I was on holiday recently and relied heavily on websites that rated restaurants and activities to inform my choices about where to go and what to do. It’s natural that people, their families and carers should be able to access information about the performance of their public services, after all it’s their money that pays for them. So why should adult social care be any different?
As a former overview and scrutiny officer in a couple of councils, I’m a big advocate of transparency and accountability. This is no different at the Association of Directors of Adult Social Services (ADASS). We’ve been committed to the principle of transparency for a long time, and by proxy the implementation of the assurance and assessment of adult social care.
However, as we set out in our response to the Health and Social Care White Paper, we are of the opinion that assurance should have followed long-term investment and reform of adult social care. We have since commissioned and published an independent report, Time to Act: A Roadmap for Reforming Care and Support in England. This report draws together the thinking that’s been done on the future path we could take for social care and develops a roadmap to get us there. Our point is that without adult social care reform, CQC assessment will become an expensive way of reinforcing what numerous reports have been telling us for a number of years. Namely, that despite the best efforts, social care is struggling to fully meet its legal duties which has a direct impact on the ability of people being able to live the lives they want to lead.
A complex task
I’ve led on the ADASS Spring Survey for several years and it’s clear from the insight collected that directors’ confidence in meeting their legal responsibilities is dwindling, which has a detrimental effect on those of us that need adult social care. This year, 86% of directors indicated that they are either partially confident or have no confidence that their budgets will be sufficient to fully meet their statutory duties in 2023/24; this has increased from 69% in 2017/18. We also know that over 400,000 people are waiting for an assessment, care or direct payments to begin or for a review of their care plan, which means too many people aren’t getting the care and support they need and too often, it’s unpaid family carers being left to pick up the pieces.
Aside from what social care is struggling to do, it’s also important to remember that adult social care touches on a broad cross-section of people’s lives across our communities. As well as care homes and homecare, it covers vital areas such as probation, carers, domestic abuse, mental health and homelessness, to name a few. This is one reason why we’ve not been supportive of the use of single-word ratings, because they can’t possibly reflect the complexity and reach of adult social care or show the public how good different parts of adult social care are. We have also seen the experience of Ofsted’s inspections of children’s social care, which has also shown the damaging impact a negative single judgement can have on retaining vital staff. There are already 152,000 adult social care vacancies; as such it’s vital for councils and providers that we don’t make the significant recruitment and retention challenges worse.
Good data and insight are also areas where more work is required to ensure that assurance and CQC assessment of local authorities can better reflect the outcomes, views and aspirations of people who access care and support. In an ideal world, the data that feeds into the CQC assessment process would have been reformed by The Department of Health and Social Care (DHSC) prior to the formal ‘go live’ of assurance. DHSC has acknowledged, through the publication of Care Data Matters, its roadmap for achieving data transformation across adult social care. Most importantly, there is a commitment to update the user and carer surveys which are the primary means of gathering the opinions of people who access care and support at a national level. As work undertaken by Ipsos in 2021 found, the current surveys are not fully representative of the range of people who access care and support, including people with memory and cognition support needs, mental health as their primary support reason and the youngest and the oldest people from all ethnic minority groups.
I’m hopeful that CQC assessment will offer the opportunity to ensure that those people who are under-represented in these surveys will have an opportunity to have their say. Providers will also have a role to play in local authority assessment. The CQC local authority assessment framework includes care providers and local provider forums as key partners from whom feedback will be sought, including through surveys. CQC also has a swathe of knowledge from its provider assessment work which will also be used to feed into the process.
Shaping the framework
Although we may not agree about the use of single word ratings, ADASS has been an active part of the discussions and development of the assurance process with the Department of Health and Social Care, CQC and the Local Government Association. For me personally this process has been one of the most open and transparent that I can remember since the development of the Care Act guidance. During the development of CQC’s assessment local authority framework, real positives emerged, such as the use of Think Local Act Personal’s I and We statements to help shape the content, to ensure that what good looks like from an individual perspective is at its heart.
We know that good-quality adult social care helps thousands of people to stay well and live the life they want every day. However, we are realistic that there may be instances where services and support could be better, which led to the development and publication of the operational framework for adult social care intervention in local authorities. The framework clearly sets out what will happen if improvements are needed and acknowledges that councils should be given the opportunity to drive their own improvement journey. On the latter, I know that a significant amount of work has gone in across councils, with support from their ADASS and Partners in Care and Health at a national level to prepare for the assurance.
From our regular discussions with the directors of the five pilot areas, it’s clear that the process has been challenging, but also worthwhile. Staff have positively embraced the opportunity to share the good work that they and their teams are doing with CQC assessors. You can read about the experiences of one of the pilot areas, Lincolnshire, on the ADASS website. You will see from Glen Garrod, Lincolnshire’s Executive Director of Adult Care and Community Wellbeing, the type of process that councils can expect from the CQC’s local authority assessment process. The process is much more than CQC assessors visiting a council and holding interviews (which is an intensive period in itself), it starts weeks in advance with evidence gathering and the collation of key documents. There is also a range of follow-up activity from CQC, with the need for clarifications and further evidence requests.
Continuous improvement
It’s an ongoing process, which is important as the learning from the evaluation of the five local authority assessment pilots will shortly be discussed by all the groups involved with assurance, prior to the CQC starting the formal baseline assessments later this year. This will guide decisions on whether the documentation that underpins assurance and CQC’s assessment framework for local authority assurance support CQC to refine the assessment process such as information requests to councils.
It’s also important to remember that Integrated Care Systems (ICSs) will be subject to a separate CQC assessment, with Birmingham and Solihull ICS and Dorset ICS acting as the pilots for this approach. CQC will need to ensure that learning from these pilots, including the evidence gathering process, is used to refine their approach for both ICS and local authority assessment so that they are as efficient as possible to minimise burden on councils and their staff. Interestingly CQC has recently announced that these pilots, unlike CQC local authority assessment pilots, will not be subject to ratings.
An opportunity to celebrate
One thing that struck me when looking at websites that rated restaurants and activities when I was on holiday was the importance of the detail that exists beneath the star rating. It’s only when you read this and look at the pictures that have been posted that you begin to get a real sense of what a place is really like. Although not directly comparable, the same will hold true for single word ratings from CQC. It’s only when you take the time to read the narrative, that you’ll be able to get a sense of the real value of what social care teams are doing. Beyond the judgements, my hope is that assurance will offer an opportunity to highlight and celebrate the good that adult social care does each and every day.