CQC rates Derbyshire County Council’s adult social care provision as good

The Care Quality Commission (CQC), has rated Derbyshire County Council as good, 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 good 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 - 3
5. partnership and communities - 3
6. safe pathways, systems and transitions - 3
7. safeguarding - 2
8. governance, management and sustainability - 3
9. learning, improvement and innovation - 3

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

“At this assessment of Derbyshire County Council, we found staff who were passionate about serving local people. They were being supported by leaders who had implemented very efficient systems and processes and assessments and support waiting times generally low.  

“The authority worked well with partners, especially when assessing people waiting to be discharged from hospital. We found people didn’t have to wait long for an assessment because the system was well organised and resourced.

“People who were using their services generally gave good feedback, higher than the England average and felt well supported by staff who went out of their way to put people’s needs first. People also told us staff were creative in helping to keep them well at home for longer to prevent them from needing acute, residential or more long-term help. This was reflected in what staff told us about having been given permission by leaders to do what was needed to keep people well and safe.

“We also heard good feedback from carers who were able to access support quickly, and it was bespoke to them rather than the person they were caring for. There needs to be some work to ensure that there were enough options for them to access respite or breaks.

“However the authority recognises it still has some work to do to better understand the needs of their population more fully, including from seldom-heard groups. They also know there is more work to do to ensure that people living in the rural pockets of Derbyshire were able to access services as easily as those were lived in the more urban areas.

“Overall, Derbyshire County Council should be really pleased with this assessment. They’ve built a great foundation on which to progress their current transformation plans and make further changes. We look forward to returning to see how they’ve done this and how their current plans mature.”

The assessment team found:

1. People with care and support needs could access services and waiting times were generally low when it came to initial assessments and care planning. Recent changes to team roles and the duty system meant that people waiting for assessments had been seen more quickly, reducing overall waiting times
2. Out-of-hours social workers used short-term assessment plans, to arrange care quickly and senior managers effectively reviewed staffing levels, based on demand and complexity. There were no waits for approved mental health professional assessments and this enabled effective mental health support
3. Direct payments for services were used in an innovative way to enable people to receive care, particularly when there were unique personal preferences. This included when people used assistive technology. There were significantly larger numbers of people who accessed direct payments in Derbyshire than the national average
4. The occupational therapy service had recently been redesigned which improved the timeliness of assessments
5. Neuro-development hubs had been implemented across Derbyshire for children and young people who were neuro-diverse
6. Reablement staff supported people to regain their independence. For example, the local authority provided step-up and step-down beds to support falls and the avoidance of hospital admissions. In turn this supported a better flow around the health and social care system. Mental health enablement was also available, which helped to avoid short term support becoming longer-term support
7. The carers organisation offered a telephone befriending service for isolated carers in the rural population. We heard they intended to support more seldom-heard carers from ethnic minorities, lesbian, gay, bisexual and transgender carers and those caring for people with substance misuse issues. There was also a male carers support group
8. Social work staff worked hard to encourage people’s independence according to their specific needs. People were encouraged via the Community Connector service to try new things and they reached into local resources and build relationships with families. People felt they had more control over their daily life and were satisfied with their care and support in Derbyshire than the national average.
9. Staff provided a brokerage service which offered alternatives to people who weren’t eligible for funding for local authority commissioned support. Inspectors saw examples of how social workers had supported them around their wider needs, which had been beneficial to their long-term wellbeing.
10. There was a focus on making sure young people transitioning from children to adult social care services were having good experiences, supported by specialist teams.

However, the assessment team also found:

1. People’s experiences of their assessment, care and support in Derbyshire was mixed. People in more rural and difficult to access places were less likely to get the full range of community services and homecare services could be a challenge to organise. However, feedback from people showed staff demonstrated a strong level of creativity and purpose in keeping people well and at home for longer
2. There was a backlog in financial assessments which impacted payments to services. The average wait for financial assessments was 21 days, but some people waited much longer than this. This could cause financial worry to people and their loved ones
3. Leaders, staff and partners mainly described addressing equality for the rural population and the deaf community, with very little description about supporting other groups as ethnic minority communities made up a very small proportion of the population
4. Recruitment and retention of skilled workers and a reliance on agency workers, was a challenge. People said homecare staff shortages had an impact on their daily life and their sense of choice and control. People in rural areas found it particularly difficult to access homecare and other facilities such as transport
5. Mental health hospital discharges could be complicated by a shortage of supported housing services for homeless people. However, there were good examples of housing officers being routinely present in a mental-health hospital, to support housing on discharge.