Milestone report finds systemic weaknesses in some councils’ delivery of adult social care

A “milestone” report by the care watchdog has found “systemic weaknesses” in the way some local authorities across England are delivering their adult social care duties.

The Care Quality Commission (CQC) said it was most concerned about the variation in performance on safeguarding across different councils.

It said it had found “areas of real concern about the safety of people”, with “systemic weaknesses in governance, oversight and assurance of safeguarding, in some places”.

Some areas also showed “significant” weakness in assessing disabled people’s needs, with delays in care assessments and reviews.

How local authorities deal with young disabled people’s transition from children’s to adult services was “consistently identified as one of the most challenging areas and a persistent area of risk”.

There were also variations in waiting times and access to support for people with learning difficulties, autistic people, people with “complex mental health needs” and people with sensory impairments.

And CQC uncovered “stark variation” in how councils implemented co-production, finding that it was “frequently perceived as tokenistic, with people unclear about their role, influence, or the impact of their involvement” and “engagement taking place after decisions had effectively been made”.

Where effective co-production had taken place, those involved could “clearly describe what had changed because of their involvement, demonstrating that co-production was influencing decisions rather than simply providing opportunities for engagement”.

The report also concludes that there is “no clear link between the quality of adult social care provision” within a council and that area’s level of deprivation.

CQC’s inspectors found that intersectionality remained “poorly embedded” in adult social care, with councils failing to recognise age, disability, mental health, sexuality and caring roles as “overlapping drivers of inequality”.

The report draws together conclusions from the first national programme of assessments of how local authorities deliver their adult social care duties under the Care Act, examining the first 143 assessments carried out across the 153 local authorities in England with adult social care responsibilities.

The programme, which began in December 2023, found that, so far, 60 per cent of councils have been rated as good, 35 per cent as requires improvement, with four councils (three per cent) outstanding and three (two per cent) inadequate.

Chris Badger, CQC’s chief inspector of adult social care, said there were “local authorities close to each other, some side by side, dealing with the same challenges but whose residents are having very different experiences”.

He said too many people were waiting “far too long” for assessments, reviews, services and equipment.

And he said it was clear that the most important factor when determining how good services were was the standard of leadership within the local authority.

Picture by Andrew Parsons/No 10 Downing Street