CQC rates Derby City Council’s adult social care provision as requires improvement

The Care Quality Commission (CQC), has rated Derby City 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 - 2
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 - 2
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 people’s experiences of care and support from Derby City Council were mixed. However, leaders at the authority had really good oversight and were already aware of some of their shortfalls prior to the inspection and were taking steps to address them, such as their notable improvement reducing waiting times in safeguarding enquiries and assessments.

“Some people felt their views were listened to, and their needs considered throughout the assessment process. However, carers told us assessments weren’t always carried out quickly, highlighting a lack of communication between the assessment teams and providers.

“There were 48% of known carers who were overdue a review, with some telling us they would like more preventative support as they were only reviewed following a mental breakdown or other serious situation. However, work had started to improve communication with them to help understand their needs.

“Providers of social care told us there were people whose care and support needs had increased, and this wasn’t reflected in their current support plans. Also, some people who were accessing their services hadn’t had a review in many years to ensure they were receiving care that was right for them.

“There were also differences in health inequalities across minority groups affecting access to services. There was a rising demand for people with complex needs that might require specialist provision for mental health, homelessness, substance misuse, learning disabilities and autistic people. Also, there was a gap in services for the deaf community and for those living with dementia, where the authority was unable to provide local services and placements, including limited respite care, due to the rise in demand.

“However, the local authority was working in partnership with a number of organisations to ensure they formed closer links to the community with the aim of reducing health inequalities across Derby City.

“It was positive to find the local authority had started work to understand the needs of seldom heard groups, those people who find it more difficult to access council services, through various initiatives, but there was still more work to be done in this area.

“It was reassuring that partners spoke positively about the relationship they had with the authority. Also, staff told us that there was a strong leadership team with an open, trustworthy culture.

“Leaders at Derby City Council had already started to draft strategies to make improvements in the areas we found at this assessment, in order to improve services for people in Derby. The authority should continue to make further improvements for carers, for providers, and to address inequalities through these strategies.  We look forward to returning to see how these changes have been made and embedded.”

The assessment team found:

1. There was a shortage of social care staff, in some areas which was impacting the delivery of services. Staff specifically spoke of the difficulties in recruiting to support people with more complex needs meaning people were allocated standard placements which didn’t meet their needs
2. The reduced number of staff in the occupational therapist team had led to an increase in waiting list times in all areas including assessments, grant approvals, and funding allocations
3. The authority had teams in place to deaf people and British Sign Language interpretation was made available and accessible from multiple sources However, partners highlighted that they did not always provide adequate face to face translation and that accessible information documents weren’t always available
4. There were concerns around the use of direct payments and prepayment cards, stating if people were eligible for personal budgets, they were often told that it was the only option to purchase services. Partners felt commissioners were often unable to advise people of alternative options to prepayment cards
5. There were also inconsistencies around the direct payment usage as information shared explained that some families have direct payment accounts building up excessive amounts, for services that are unavailable or non-existent with no support to identify suitable services to meet their needs
6. There was a shortage of specialist housing provision for people with complex needs and a shortage of supported living and extra care for individuals over 60. This sometimes led to people being placed outside of the local area
7. The transition from children to adult services was not always a smooth process. Some people at the age of 18 had no support in place, for others an assessment had been completed, however, their needs were not met
8. The local authority had waiting lists for assessments and reviews. There were 1454 overdue reviews equating to 42% of total cases.

However, the assessment team also found:

1. People had access to the local authority’s care and support services via a variety of channels, this included Derby Direct which offered people both telephone and a website support service
2. There were some good examples of positive preventative support in the community such as the work of local area coordinators and community connectors who were trained to take peoples blood pressure in the local community to spot hypertension and prevent/delay need for future services
3. There was good access to equipment and minor home adaptations to help people maintain their independence and continue living in their own homes
4. Joint working with Derbyshire Community Health Services had started focusing on preventative measures to improve hospital discharge pathways, with an aim to keep people in their homes for longer. This had already led to a decrease in hospital admissions compared to the previous year due to joint working
5. The local authority recognised that they faced additional challenges in relation to the financial impacts on carers due to levels of deprivation in Derby, and the cost-of-living crisis. They were working to ensure carers were identified and able to access support.