CQC publishes report on Medway Council’s care act responsibilities

The Care Quality Commission (CQC), has rated Medway Council as requires improvement, in how well they are meeting their responsibilities to ensure people have access to adult social care and support.  

CQC has a new responsibility to assess how local authorities meet their duties under Part 1 of the Care Act (2014).

CQC looked at nine areas spread across four themes to assess how well the authority is meeting their responsibilities in order to create their requires improvement rating. CQC has given each of these nine areas a score out of four with one being the evidence shows significant shortfalls, and four showing an exceptional standard.

1. Assessing people’s needs – 2
2. Supporting people to lead healthier lives – 3
3. Equity in experience and outcomes – 2
4. Care provision, integration and continuity of care - 2
5. Partnership and communities – 3
6. Safe pathways, systems and transitions - 3
7. Safeguarding - 2
8. Governance, management and sustainability - 2
9. Learning, improvement and innovation - 2

James Bullion, CQC’s chief inspector of adult social care and integrated care, said:

“At this assessment we found staff who were proud to work at Medway Council and were passionate about serving local people. However, the council faced challenges with staffing and recruitment, particularly with adult social care staff, which was having an impact on how long people were waiting for assessments and the effectiveness of their services.

“One of the areas this was impacting was safeguarding. Staff weren’t always able to contact people in a timely way following a safeguarding referral. Leaders were aware of the issue and work had begun to improve this, specifically for those waiting to hear back regarding information of concern.

“We heard mixed feedback when we spoke to people using services and about their individual experiences. Some people gave us positive feedback of being supported and listened to during the assessment and the ease of direct contact with their allocated social worker. However, we were also told of an example where staff weren’t knowledgeable about the specific disabilities of a person and their family members felt staff had been reluctant to help or support.

“Medway delivered basic home equipment quickly, usually in five days. They also helped people stay independent through adaptations and safety features like emergency alarms. While this worked well for simple items, we saw longer waits of up to 98 days for complex equipment, as it relied on external manufacturers. Voluntary sectors partners also highlighted some unacceptable waiting times for property modifications – with one resident unable to leave their home for 15 months while waiting for adaptations.

“People told us they used direct payments to control how their care and support needs were met and mostly described positive outcomes from using them. People could also access support in using direct payments from a dedicated team.

“We found the recruitment and retention of adult social care staff was a significant challenge across Medway. Care organisations told us that poor collaboration with the authority on appropriate working conditions including pay, sick pay or travel time had contributed to this. They also fed back that there also needed to be more collaboration on the cost of care, and to make sure contracting arrangement were transparent and fair.

“Leaders at Medway are aware of where improvements need to be made to ensure people have access to the services they need.  We look forward to returning to see how they’ve done this and how their current plans mature.”

The assessment team found:

1. The local authority used a number of measures to understand of the needs of people in Medway and the impact of inequalities. There was some good partnership working with voluntary sector groups, but this needed developing more to understand the needs of local communities.
2. The council aimed to have financial assessments completed within 56 days. However, they struggled to meet this target and the average was 181 days. The council confirmed that a shortage of staff, delays in information being provided by people, and responses to information requests from social workers were the main causes to the delays. New staff were being trained to undertake financial assessments to address this.
3. Staff were able to use different communication methods depending on people’s needs. At the time of the assessment a partner organisation said the deaf community may struggle to access services as there was no funding for an interpreter. However, the local authority later confirmed they would have video interpreters for deaf people available in September 2024. Staff also said the local authority needed to pay more consideration to accessible information and communication methods.
4. The experiences people had of carers assessments and local authority support was mixed. Some unpaid carers did not know carers assessments were available and there was a general lack of information available about them. A carer said they had been asking since January 2024 for a carer’s assessment and had still not yet received one at the time of this assessment in May 2024.
5. More work was needed with care providers to ensure they all received a consistent service from the local authority and were in receipt of the support the local authority stated they received.
6. Senior leaders were jointly responsible for the oversight of safeguarding processes, systems and practices, however safeguarding needed improvements. This was being addressed in a number of ways including restructuring of the current safeguarding hubs and learning sessions for staff from Safeguarding Adult Reviews.

However, the assessment team also found:

1. The local authority recognised the increase in demand for services and staff shortages had resulted in a backlog of assessments. They had begun additional recruitment, were providing extra training to support staff skills and retention, and had accessed funding to address the back log
2. Care services in Medway had experienced a reduction of staff especially in residential and nursing care homes. In response to this the local authority had created a number of strategies to address and monitor this.
3. The local authority worked with partners to deliver intermediate care to support people to remain independent following a hospital stay. Daily meetings were held with the local authority and stakeholders to discuss people’s individual needs. NHS leaders described the relationship with Medway as a good example of partnership working.
4. An Ofsted report from July 2023 recognised for some young people with disabilities transitioning from children’s to adult services was not started early enough. As a result, the council had established clear processes for staff to follow and now started to identify children from the age of 16 who would need support. However, the authority understood it needed to address shortfalls in available nursing and residential beds in Medway, particularly for young people with complex needs leaving children's services.
5. The local authority was proud of the partner working to support multi-disadvantaged people and they had a multi-disciplinary drug and alcohol service team. These were developed following identifying gaps in the market and worked to support people in the community. It brought together separate initiatives to bridge the gap to people who found it difficult to access services.
6. Occupational therapy waiting lists were increasing and the local authority were positive about demonstrating more people were accessing the right support, at the right time to stay independent.

The assessment will be published on CQC’s website on Friday 10 January