Adult Social Care Assurance - preparing for Care Quality Commission assessment
The Health and Social Care Act 2022 sets out key legislative reform for the delivery and organisation of health and care services in England. This will promote more collaborative services and to focus more on improving health, rather than simply providing health care services. The act builds on existing non-statutory Integrated Care Systems (ICSs) through the creation of Integrated Care Boards (ICBs) and the creation of Integrated Care Partnerships (ICPs) in each local area.
The Government legislation places a duty on the Care Quality Commission (CQC) to carry out reviews of councils’ performance of their Care Act 2014 duties. The CQC will focus on Early Help and Prevention, working across its local health and care system with partners and, importantly, people who access and use services.
The legislation also gives the Department of Health and Social Care (DHSC) the power to intervene and, if deemed necessary, direct improvements at authorities found to be failing, in a similar regime to Ofsted in children’s services.
The Council, through its Adult Social Care department, has started a positive and productive approach in co-designing and engaging with partners. This includes people across social care, health, community, and workforce, including people who access and use adult social care services.
Work began in 2022 when Sefton Council invited the Local Government Association to peer review its position at that time. This helped to put in place a robust service assurance plan.
The CQC approach
- All 153 councils will be assessed once during a two-year period, due to start in September 2023.
- Councils will each receive an overall rating on the same four-point scale that Ofsted uses for children’s services and the CQC uses for care providers: ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’.
- Councils will also receive a score of 1-4 for:
- assessing needs;
- supporting people to live healthier lives;
- equity in experiences and outcomes;
- care provision, integration and continuity;
- partnerships and communities;
- safe systems, pathways and transitions;
- safeguarding;
- governance, management and sustainability.
- The CQC’s assessments will involve a combination of virtual checks and visits to the council concerned.
- Evidence will include feedback from people who give and receive care and support, including:
- self-funders;
- carers;
- voluntary and community groups;
- the Principal Social Worker;
- Director of Adult Social Care;
- social workers;
- There are no anticipated observations of practice by social workers or other professionals, such as occupational therapists.
- Councils will have four weeks from being notified to send their self–assessment to the CQC, and a 20-week assessment will follow.
InvictIQ has created a short video explaining the new single-frame assessment approach that CQC will take. You can view this below.
The Adult Social Care Big Assurance Conversation
The Adult Social Care Big Assurance Conversation is about co-designing Sefton Council's approach to preparing for its Care Quality Commission Assessment. Adult Social Care will become a regulated service, like other providers in the care and support sector.
The CQC Assessment focuses on four important quality assurance themes:
- Theme 1 – Working with people: how local authorities work with people (including unpaid carers, supporting people to live healthier lives, prevention, well-being, information, and advice).
- Theme 2 – Providing support: how local authorities provide support (including market shaping, commissioning, workforce equality, integration, and partnership working).
- Theme 3 – Ensuring safety: how local authorities ensure safety within the system (safeguarding, safe systems, and continuity of care).
- Theme 4 – Leadership and workforce: leadership capability within local authorities (capable and compassionate leaders, learning, improvement, and innovation).
Sefton Council has started at an amazing pace, holding co-design workshops with partners, colleagues, and people who access and use services. The Council is listening to everyone involved and learning from feedback. In workshops, participants are asked:
- Where are we now and how do we know?
- Where do we want to be and how?
- How will we get there together?
A plan has been designed with partners, colleagues and people who access and use services that sets out four phases:
- Phase 1 – Co-designing our self-assessment baseline together. This describes what looks good and what needs developing.
- Phase 2 – Developing from our self–assessment baseline – our full self–assessment and quality assurance statements. This sets out how assurance themes are met and also what priorities are in place.
- Phase 3 – Developing our local annual assurance account that we will publish. This is focused on "You Said, We Did", showing progress and improvement targets.
- Phase 4 - Using the assurance process, to inform our early help and prevention strategy and program of work over the next five years. This is about having a vision, ambition and plan that can be delivered together.
Sefton Council has put in place assurance groups that report to the new Executive Assurance Board.
Quality assurance plan and monitoring documents
Documents will be updated soon.
How the CQC will regulate Councils.
How you can help
If you would like to contribute towards The Adult Social Care Big Assurance Conversation, please contact Lorraine Goude, Consultant Director for Children and Adult Social Care (Assurance Lead) at Lorraine.goude@sefton.gov.uk.
We want to tell your story
If you have received help from any of our Adult Social Care teams and would like to tell your story, please let us know. We would like to share stories from people in Sefton to a big audience.
Stories and feedback can be told anonymously through text, or with a picture or video if you’re happy to be involved. These stories will be told publicly to showcase the work our teams do.
If you are interested or would like to find out more, please contact sian.mccosh@sefton.gov.uk.
Frequently asked questions
The CQC has not said what data they will be using yet, but has said that it will be focused on the Adult Social Care Outcomes Framework (ASCOF). These are a set of annual indicators of outcomes that measure how well care and support services work. The ASCOF is based around six objectives:
- Quality of life: people’s quality of life is maximised by the support and services which they access.
- Independence: people are enabled to maintain or regain their independence where possible.
- Empowerment: individuals, their families and carers are empowered by access to good quality information and advice to have choice and control over the care they access.
- Safety: people have access to care and support that is safe and which is appropriate to their needs.
- Social connections: people are enabled to maintain and regain their connections to their own home, family and community where possible.
- Continuity and quality of care: people receive quality care, underpinned by a sustainable and high quality care market and an adequate supply of appropriately qualified and trained staff.
The assessment will take 20 weeks in total. Councils have four weeks from receiving their letter from the CQC to update their self-assessment with evidence. At the end of the assessment, the CQC will publish a report that will be available to the public.
Deborah Butcher, Place Director, and Philip Porter, Sefton Council's Chief Executive Officer, will receive a letter from the CQC informing them of the date and time of the assessment. Once they receive this they will begin to follow the Operational Assessment Assurance Plan, which is currently in development.
The CQC will come to the Council in person for at least three days. The rest of the assessment will be done virtually, looking at documents and supporting information that covers the nine assurance statements.
The Association of Directors of Adult Social Services, Local Government Association and Think Local Act Personal have all been involved in the creation of the framework. The CQC has also been working closely with experts by experience and trailblazer councils to test the process.
The assessment affects everyone - not just Sefton Council, but people working in health and social care, people with lived experience and the community at large.
The CQC will be looking at how Sefton Council performs in:
- Working with people.
- Providing support.
- Safety.
- Leading well.
These areas will be broken down into:
- Leadership.
- Workforce.
- Safeguarding.
- Equality.
- Risks.
- People.
- Performance.
The main focus is on early help and prevention, as detailed in the Care Act 2014. This will be achieved through working well with partners and understanding what works well and what does not.
This understanding will include considering how the Council is planning with partners well, with a focus on equality across health and care.
Sefton Council will look at the lived experience of people who access and use services to ask whether targets are being met.
Each theme will receive a score from 1 to 4 (1 being 'significant shortfalls' and 4 being 'exceeds expectation'). Then, an overall rating will be given. This will be from:
- Inadequate.
- Requires improvement.
- Good.
- Outstanding.
The CQC has assured local authorities that the focus is on learning and the first assessments are to help to see how adult social care is performing nationally.
Yes - it's about how local health and social care providers work together, as well as the people who access and use services across the health and social care system.
Yes - working as partners in the local area is set out in the Care Act, as well as the changes in the NHS Forward Plans.
Quarter one and two
The CQC are focused on care provision and assessment and are looking at the information available to the public by all councils. This will help them to see the key themes nationally.
It will also assess five pilot local authorities and share what they learn with everyone.
Quarter three
The CQC will assess 20 local authorities that they choose.
Quarter four
The CQC will assess a further 20 local authorities.
The key area that councils are looking at currently is self-assessment. This is also what Sefton Council is looking at.
Councils have been assured by the CQC that they are currently focused on self-assessment and their test assessments. More formal assessments will start after October 2023 and councils could receive the news that they are being assessed from this point onwards.
Yes, when the CQC first write their report, it is sent to senior staff members. There is then an opportunity to talk through the findings and say if something is inaccurate.
Currently Sefton Council's Executive Director for Adult Social Care and Health, Assistant Director for Adult Social Care, and Service Managers are leading the assurance work.
However, it's important to understand that everyone's views are important and the Council is supported by experts by experience, health partners, and people in the community.
The CQC will focus on two statements: care provision and support. However, it may look at other statements based on things that may be missing or unclear from the self-assessment stage.
The CQC will place any council rated as inadequate under specific special measures. Every decision made will consider the impact on adults accessing the services and will work in their best interest.