CQC Inspections of Local Authorities – What you need to know
CQC inspections of local authorities were reintroduced as part of the Health and Care Act 2022, as you are probably already aware.
These changes allow the CQC to act upon their additional responsibilities laid out in the Care Act 2014. Here their additional responsibilities include assessing how local authorities are meeting their adult social care duties including market shaping, market oversight and more.
You may be wondering exactly how the CQC inspections of local authorities will work, what will the CQC be assessing, and most importantly how can your local council can best prepare for CQC local authority inspections.
At the Access Group we want to make sure that all local authorities are as prepared as they can be for these new inspection changes, and we will be answering these key questions in this article.
As well as addressing the fundamentals about the changes to the CQC inspection we will also address how the CQC have been preparing their assessment methods and what they discovered from testing and the changes they are making to ensure when these new inspections take place they will be effective and beneficial for all those involved.
CQC Local Authority Inspections 2023 - What is it?
Previously, the CQC used to conduct annual assessments and inspections of local authorities, however these were scrapped by the government in 2010 and led to a higher focus on adult safeguarding. Since 2010 councils have often worked together to support their own performance through sector-led improvements.
In March last year it was announced that the CQC inspections were changing, with their predominant aim to streamline and simplify the assessment process. The changes to inspections meant that instead of having 4 individual frameworks there would be one single assessment framework used across all health and care services.
Through streamlining this process, the CQC have the responsibility to assess how well local authorities are meeting their duties under part 1 of the Care Act.
Their aim is to understand how the care provided in local areas is improving outcomes for people and how that is reducing health inequalities in their access to care and their experiences in the health and care system.
Some of their main priorities include looking at how services work together in integrated systems as well as how systems perform overall.
So, in simple terms, the CQC will inspect council services and how they commission and oversee adult social care in their local area.
CQC local authority inspections - what will they look like?
One of the biggest changes to the CQC inspections of local authorities is that they will no longer be using the Key Lines of Enquiry (KLOE) and instead will be assessing councils using Quality ‘We’ Statements within the single assessment framework.
The Quality ‘We’ Statements will work similarly to KLOEs and will help prompt inspectors on what to assess, check, and question. These statements will then be scored accordingly and are aimed at focusing on what matters to the people who use local health and social care services, as well as their families. The total score across all the We statements will then be converted into a percentage and that will allocate your rating.
The quality We statements for the CQC Assurance Framework for Local Authorities will be grouped into 4 different categories. Regardless of the category and whether the quality statements are assessing local authorities or ICSs all quality statements will be used to assess how both are working to improve outcomes, tackle unequal access, enhance productivity, and offer better value for money. For more information about what the We statements are learn more on the CQC website today.
The changes to CQC inspections of local authorities mean that the CQC will have more power and can look more effectively at how home care is provided within local systems.
People’s experiences will also be a key part of the CQC inspections. This is because the CQC see people’s experiences as the best sources of evidence for lived experiences of care and their perspective of how good it is or was.
The CQC understands how people’s experiences can be diverse, so the CQC has announced that they will use a variety of data characteristics to put people’s experiences more into perspective.
Unlike typical inspections the changes mean that local authorities won’t be assessed on one singular date, and instead the CQC will take a more continuous approach where information will be gathered across a variety of domains such as: provider submissions, contacting service users, and meetings with managers and other leaders.
The start of the process will involve an information return to be sent. An information return is a tool the CQC will use to collect evidence used in their assessments to collate key documents, information, and data to help the CQC plan their interviews, understand trends, issues, and performance across England.
These will be sent out at least 8 weeks before they visit which will include a full explanation of what the CQC need and the dates they need it by. For more guidance on what can or cannot be included within a local authority information return learn more on the CQC website for all their most up-to-date guidance.
CQC inspections of local authorities – what are the latest updates?
Since the changes were announced last March, the CQC have been working together to determine how the inspection would take place.
This baseline period involves a phased approach to initially tackle four key areas of the assessment:
- Develop and embed an assessment approach through a series of piloted assessments
- Gather the evidence
- Develop an understanding of the performance across the local authorities assessed
- Build a relationship within each of the areas
The idea was by the end of this baselining approach the CQC would have developed a jargon-free set of personalised principles focusing on what matters to people.
CQC inspections of local authorities – Pilot findings
To test this, the CQC held mini-inspections with Hampshire County Council and Manchester City Council. These pilot CQC inspections focused on two themes, how local authorities work with people and leadership.
Through piloting these investigations, the CQC were able to start to understand how the inspection would work in practice and how long a full assessment might take.
All the findings were presented in a small report where they also highlighted the key challenges, they faced such as:
- A lack of standard datasets which they could draw from leading to limited comparisons of datasets for consistency
- There were gaps around regulated provider voice
- A lack of guidance on benchmarking
- Weaknesses in reporting
To address these issues further, the CQC held local authority pilot assessments across 5 local authorities between April to September 2023. These local authorities included:
- Birmingham City Council
- Lincolnshire County Council
- North Lincolnshire Council
- Nottingham City Council
- Suffolk County Council
In the CQC’s evaluation report following the pilot inspections they acknowledged similar themes across all five councils including what is working well and what needs to be improved. The overarching quality statement that needed improvement across all 5 councils were the quality of transitions between services, especially from children services to adult social care.
Issues concerning staff retention were also addressed acknowledging that staff would tend to stay within a local authority when they felt their work was valued and they were consistently progressing within their career. For more specific information on the outcomes of the CQC local authority inspection pilot learn more on their website today.
How will the new CQC assessment of local authorities work?
After gathering their findings from the pilot inspections, the CQC identified three main areas of the approach that needed changing to improve the inspection process:
- Simplify the Information Return Process
- Review Case Tracking Processes
- Develop further how the CQC engages with the public through community and voluntary groups
It was also decided that there would be nine Quality Statements that will be assessed across the four themes we highlighted earlier. Each of these themes will contain quality statements that local authorities must commit to, and I statements which people will expect.
The CQC has stated that their aim is to award ratings to local authorities within a two-year timeframe. By having a longer-term regulatory intention of ongoing assessments rather than a single visit inspection, it allows the CQC to continue to evolve and adapt their approach until they move out into their 3rd phase of the ongoing assessment model. This also includes deciding what are the best options to gather and collect evidence and how some may be better to collect on and off site.
CQC inspections of local authorities - How will they be scored?
These changes to the CQC inspection process will allow greater transparency in the scoring. This will mean that providers will be able to clearly identify what they are doing well and what areas require improvement. The CQC will assess the required evidence and assign a relevant score to each Quality Statement.
The scoring will work as follows:
1 = Evidence shows significant shortfalls in the standard of care.
2 = Evidence shows some shortfalls in the standard of care.
3 = Evidence shows a good standard of care.
4 = Evidence shows an exceptional standard of care
The scores for each quality statement will then be added up and converted into a percentage. The CQC have said that they will still use the same 4 ratings as before: inadequate, requires improvement, good, and outstanding.
Anything rated between 25 to 28% will be considered inadequate, anything between 39% and 62% will be considered requires improvement, percentage scores varying between 63% and 87% will be considered good, and anything above 87% will be considered outstanding.
The CQC have also stated that when local authorities are rated a specific category, local authorities will be aware of their threshold within the scoring system.
At the Access Group we are determined to help all our customers be as prepared as possible to receive the outstanding CQC rating they deserve.
We are aware of the current issues local authorities are facing and we want to help by offering a variety of digital solutions and tools which can help manage your services so you can find the information you need all in one place to offer better joined-up, person-centred care.
The next part of the article will explore the different types of quality statements our technology can help you with to ensure your local council can get the best rating possible.
What are the best ways to prepare for the CQC local authority inspections?
To prepare for the CQC local authority inspections 2023 there are a variety of things your local authority should do.
The first priority is to evaluate your services currently. Once your services are evaluated in your current form you can identify where your weaknesses are in relation to the quality statements and where the CQC would mark you lower.
For example, you should consider what is and is not working well, are your services well led, do staff have the opportunity for further development and training, are you promoting to the people in your local area how to live an independent healthy lifestyle, and have you got plans in place to work more sustainably.
During this process it is also important to make sure your residents and patients are at the heart of every decision made and that they will benefit from them in the long run. Through using and applying this person-centred approach you are already on your way to following the CQC’s credentials and their 5 key questions to ensure your services are safe, effective, caring, responsive, and well-led.
CQC assurance framework of local authorities - how can technology help you prepare?
Following the findings from the pilot inspections, it has been made it clear that all local authorities are heading in the right direction when it comes to overcoming the challenges facing the health and social care market. It also highlights that in order for your local authority to be successful in your CQC council inspection, being consistent, safe, and well-led is essential.
Technology can help local authorities better manage and improve their care delivery across the community to deliver better quality care for every quality statement. Depending on what your local authority needs to improve, technology can offer a variety of tools to streamline case management, help internal delivery, as well as the management of external care providers too. Technology can also help provide a better oversight of the care market so your local authority can be better prepared for both now and in the future. This, in turn, helps deliver more sustainable, person-centred care that is outcomes focused and always concentrates on the individual.
Using technology and a variety of solutions is a great way to prepare. At the Access Group we offer an eco-system of digital tools and solutions which can help your local authority prepare and improve your existing services further to achieve better outcomes and a higher CQC rating. We also know that innovation and integration of technology also helps support and overcome the inequalities your local area may be experiencing.
Within our digital eco-system of solutions, we are continuously trying to find new ways our solutions can integrate together to make inputting and monitoring data easier. Whether it’s to help share data across the market to mitigate risks, help with future demand, or manage referrals from one service to another we are working hard to find ways our solutions can work together.
1. Performance
One of the first ways our technology can help you prepare is through offering solutions that not only can enhance your outcomes but help you to monitor, track, and improve your performance too.
Under the CQC’s quality statements in terms of performance the CQC will be examining:
- How you assess the needs of your population
- How the care needed is commissioned
- The ways you share information and resources across other local communities
- How well your local authority, your services, and your staff are led
- The learning and development opportunities you have to offer
- Your working ethos and whether you enforce a caring working culture with no discrimination
It is clear therefore, one of the most obvious ways to indicate the quality of care and support your local authority offers is through the performance and outcomes of your care services.
Being able to track, monitor, and measure your outcomes is one of the best ways to show to the CQC you are a well-led organsiation that has evidence-based outcomes to prove this.
Through using digital technology all users will have access to real-time information which can be essential when one individual is moving from one service to another. Not only does it ensure resources are being used to their full potential it also helps you see what is already available nearby that your residents could benefit from.
Our Social Care Landscape solution brings together a wide range of datasets to enhance your visibility and provide you a powerful view of your social care market and provision. Unlike other solutions which concentrate on datasets in silos our Social Care Landscape allows you to these combine datasets and sources to access intelligent business insights.
Worcestershire County Council have used our Social Care Landscape to examine commissioned spend activity across different client groups and service providers. Through doing this the council were able to gain valuable insights in comparing the rates they pay to other localities both regionally and nationally.
Another way to ensure your services are well to improve your outcomes is by being having access to offers mobile solutions can help keep track of how your services are being delivered in real-time.
Our CM mobile solution allows support staff to access rotas within a few taps and the access to look at updated service user information whenever and wherever they are. One of our customers, Johanna Hart, the Practice Manager of East Sussex Joint Rehabilitation service explains:
“The CMBI business intelligence data is providing the high-level view needed to manage the service whilst allowing us to drill down into individual detail if required. In addition to the standard reports we have found the ability to develop bespoke reports very useful.”
2. Risk Management
Another example of technology improving services across local authorities is through managing and mitigating risks.
Our Risk Profiler tool brings together a range of intelligent data to highlight providers at various stages of risk. This helps local councils keep a watchful eye over the provider market to give support where needed as well as prevent provider failure and minimise any service-user disruption.
ADASS East of England Region has found using our Risk Profiler solution very beneficial as they have seen an improvement in quality which has been recognised by the CQC, and since 2016, when they started using our PAMMs technology, there has been a 124% increase in the number of regulation locations now rated as ‘Good’ or ‘Outstanding’ by the CQC.
Our commissioning and brokerage technology enhances the mitigation of provider failure further. Wren Housing has found by using our Access Adam Care Commissioning solution no provider that isn’t fully compliant can place any bids and because of this we have been able to automatically check 17,500 safety certificates from 4200 different listings.
3. Prevention
Shifting from a reactive to a preventative care model is vital to ensure outcomes are improved.
With more individuals living independently and having to cope with several health conditions, mobility issues, disabilities or at be at a high risk of hospital admissions and readmissions, it is important to have technology in place to help manage these risks to prevent declines in individual’s health, reduce the pressure on the already overstretched NHS, and promote and encourage longer, more fulfilling independent lives for as long as possible.
Our Access Technology Enabled Care (TEC) solutions go further than just a digital social alarm system, it uniquely combines traditional reactive alarm functionality and proactive digital monitoring of daily living. By managing smart alerts in our Access Assure App we can track and learn daily routines in a matter of 14 days to provide reassurance of wellbeing and preventative alerts when situations change. Our technology addresses a key gap in the current social care system to make a real difference for the individuals in your local community who need to draw on your care and support.
4. Future planning
As well as concentrating on the now and catering to the needs of your community currently, the CQC will also be assessing your abilities to ensure your services are responsive, and how they can adapt in the future.
We are aware of the limiting budgets and how the needs of a community can quickly change year on year or how the need for services can dramatically increase over a short period of time. Being able to forecast these changes accurately is crucial to ensure your spending on commissioning services is efficient and that your services can deliver to the increasing demand.
Middlesbrough Council use our demand modelling technology to improve how their data is analysed to optimise their future planning. What previously took them a month of analysis now only takes a few seconds and they can now have up to 630 separate analyses happen at any one time, improving their forecasts and future planning with up to 99% accuracy.
Here our demand modelling technology can accurately predict the budget required to meet your future needs with great success. This in turn, helps prove to the CQC that your services are meeting their duties under the Care Act, and are prepared for your community’s needs now and in the future.
5. Information and Advice
Another key area the CQC will assess is how local authorities are encouraging individuals to live more independent lives. As already discussed, this can be done by installing preventative measures within households, but it can also be encouraged through social prescribing.
Here social prescribing offers individuals help to overcome any wider social determinants of health they may be suffering with. Digital social prescribing therefore, helps local authorities to manage referrals more effectively so individuals get referred to interventions to best suit their needs.
The services individuals get referred to can educate and empower individuals on how to maintain a healthy lifestyle and find non-clinical ways to manage their mental health and wellbeing. At Access Elemental Social Prescribing we integrate with leading clinical systems to manage social prescribing referrals better.
CQC Inspection Framework of local authorities - Summarising how best to prepare
In this article we have addressed the changes that will happen to CQC inspections for local authorities, how they will work, how the CQC have been preparing, and most importantly the best ways local authorities can prepare.
We have highlighted how investing in digital technological solutions and digitally transforming your services can help your local authorities deliver better joined-up person-centred care.
Here our local authority software can help you best prepare for the upcoming inspections by helping you to drive innovation and deliver all your responsibilities under the Care Act without going over budget.
The government understand the pressure all local authorities to deliver the best quality social care across both adult and children services and have announced in January 2024 that an additional £500 million of social care funding is going to be invested. This provides a great opportunity for your local authority to drive innovation with technology that best suits your community needs to help improve performance and get the best CQC rating possible.
For more information on our Local Authority Software learn more today and contact us with any questions you have, and we can work together to ensure you are fully prepared to get the best CQC rating possible.
