Councils would be assessed on their adult social services performance every three to four years under proposed reforms to the Care Quality Commission's (CQC) local authority assurance process.
Authorities would also be expected to carry out an annual self-assessment, which would be discussed with the CQC, while the regulator also intends to carry out thematic checks on samples of councils in relation to key issues facing the sector.
Proposed reforms to the assurance system also include an increased focus on councils' performance in supporting unpaid carers, which the CQC has repeatedly identified as an improvement area in assessments carried out to date.
The proposed changes, which must be agreed by the health and social care secretary, were set out by CQC chief inspector of adult social care and integrated care Chris Badger, in a speech last week to the National Children and Adult Services Conference (NCASC).
CQC's two years of assessing local authorities
His comments come with the CQC due to complete shortly its initial round of assessments of local authorities, which started in December 2023.
Badger, who took up his post in September this year, told NCASC delegates that the regulator had published 85 reports and carried out site visits to 141 authorities, with the remaining 12 visits due to be carried out before Christmas.
This two-year process was designed to establish a baseline of local authority performance that would shape the regulator's future approach to assessing councils.
Of the 85 reports, three councils (Barking and Dagenham, Camden and Kensington and Chelsea) have been rated outstanding, 55 good, 25 requires improvement and two inadequate (Blackpool and East Riding of Yorkshire).
Councils are rated from 1-4 against nine quality outcomes (assessing needs; supporting people to lead healthier lives; equity in experience and outcomes; care provision, integration and continuity; partnerships and communities; safe pathways, systems and transitions; safeguarding; governance, management and sustainibility, and leadership, improvement and innovation). On the basis of these, the CQC gives authorities a score out of 100, which is the basis for their overall ratings.
Councils' key performance issues in adult care
Summarising its key conclusions so far, Badger said CQC assessors had found:
- More support for unpaid carers was needed.
- Scores for equity of experience and outcomes were consistently low, with "shocking inequalities" for people with learning disabilities.
- There are some very long waits for services in some places.
- Data is used inconsistently.
- Transitions are a consistent area of challenge.
- Safeguarding practice is inconsistent.
- There's a mixed picture of commissioning practice, with some of being "transactional".
However, despite these challenges, councils were "performing remarkably well given the pressures they are under", said Badger. "The level of commitment, passion and values really comes through."
In terms of what the CQC had learnt from the process, Badger cited the value of it having sector specialists on its assessment teams.
Assessments every three to four years
Under its plans for the future, each council would carry out an annual self-assessment, which would be discussed in an annual engagement meeting with the CQC, Badger said.
He added that there would be "a comprehensive assessment every three to four years", though he stressed that the CQC wanted to ensure safeguarding performance was checked between times.
As well as these, the regulator also wanted to carry out thematic assessments of samples of councils in relation to particular issues, said Badger.
While the assessment framework was likely to remain relatively unchanged, the CQC wanted to increase the focus on carers, potentially through a dedicated quality statement, he added.
Badger said the CQC would be "clear about what good looks like", though he admitted that there was a risk of this being over prescriptive, leading to the process being a box-ticking exercise.
He said the regulator also wanted to improve the link between its commentary on councils and its scores and to speed up the publication of reports.
CQC assessments 'bumpy' for councils
Speaking alongside Badger, Association of Directors of Adult Social Services vice-president Phil Holmes said the assurance process had been "bumpy" for local authorities.
"It's been a lot of work in a compressed period of time where we haven't had time to do anything else," he said. "CQC has been building a plane mid-flight. What we need is a simpler environment to do things in."
