Care Quality Commission assessments for adult social care: Must know guide for lead members

The Government announced their intention to introduce assurance in adult social care in a White Paper ‘Integration and innovation: working together to improve health and social care for all’ in February 2021 which was then followed up in December 2021 with the White Paper, ‘People at the Heart of Care’ when it was announced that the CQC would independently review and assess local authority performance in delivering their adult social care duties under Part 1 of the Care Act 2014. It also stated that new legal powers were being put in place for the Secretary of State for Health and Social Care to intervene in local authorities to secure improvement where there are significant failings in the discharge of their adult social care functions under Part 1 of the Care Act 2014.

A similar CQC assurance process for integrated care boards is also planned. 

It is grouped into four key themes, each with nine quality statements mapped to the themes. The quality statements are a subset of CQCs single assessment framework, and each quality statement is linked to one or more of the “I” statements in the TLAP Making it Real framework. The CQC assurance assessment process is driven by the ambition to improve the outcomes for people with lived experience and their carers.

The four themes for the assessment framework for local authority assurance are:

The CQC will be looking at how local authorities meet their duties under Part 1 of the Care Act (2014).

There is a timetable for the local authority assessment which starts with a notification to the local authority giving them three weeks to complete an information return including a self-assessment and key documents. CQC will then inform the local authority of their date for on-site interviews six to eight weeks in advance of their arrival. Some meetings may be held with the local authority leadership in advance of the on-site visits. 

Following the council assessment, a report will be produced which will give a rating for the council – inadequate, requires improvement, good or outstanding. Support will be available from the Local Government Association (LGA), the Association of Directors of Adult Social Services (ADASS) and other sources following the publication of the report and members will be aware of the policy, already in place for statutory and non-statutory intervention for councils.  
 

There is no mandatory requirement to produce a self-assessment for CQC to review, however, most local authorities have chosen to develop this as it supports the assessment process by demonstrating the authority’s self-awareness of strengths and areas of development. 

If you choose not to complete a self-assessment, CQC may need to spend more time in the on-site part of their assessment to gather and analyse required evidence from various sources. 

The self-assessment is a useful tool for councils to use in their preparation with staff and partners for the assessment and we have produced guidance to enable councils to complete an objective, honest and authentic view of their strengths and areas for improvement.

The CQC will look at a range of specific metrics under some quality statements. Metrics are considered alongside other evidence within a quality statement and include some metrics from the Adult Social Care Outcomes Framework (ASCOF) Safeguarding Adults Collection, Adult Social Care Survey, and the Survey of Adult Carers in England.

These are some potential questions which have been informed by those asked in the five CQC pilot assessments and from some of the early ‘live’ council assessments. There will also be questions which will be specific to each council which will have been drawn from the data analysis and pre-visit discussions between the council and CQC for example, an overview of the local authority, its main features and key areas of demand for adult social care.

Lead members can do the following:

• ensure the council is giving priority to the preparation for CQC assessment, allocating resources and creating time in the political calendar for briefing cabinet and scrutiny panels. The CQC pilot sites reported underestimating the cost and the staff time involved in the preparation for and hosting of the assurance process.
   
• ask for regular updates on CQC preparation and assurance across key areas such as waiting lists, hospital discharge and safeguarding.
   
• consider having an LGA Adult Social Care Preparation for Assurance Peer Challenge, if one is not already scheduled. If the assessment visit is already scheduled explore what immediate support is available from our team.
   
• consider the regional support offers of peer review or annual conversations.
   
• encourage the council to embrace the assurance process, using it as an opportunity  to celebrate the good work being done and address the areas where you want to improve. It can be used as an opportunity to educate and influence others as to the complexity of need and the range of challenges in adult social care both within the council and with partners.
   
• understand what questions you need to be asking of the adult social care leadership team to give direction and hold them to account.

• ensure you and your member colleagues are aware of the central themes of the Care Act 2014 especially the overall spirit of the Act and its specific statutory requirements. Be aware of the cost and quality issues which impact on delivery, both commissioned and provided in house.
   
• work with the lead member for children's services to share and learn from their experience with Ofsted – the methodology is different but equally rigorous and the preparation, communication and reputational considerations are similar. Consider the areas of shared concern with the lead member for children's services – transitions, community health provision, public health, mental health.
   
• work with the director of adult social services (DASS) to prepare a communication plan for the publication of the CQC assessment report agreeing in advance who leads with the media and any other external messaging. Case studies of how this has been tackled by other councils are available.
   
• engaging with staff and partners is a routine part of the portfolio lead in adult social care. It will be important to ensure that time is available to do this to hear from them directly about their successes and challenges.
   
• work with and support the directorate leadership team to build the narrative about their performance and identification of issues and plans to address them and socialise that within the council giving attention to the direction of travel and ambition for the residents of your council.
   
• engage with health and community partners in the preparation for CQC assurance -particularly the health and wellbeing board and integrated care board leadership to establish a system self-awareness of the shared challenges and successes.
   
• understand how the council listens to the voices of people with lived experience and carers and ensures their views influence policy and practice. This will be a key line of enquiry for CQC – this is more than co production and co design but ensuring the delivery of personalised strength based social work practice.
   
• ensure you are well briefed on key finance and performance data – CQC will have analysed historical data including satisfaction survey results, compliments and complaints, workforce gaps and safeguarding reviews. The data and narrative need to tell a consistent story to create an evidence-based picture recognisable by everyone. Use the data available through LG Inform to ensure you have the most up to date and comprehensive performance picture.
   
• start to prepare for CQC assurance now and maintain the focus and priority – the plan is that all 153 councils will be assessed within two years.
   
• be involved in the development of your self-assessment and have opportunities to review and comment on it.
   
• consider engaging with the other adult social care portfolio holders in your region to hear how they and their departments are managing the demands of CQC assurance. Share what is known and unknown and what you can do both individually and collectively.
   
• the CQC will also be assessing your local ICS. Consider the links between the two assessment processes, working with member colleagues in other councils and NHS partners in the ICS.
   
• ask for detailed briefings in key areas such as support to carers, hospital discharge and safeguarding or deprivation of liberties. Ask for face to face briefings with your DASS prior to interview.

Shared learning from the CQC pilots was presented at a webinar where the lead members and directors from Suffolk and Lincolnshire presented alongside the CQC and Department of Health and Social Care 

Care Quality Commission assessments of adult social care - the communications response

 

Care Quality Commission, How we are using our new approach to assessments

Care Quality Commission, How the assessment process will work

The Department of Health and Social Care guidance on statutory and non-statutory intervention

Partners in Care and Health, The return of regulator: what adult social care needs to know

Partners in Care and Health, Top tips for CQC assurance preparation

The Local Government Association, data analysis training for members

LG Inform training resources

CQC assessment framework for local authorities detailed metrics - the LGA is working closely with the CQC to understand the metrics they are using to inform the assessment, as well as their dashboard which shows how they are using the data. The LGA is aiming to recreate this in LG Inform.

Adult social care: A guide to support the development of your self-assessment (Part one - an introduction and overview and Part two - tools and templates)

LG Inform themed reports - For adult social care data queries, contact the Partners in Care & Health (PCH) Research and Data team through [email protected]

CQC local authority information return