Emerging themes from local authority assessments
James Bullion, Chief Inspector of Adult Social Care and Integrated Care, reflects on the progress of CQC’s local authority assessments as the latest reports publish.
We are continuing to increase the number of our local authority assessments and have recently published several more reports to share our findings. We are currently on track to assess how all 153 local authorities deliver adult social care services in our 2-year requirement. Reflecting on our assessments to date, it’s interesting to see that similar themes are emerging in adult social care provision across different councils in different parts of the country.
Our ambition has always been for our assessments to help shine a light on social care. We do this by identifying local good practice and areas for improvement and sharing this nationally.
Emerging themes
From our assessments so far, we’re seeing the following emerging themes:
- Unpaid carers need better support. This could include improving how to identify unpaid carers in a local area, better services and facilities to support them, and more timely assessments.
- A greater understanding of equality and diversity issues in a local population is needed. We have seen this working well when a local authority has good relationships with the community, voluntary and faith sectors.
- There’s an increasing focus from local authorities to prevent, reduce and delay the need for people in their local populations to use care services.
- Recruitment pressures are having a continued impact, particularly for occupational therapists.
Implementing our assessment approach
Assessing how local authorities are meeting their Care Act duties is a new responsibility for CQC under the Health and Care Act 2022. Our approach has been co-designed with the Local Government Association (LGA), Association of Directors of Adult Social Services (ADASS), provider trade associations, voluntary sector organisations, and people using services. We’ve taken a phased approach to introducing assessments, starting in 2023 with pilot assessments of 5 local authorities that volunteered to help us test our approach — we are grateful for their support. The wealth of learning from the pilots has been integral to shaping our approach, which we are using to establish a baseline of quality across all 153 local authorities with adult social care responsibilities.
Following this baselining phase, we will begin our longer-term approach to regular ongoing assessments and will be looking to local authorities, stakeholders, and people with experience of using adult social care services to help shape this.
Bringing our assessments to life
We’ve heard feedback from local authorities that our assessments are useful in helping them to make immediate improvements, by identifying their strengths and where there may be gaps. Our assessments are not about the individual practice of staff, and our judgements and ratings do not detract from their hard work and dedication.
During our on-site visits it’s been clear that frontline social care teams have a real sense of pride and a strong focus on doing the best for people accessing social care services. We’ve found that staff like telling us about their work and the impact it has on people. This really brings our assessments to life by putting people at the forefront and is why hearing from people who use services is integral to what we do.
Continuous improvement
We’re acutely aware that our assessments are taking place against a backdrop of increasing demand along with workforce and financial pressures in local government. We’re committed to making our processes as efficient and meaningful as possible for local authorities and our own teams, and we will continue to listen and learn in the spirit of continuous improvement.
To do this, we’re working with the LGA, ADASS, provider representatives and voluntary and community sector organisations on several improvement areas including:
- our guidance on how we carry out our assessments
- our relationships with directors of adult social services and regional ADASS groups in relation to our assessments
- enhancing our site visits by focusing on the key areas of commissioning, safeguarding, prevention, specific client groups and introducing case sampling
- the provider voice — including refining our provider survey
- how we gather and use people’s experiences in our assessments.
Dr Penny Dash’s review into our operational effectiveness recommends that we continue to evolve and improve our local authority assessments. In response, we will make scoring of evidence more transparent and will strengthen our focus on nationally agreed priorities.
Our assessment teams have a breadth of regulatory and sector experience. They work alongside executive reviewers and specialist advisors who provide expert peer perspective and advice. We will be looking at how we can strengthen arrangements for peer involvement of expert reviewers and advisors in response to Dr Penny Dash’s review.
Using feedback from local authorities
We’re keen to understand the impact of our assessments on care, and how our work is influencing this. Evidence from our research on this will enable us to strengthen our approach to assessment. It will also provide assurance to local authorities, stakeholders, and the public that our approach is effective and based in evidence. As part of this research, we are asking local authorities that are currently being assessed to respond to surveys looking at different parts of the assessment process. We’ll analyse feedback from the surveys and use it to help improve the assessment process. For more information visit Local authority assessment feedback survey — Care Quality Commission
