CQC rates Hounslow Council’s adult social care provision as good

The Care Quality Commission (CQC), has rated Hounslow Council as good, in how well it is meeting its 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 to assess how well the authority is meeting its 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. how the local authority works with people – 2
2. supporting people to lead healthier lives – 2
3. equity in experience and outcomes – 3
4. providing support (care provision, integration and continuity) – 3
5. partnership and communities – 3
6. how the local authority ensures safety in the system – 3
7. safeguarding – 3
8. leadership – 3
9. learning, improvement and innovation – 3

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 Hounslow Council and were passionate about serving local people. We also found staff who were broadly representative of the local population they served. This is important as Hounslow is an ethnically diverse area, with almost 40% of people living in the area having an Asian heritage and more than half of the whole borough come from ethnic minority backgrounds.

Staff were supported by leaders who understood the area well and used data and people’s experiences to help them plan services, not just for now, but in the future. They knew they had an ageing population as well as an increasing Asian population who weren’t currently accessing adult social care as often as other community groups. They were aware that might change in the future and there may be an impact on the demand for services if it did.

The authority worked well with other partners, which was helping to make sure people were discharged from hospital into care quickly. We also saw them pooling budgets with partners in a creative approach to provide people with mental health care and support that was reducing the demand for inpatient hospital treatment.

However, we heard mixed feedback when we spoke to people using services about their individual experiences. It was good to hear that most people felt safe and could easily access a good choice of services and the information they needed. But some people told us that they didn’t always feel listened to, and care wasn’t always personalised to help them live how they wanted to or take account of their goals and what was important to them.

Carers told us they struggled to access information, packages of support and direct payments. Combined with a shortage of flexible, responsive places where the people they cared for could get short term support, the ability of carers to work, rest and have control over their lives was significantly impacted. The authority recognises that it needs to do more to make sure that carers felt more supported and we have told them we expect to see improvements.

Overall, Hounslow Council should be really pleased with this assessment. They’ve built a great foundation on which to build their future plans and make improvements. 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 easily access services and waiting times were generally low when it came to initial assessments and care planning. Although some people waited longer for completion of a full assessment, the local authority managed risks to them, including providing short term support, during this time very well.
2. Leaders at Hounslow had a good awareness of the areas where they needed to develop and improve. They also had a plan to address the shortfalls they’d identified which included carers support, reviews, access to occupational therapy and direct payments.
3. The local authority worked with partners to promote people’s independence and work on their resilience to reduce or delay the need to be admitted to a residential health or care setting. Data showed that 86% of people from Hounslow who had received short term support no longer required ongoing support. For example, people in Hounslow were significantly more likely to receive reablement/rehabilitation services after their discharge from hospital. This resulted in a higher number of people who were still independent in their homes 91 days after discharge than the England average.
4. 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.
5. The authority was working to reduce inequalities in health and social care where certain community groups had worse outcomes. For example, they had identified 30 neighbourhoods which had multiple indicators of high deprivation including unemployment, poor housing, and high levels of crime which was impacting people’s care and well-being. They had ambitious plans to target resources in these neighbourhoods to provide people with more opportunities and secure better care outcomes through preventative interventions.
6. Hounslow Council invested significant time and resources in listening to different communities and using what they were told to increase access, design and plan services and make improvements:

• The local authority’s footprint includes a well-established Traveller site in Cranford and they recognised this was a population who had poorer access and outcomes from their services. They talked to the community using existing connections and representative groups to find out their concerns and what barriers there were to them accessing adult social care. They were using this information to design better access.
• They acknowledged members of the LGBTQ+ community didn’t always feel represented so they facilitated the development of a public forum, to engage with them on adult social care services and other local authority matters.
• They had good sign language interpretation and translation services to ensure there were no language barriers to assessment (particularly important as Hounslow has a population with 188 different languages.)
• Following feedback from a user group for autistic people and people with a learning disability about the accessibility of their documentation, the local authority commissioned the group to create easy read versions. The work was so successful it led to work for other council departments, and the NHS both locally and nationally.
• They worked with voluntary, community and social enterprise organisations to make services more accessible for blind people and others who do not use spoken or written English as a first language, via grants and commissioned services.

7. They had created a new model of support and accommodation for people with mental health and substance misuse support needs, who wouldn’t typically accept help. The local authority told CQC of their pride in developing a new service which felt like a hotel but had security and support services, minimising the amount of people being admitted to long stay and secure mental health wards.
8. Hounslow Council does valuable work with partners to bring attention to the issue of modern slavery. They created a series of webinars on the issue to help their staff and others recognise the signs of modern trafficking and created an advocate role who people could report concerns to.
9. People were usually able to access care when and how they needed it, although for residential or nursing care this might be out of area.

However, the assessment team also found:

1. Carers in Hounslow felt less supported than people who used services. They were less likely to have an assessment, found it harder to access information that they found helpful, and were less likely to have services to support them in their caring role. Only 27% of carers felt they had encouragement and support and 44% of carers in Hounslow weren’t in paid employment because of caring responsibilities, which is significantly worse than the England average of 28%. The uptake of services for carers was low and the waiting time for assessment could be as long as 93 days. The authority were aware of these issues and had a plan to address them.
2. Uptake of direct payments in Hounslow was lower than the England average for people who use services, and particularly low for carers.
3. Hounslow had outsourced financial assessments and people often waited a long time for decisions to be made on their outcome, particularly when moving into residential care. Although there wasn’t evidence it had delayed people moving into placements, this could cause financial worry to them or their families. It could also mean that people were unable to make a fully informed decision prior to moving without delaying a necessary move.
4. People couldn’t always access equipment and minor adaptations to maintain their independence quickly enough. By the time some people’s needs were assessed they no longer needed support.
5. Recruitment and retention in adult social care workers was a challenge in Hounslow with a higher level of adult social vacancies than the England average. To counter this, they were conducting an international recruitment campaign with other London local authorities. A significant number of homecare staff had been recruited through the UK Immigration Sponsor Scheme, and proposed changes to this may impact on recruitment and retention.