CQC assurance begins

For a number of councils, the taking down this month of office Christmas decorations may well be swiftly followed by the putting up of flipcharts, timelines and checklists on office walls. 

That’s because these local authorities have been, or will be over the coming weeks, notified that they are in the first tranche of councils in England to go through adult social care assurance, the new process of assessment led by the Care Quality Commission (CQC).

It will be a busy start to the new year for these councils, and any resolutions to stop excessively long working hours may have to be put on hold temporarily. 

At least they will not be starting from scratch. Thanks to five councils who piloted assurance in the second half of last year, and two ‘test and learn’ councils that partially tested the process in 2022, the councils kicking off full rollout will do so with valuable learning under their belts. 

Partners in Care and Health (PCH), the improvement and support programme for adult social care and public health led by the LGA and the Association of Directors of Adult Social Services, has done a great deal to capture this learning in recent months. 

Most recently, PCH commissioned some rapid learning of the pilots’ experience through interviews with the councils’ directors of adult services. Each experience was unique to each council, of course, but some of the key learning will almost certainly apply across the board. 

Ably demonstrating local government’s capacity for optimism at even the most challenging times, part of the learning points to the need to embrace the process and the opportunity it affords to showcase adult social care at its best and identify or corroborate areas for improvement. 

However, councils’ optimism often sits alongside a healthy degree of pragmatism and realism, and the five pilots pulled no punches when it comes to the message that assurance is incredibly time-consuming. 

Even before the on-site assessment, the councils had to submit hundreds of documents, run workshops for staff, hold mock interviews, pull together case-tracking material and produce a comprehensive self-assessment. 

This, and considerable amounts of other preparatory work, culminated in the on-site visits by the CQC assessment team, which itself involved numerous meetings with council staff and the councils’ many relevant partners, plus focus groups and wrap-up sessions with the inspection team.

It’s not just councils that have benefited from the pilots’ experience. 

CQC has conducted an evaluation of the pilots, which has resulted in the regulator revisiting aspects of its assurance processes and methodology. Key areas of focus include clarity on scoring evidence (which leads to overall judgements), building in more time to digest material before on-site fieldwork, reviewing the information return, and changes to the final reports. 

The pilots’ experience has also informed a review and update of CQC’s definitive assurance guidance for councils.

PCH is doing a huge amount of work to support councils with adult social care assurance. Whether you are one of the councils about to start full rollout or want to get ahead of the game, I would encourage you to take a look through the PCH pages of the LGA’s website.

Here you’ll find a significant amount of material to help you prepare for assessment, including details of upcoming events that you may wish to attend to learn more.

While much of the focus at the moment is understandably on the operational rollout of assurance, we are pushing key policy issues on councils’ behalf. 

The absence of any new funding for adult social care in November’s Autumn Statement and December’s provisional local government finance settlement – despite mounting pressures that carry serious consequences for people who draw on care and support, and the workforce – means councils embark on assurance from a precarious position. 

The extent to which this impacts on the single-word rating councils receive (which we continue to argue against) is something on which we will be keeping a close eye. 

We are also mindful of the risk of government thinking adult social care has what it needs if overall ratings are, in the main, positive. 

Perhaps of most immediate concern to councils is the serious drain that assurance will have on colleagues’ time and capacity. This is an issue that surfaced time and again at the National Children and Adult Services Conference (NCASC) in November. We used the focus of NCASC to call on government to keep its ‘new burdens’ funding for assurance under close review, and to guarantee additional resources if the experience of the first councils starting assessment shows it is needed.

Ever since assurance was introduced as a policy intention in 2021, the LGA has committed to working with CQC and the Department of Health and Social Care to ensure the process is fair and proportionate for councils. 

Local government does not shy away from transparency and accountability, and is committed to ongoing improvement to services that support people who draw on care and support to live their best life. The voice of those people, encouragingly, feels to be at the heart of assurance, but whether the process helps strengthen the case for much-needed additional investment remains to be seen. 

On its own, and through PCH, the LGA will continue to advance the policy, improvement and support interests of councils in adult social care assurance. We wish every council going through assessment this year the very best of luck for a positive and constructive experience.

‘The return of the regulator: what adult social care needs to know’, a summary of learning from the adult social care assurance pilots, is available to download for free at www.local.gov.uk/publications/return-regulator-what-adult-social-care-needs-know. See www.cqc.org.uk/publications/evaluation-la-pilot-assessments for the CQC’s evaluation of the pilots.

Preparing for assurance – top tips

  • Embrace the process positively and openly – be open about your weaknesses and areas for improvement and set out how you are addressing them. Even outstanding services will have challenges that they are working on.
  • Resource the assessment process – the workload is immense. A dedicated core team with a lead officer are needed to prepare and coordinate the work on a full-time basis. 
  • Corporate and political awareness – secure corporate buy-in from senior leadership as well as political leaders. Provide regular briefings to cabinet on CQC expectations and how the council’s performance will be measured in key areas and the significant risks arising from any adverse judgements.
  • Maximise your business intelligence in advance – use available activity and performance data to inform your preparation. However, primarily focus on what your data tells you about care quality, impact, user and carer experiences and outcomes – not processes.
  • Self-assessment and evidence – ensure these align to support your key assertions. Everything flows from the self-assessment questionnaire: it should establish 
  • your story.
  • Staff need supporting – frontline staff were sometimes anxious and apprehensive about being interviewed by CQC during the onsite visits, but it is a chance to tell their story and the difference they make.
  • Communications – think about how to communicate the results of the assessment once it is published to both internal and external audiences.
  • Gather insights from partners and providers – the CQC assessment is likely to look for evidence of collaborative and co-operative working relationships with partners, and will comment on your organisational culture as observed or experienced by your partners.
  • Be clear on co-production and responding to diverse needs – part of this is about knowing your place and community, but also understanding which groups or communities are more likely to experience poor care and support.

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