This was a new responsibility for CQC under the Health and Care Act 2022 and, together with my team, I have supported the design, development and implementation of the work. Now, having engaged with just over half of local authorities, we are improving and enhancing the existing approach using feedback from a range of stakeholders along with what we have learned along the way.
It is important to note that we are not changing the methodology – this was co-designed with stakeholders, provider trade associations, voluntary sector organisations and people using services, and it has been approved by Ministers. It will not change during our activity to set a baseline of quality across all 153 local authorities by April 2026. Rather, we are improving, enhancing and refining the existing approach.
We continue to learn as we go and are committed to making our processes as efficient and meaningful as possible – both for local authorities and our own teams. To do this, we are working with the Local Government Association (LGA), Association of Directors of Adult Social Services (ADASS), provider representatives and voluntary and community sector organisations on several improvement areas.
These include:
- Our guidance on how we carry out our assessments.
- Our relationships with directors of adult social services and regional ADASS groups outside of the formal assessments.
- Enhancing our site visits by focusing on the key areas of commissioning, safeguarding, prevention, specific client groups and introducing case sampling.
- Enhancing the provider voice – including refining our provider survey.
- How we gather and use people’s experiences in our assessments.
One example of where we are making improvements is using feedback from a workshop with provider trade associations to help inform revisions to our provider survey. We are making it clearer what and who the survey is for and targeting its reach to improve response rates. We have also heard valuable feedback from unpaid carers and voluntary sector organisations and have commissioned research on how we can enhance how we gather people’s voices.
Colleagues delivering the assessments have a breadth of health, social care and regulatory experience. Teams include social workers, nurses, occupational therapists, commissioners and people who have delivered care and run services. They also work alongside executive reviewers and specialist advisers, many of whom are current or recent employees of local authorities, including directors of adult services. Their collective expertise and experience is essential for the successful delivery of our assessment programme.
The assessments we make give a baseline indication of how well the local authority is meeting its duties. In the longer term, we want to understand if our assessments are having an impact on care being delivered in local authorities and we have commissioned research to evaluate this. Evidence from the research will enable us to strengthen our approach to assessment. It also presents the opportunity to get a national picture, to identify trends and to share innovations and lessons. Importantly, it will help showcase the essential role that adult social care plays working alongside the NHS.
I always like to use this column to highlight some of the exceptional care we see during our regulatory work. Colleagues returned to Manor Lodge, a residential care home in Essex, after some questions were raised with us. During the assessment, we found no concerns and were able to re-rate it as ‘Outstanding’ for the second consecutive time.
Commenting on the inspection, Hazel Roberts, CQC Deputy Director of Operations in the East of England, said, ‘Staff and leaders demonstrated pride in their work, showing a commitment to transparency and learning from experience to constantly improve the care they provide. They worked collaboratively with external stakeholders, including GPs, speech and language therapists and the local church, to achieve better outcomes for people.’
Again, it is the focus on collaboration that can help to drive improvement. Whether that is in a single care home or across a national programme of local authority assessments.
How is your care setting leveraging collaborative opportunities to drive improvements? Leave a comment on this column or join the conversation to share your thoughts.
Mary Cridge is Director of Adult Social Care at the Care Quality Commission (CQC). Email: [email protected] X: @CQCProf