing financial difficulties due to their caring responsibilities.
Council staff at all levels said they were supported to access learning and development, while the inclusion of the PSW, who was also director of practice and quality, in the leadership team ensured that the voice of social work was heard, and continuous improvement embedded, at a senior level.
Following the report, the council’s executive member for adult social care, health and wellbeing, Tony Kingsbury, said the CQC’s assessment “reflects the commitment of our dedicated and skilled staff who work hard to create a place where people can lead healthy, fulfilling and self-supporting lives”.
He added that the report had also identified how the authority “can continue to learn and improve”.
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.
West Berkshire (good, 64)
West Berkshire was rated 3 on five quality statements and 2 on the other four.
The CQC was positive about the calibre of social work practice at the authority. It found that frontline teams had “the training, knowledge and experience they needed to carry out assessments” and, there were systems in place to enable staff to share knowledge, helping to develop skills.
Safeguarding enquiries were “carried out sensitively without delay, keeping the wishes and best interests of the person central”, and practitioners had a good understanding of how to support people in line with their human rights, the Mental Capacity Act 2005 and the Equality Act 2010.
The regulator found that transitions from children’s services worked well, with adult social care staff starting to work with young people from age 16 and feedback that the process worked well and supported them to achieve their goals and maximise independence.
Mixed performance on prevention and for carers
Assessors also praised the authority’s provision of reablement for older people and its impact in enabling them to remain independent. The service was received by 5% of older people on hospital discharge, compared to an England average of 3%, and 89% were still at home 91 days after discharge to a reablement service, compared with a national average of 82%.
However, its broader performance on prevention was less good, the CQC found, with 64% of those who received a short-term care package no longer needing support, well below the England average of 77%. The council had identified that this was down to too many people being discharged to care homes and it had revised its care pathways to tackle this.
Though carers were positive about the support they received, the proportion who did so was just 20%, according to the national survey of adult carers, against an England average of 34%. The council was seeking to address this by working with partner groups to better identify carers.
Uptake of direct payments was low at 16%, compared to an England average of 27%, while there was also a backlog in direct payment reviews. Frontline staff told assessors that the process was “over-complicated to implement and difficult to use effectively to give people
choice”, making it easier for them to have their support commissioned by the council.
Insufficient care to meet demand
The CQC also found that there was “not always sufficient care and support available to meet demand”, with a lack of suitable provision for people with learning disabilities and autistic people, particularly where they also had multiple needs that required adapted environments.
There were also shortages for people who needed complex dementia care, demand for which was increasing as the population aged. The insufficiency of care and the high cost of care locally resulted in people being placed out of area, with those with more complex needs placed further away from the authority.
The report also said it was “not clear” how the council was meeting its public sector equality duty, under the Equality Act 2010, in relation to its Care Act functions. The duty requires public bodies to have due regard to the need to eliminate unlawful discrimination, promote good relations between groups and promote equality of opportunity.
The CQC found that, while individual staff had knowledge of their areas, this was not built upon strategically to develop an understanding the needs of West Berkshire’s diverse communities. The authority did not break complaints or out of area placement data by protected characteristics, while most of its equalities work focused on nationality and ethnicity, with less focus on the needs of people from LGBTQ+ groups.
In response to the report, the authority’s executive member for adult social care and public health, Patrick Clark, said the report “gives us reassurance that we are performing well in the areas providing vital services for vulnerable residents, which we spend a considerable portion of our budget on”.
He added that the authority was working to address the areas identified for improvement.
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My definition of good is clearly different….
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.
The statement above is an indication that assessments for carers are still service driven, rather than needs led.
A carers assessment is not just a gateway to services. It’s an intervention in itself. Without a carers assessment, how have the eligible needs of carers been identified that support the need for provision of ‘replacement care’?
The fundamental function of assessing need, which is a main duty, has not been understood or met, which undermines one of main aims of the care act by supporting carers.
Dear Anonymous
An accurate summary of the current picture for Carers.
I fully support all that you say; LA’s are absolutely failing in their duty towards Carers under the Care Act 2014 and unless there are penalties for LA’s, it will continue.
Most Carers are struggling, physically mentally and emotionally, and some are being hounded/criminilised by the DWP for their over payment mistakes.
Without unpaid Carers this country would be bankrupt
They deserve more…much more
So well said.
Wonder what they will find when they come up north!
Demand, divide & LA’s facing near bankruptcy.
DWP stance on carers is appalling!