CQC points first insufficient ranking for council adults’ providers

Photo: Andrey Popov/Adobe Stock

The Care Quality Commission (CQC) has issued its first insufficient judgment because it began assessing English councils on their grownup social care efficiency in December 2023.

Blackpool Council grew to become the primary of the 54 authorities graded up to now to obtain the underside ranking, after the CQC found a culture of the authority making decisions for people and longstanding inequalities in standards of care for different groups.

The North West council additionally acquired by far the bottom rating of any authority, based on its performance against the nine quality statements that inform the CQC’s assessments.

Its rating – 34 out of 100 – compares with a median of 65.6 for the opposite authorities who’ve had their evaluation studies revealed by the CQC so far.

England’s most disadvantaged authority

Blackpool is England’s most disadvantaged authority, with the very best fee of drug-related deaths within the nation and wholesome life expectancy ranges for women and men which might be 10 years wanting nationwide averages, stated the CQC.

Senior leaders instructed the regulator that individuals with care and assist wants moved to Blackpool looking for low-cost housing, including to demand for grownup social care, which was considerably above the nationwide common.

In 2023-24, the authority acquired 2,980 requests for assist per 100,000 individuals aged 18-64, in contrast with 1,785 throughout England, and 15,795 requests per 100,000 individuals aged 65 or over, as towards 13,285 nationally.

‘Crisis intervention’ strategy

Against this backdrop, the CQC discovered that the council was not doing sufficient to advertise more healthy lives or stop, scale back or delay wants for care and assist. Instead, it discovered a “crisis intervention” strategy to grownup social care throughout the authority.

This was evident in Blackpool having had many extra working-age adults (1,465) and older individuals (9,185) per 100,000 receiving long-term care and assist than the England common in 2023-24, which was 855 for working-age adults and 5,185 for older individuals.

Practitioners didn’t think about whether or not or how an individual’s wants may very well be lowered or delayed in each interplay, and a draft prevention technique – which had been awaiting implementation for over a yr – didn’t present element on how such an strategy may very well be embedded in follow.

While council-commissioned, voluntary and group providers to stop want had been accessible, individuals confronted obstacles to accessing them, stated the regulator.

Reablement providers missing

The council carried out a lot worse than others in offering individuals with short-term assist, corresponding to reablement, that prevented them from requiring longer-term care. Of those that acquired such a service in 2023-24, simply 60% didn’t subsequently require assist, in contrast with a nationwide common of 79%.

In addition, 78% of individuals aged 65 and over had been nonetheless at residence 91 days after discharge from hospital into reablement or rehabilitation providers, in contrast with 84% nationally, whereas the council had additionally seen an increase in everlasting admissions to care houses amongst these aged 18-64.

The CQC stated that the variety of individuals accessing reablement in Blackpool had declined over the earlier yr, whereas provision was “fragmented”, with remedy enter organized by way of an NHS belief somewhat than the council.

In addition, some workers reported that these with an present care bundle couldn’t entry the service, regardless of this being opposite to council steerage.

Blackpool additionally supplied preventive assist to individuals with low-level wants by way of its evaluation groups, however some workers reported that individuals may very well be “over-supported” and “deskilled” by way of this provision.

‘Culture of making decisions for people’

More broadly, the CQC discovered that Blackpool had “a culture of making decisions for people”, typically with the intention of defending them, somewhat than permitting them to make their very own decisions.

Two individuals who had been positioned in care houses instructed the regulator that this didn’t accord with their needs or wants, whereas companion companies reported that the authority didn’t all the time take heed to individuals throughout assessments and typically made choices with out involving them or unpaid carers.

The CQC concluded that this tradition created dangers to individuals’s wellbeing and human rights.

While senior leaders didn’t settle for there was such a tradition, they did acknowledge a have to shift to a extra strengths-based strategy to follow.

People ‘not treated equally’

The regulator additionally discovered that individuals had been “not being treated equally” in relation to requirements of care and that, regardless of this challenge being highlighted in a peer evaluate two years beforehand, the council didn’t have a technique to handle it.

It was instructed that individuals with studying disabilities or autistic individuals waited longest for Care Act assessments, whereas the regulator additionally cited an absence of progress in addressing findings from a charity’s report highlighting inequalities dealing with LGBTQ+ communities within the city.

Issues raised included an absence of psychological well being assist, a concern of accessing providers and provision not being tailor-made to want. However, the CQC stated there was “a lack of strategic direction” to scale back obstacles to assist and safeguarding for these teams.

Furthermore, workers constantly instructed the CQC that they wanted additional coaching and assist in cultural competence, with most unsure how accessible their providers had been to numerous teams.

Safeguarding points

The report additionally recognized points with safeguarding follow.

Partners companies stated they didn’t all the time hear again from the native authority about safeguarding considerations they’d referred, with Blackpool Council workers agreeing that referrers weren’t all the time instructed whether or not a priority had reached threshold.

CQC additionally recognized delays in some circumstances in relation to figuring out whether or not a priority needs to be adopted by a safeguarding enquiry below part 42 of the Care Act 2014, within the allocation of part 42 circumstances and of their conclusion.

Though delays had lowered within the run-up to CQC’s website go to in March 2025, the regulator concluded that the council had not evidenced that it was sufficiently lowering harms to adults awaiting an consequence to their case.

Practitioners constantly recognized a insecurity in finishing up safeguarding work, with the CQC discovering there was no particular induction or specialist coaching for employees to be deemed competent to undertake to practise on this space.

Though senior leaders highlighted a safeguarding peer assist group, which promoted finest follow and was considered positively by workers, they acknowledged extra wanted to be performed to make sure efficient supervision, coaching and high quality assurance round defending adults.

Lack of supervision

More usually, the CQC stated it was “not assured that senior leaders had effective line of sight over frontline practice”. Some practitioners solely acquired 1:1 supervision each six months and whereas others had targets for six-weekly supervision, this didn’t all the time occur, workers reported.

One senior chief attributed this to busyness, and although there have been plans to develop an digital supervision monitoring system, this was but to be applied.

The principal social employee function in adults’ providers had beforehand been break up between two operational heads of service, with Blackpool solely having not too long ago appointed a devoted PSW.

While the director of grownup social providers felt the PSW had already made an influence, notably in selling workers studying, the CQC concluded that it was “too early to evidence any impact the role could have on influencing and shaping future practice and strategy”.

‘A difficult read’

The council described the report as a “difficult read” and stated that it took the findings “exceptionally seriously”.

Its cupboard member for grownup social care, Neal Brookes, stated that, whereas there have been “areas of good work highlighted in the report”, together with that satisfaction with care was above the nationwide common, the authority recognised it wanted to enhance.

“Adults in Blackpool deserve the highest quality of care when they need it and I am committed to putting the processes in place to make sure that happens,” he added.

Improvement actions underway

The council stated it was growing an enchancment plan that will likely be scrutinised by an independently-chaired board, and that work had began on a spread of areas, together with:

• Improving safeguarding coaching and audit, and introducing a brand new high quality assurance framework.
• Reducing ready occasions for assessments and opinions.
• Improving knowledge high quality and efficiency monitoring to reinforce oversight of frontline follow and outcomes.
• Embedding strengths-based follow throughout assessments and interventions and giving adults and carers a larger say within the care and assist they obtain.

London borough earns second excellent ranking

Blackpool’s report got here within the wake of the CQC issuing its second excellent ranking, to Kensington and Chelsea council, whose prime grade adopted that awarded to fellow London borough Camden earlier this yr.

Like Camden, Kensington and Chelsea acquired a rating of 89 out of 100 towards the 9 high quality statements and gained prime marks – 4 out of 4 – throughout 5 of those: supporting individuals to steer more healthy lives, fairness in expertise and outcomes, partnerships and communities, safeguarding and governance, administration and sustainability.

The CQC praised the authority for having no ready lists, that means individuals didn’t have to attend for assessments and long-term care was offered promptly.

A ‘highly effective’ safeguarding mannequin

Kensington and Chelsea prioritised early interventions to assist individuals regain or retain independence, which regularly prevented individuals from requiring extra intrusive or intensive providers, stated the regulator.

It added that individuals had been stored free from abuse or hurt by a “highly effective model for responding to safeguarding concerns”.

The council stated it was “proud” of the ranking and that it was a “testament to the hard work” of its workers.

Current unfold of CQC and Ofsted scores

Aside from Camden, Kensington and Chelsea and Blackpool’s scores, 33 of the 54 authorities (61%) graded up to now have been rated good and 18 (33%) requires enchancment.

By comparability, 24% of council youngsters’s providers are rated excellent by Ofsted, 43% good, 20% requires enchancment and 12% insufficient.

Analysis of the primary 30 CQC adults’ providers studies discovered a constructive hyperlink between a council’s measurement – measured by its native inhabitants – and an authority’s ranking or rating.

The consultancy IMPOWER, which carried out the evaluation, questioned whether or not this meant that having a bigger infrastructure – for instance, having extra workers in efficiency administration roles – may help councils in being profitable.