An update on CQC’s development of its approach to local authority and integrated care system assessments

Mary Cridge, Director of Adult Social Care and Mandy Williams, interim Director of Integration, Inequalities and Improvement at the Care Quality Commission (CQC) update on the work we have been doing to develop our approach to local authority and integrated care system assessments

As we approach the end of the year, we want to update you on how we have been developing and testing our approach to assessing local authorities and integrated care systems. These are new powers given to us under the Health and Care Act 2022. We have no doubt that these new responsibilities will give us the opportunity to drive improvement and share best practice across health and social care, more than ever before. We also want to offer meaningful independent assurance to the public of how systems are working together to deliver high-quality care.

In July 2022, we published our single assessment framework which will be used to assess local authorities and integrated care systems (ICSs) in a way that is consistent with how we will assess providers — but tailored carefully to their context. Over the past year, we have worked in partnership with people who use health and social care services, their families, voluntary sector organisations, providers, and other stakeholders to design our approach to how we will assess systems. We would like to thank all those who have shared their insights with us, which have helped to inform our methodology development and engagement. We’ve now published the findings of our stakeholder surveys which we ran to add insight and understanding of what people think of our assessment approach for local authorities and ICSs. Please do take a look if you are interested.

For local authority assessments, our role is to assess how well a local authority is delivering under part 1 of the Care Act. To test our methodology for this, we led two test and learn projects in Hampshire and Manchester over the summer. This involved a team including inspectors, data analysts and policy leads. We tested aspects of our full assessment approach through the lens of two themes:

• How local authorities work with people — looking at the quality statement ‘assessing needs.’
• Leadership — looking at the quality statement ‘learning, improvement and innovation.’

We found a blend of virtual and on-site assessment worked well, and we produced a short report scoring each local authority against quality statements. The reports were shared with the local authorities we worked with, and their feedback will support development of our approach to reporting on our assessments. In particular, it helped identify challenges in assessment of local authorities for us to address such as how best to include user voice, understanding what good looks like and making sure the follow up report is not too fragmented.

We also wanted to test the methodology for ICS assessments, so we carried out ICS test and learn activities in North East London and South Yorkshire too. The assessment team included a range of colleagues from our operational teams, data and insight, strategy, policy, and evaluation right through to subject matter experts. We covered all 16 quality statements identified for ICS assessments and focused in on:

• Leadership
• Integration, and
• Quality and safety

Similarly to the local authority test and learn activities, we drafted and shared reports with South Yorkshire and North East London ICSs. We found the activity extremely helpful and worthwhile. It was a great opportunity for us and the systems to learn what worked well and what we need to improve on. We learnt that it is essential for assessment teams to have the correct level of skills and knowledge at system level, for example, commissioning and public health. We also learnt how crucial it is to consider carefully how we engage with the local population and how we capture people’s experience because they are at the heart of why we need to get assessment right.

The test and learn activities were a learning curve for us, local authorities and ICSs. We were not striving for perfection, but the activity effectively highlighted the strengths and weaknesses and gave us some fantastic feedback which we have incorporated into our approach and methodology.

To focus in on how useful the test and learn activities have been and what we learnt, we have published a fantastic podcast conversation between CQC colleagues and the local authorities involved in the test and learn activity. I hope it helps to provide some useful information about the work and answer some of the questions that local authorities might have. We would strongly recommend a listen! We are hoping to publish a similar podcast episode on our ICS test and learn activity next year.

We hope this gives a flavour of what we have been up to at CQC, and alongside the ICS podcast, we hope to have further updates on the next stages of this work in the early 2023.

If you are working within a local authority or ICS and would like to get further updates from CQC on this area of work, please register your interest via this short survey. We will add you to the mailing list.