CQC rates London Borough of Harrow’s adult social care provision as requires improvement

The Care Quality Commission (CQC), has rated London Borough of Harrow 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 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 - 2
3. equity in experience and outcomes - 3
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 - 3

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

“At this assessment, we saw a local authority which has seen significant change at a senior level over the past two years. This included a change of their Director of Adult Social Services (DASS), which was being provided as an interim role at the time of our assessment which had impacted on the consistency of leadership being provided at all levels.

“Although there was a positive culture, and staff spoke positively about leaders, the adult social care management team understood they had some work to do to create stability and a clear sense of direction which was impacting on various services they were providing. Overall staffing and funding issues were also contributing to some of the issues we saw.

“We heard mixed feedback when we spoke to people using services about their experiences, and from family carers about access to services. A lot of the feedback was around people’s difficulty in getting the information they needed.

“We found that both people needing support and carers struggled to access the information they needed. Some of the older population in Harrow were struggling to use the technology required to access support and advice following the authority’s decision to shift to digital channels. Not everyone felt that assessments or reviews were timely or person-centred.

“As well as difficulty accessing information, carers also told us they had problems accessing direct payments. The local authority was aware of the issues and had a strategy in place to make improvements in this area. However, carers did also speak positively about the support they received from local carer organisations.

“Front-line staff had a very good understanding of the diverse needs of the communities within Harrow which is important as almost half of the population is of Asian heritage. We heard some great examples of staff using their own lived experience to support colleagues to reach seldom heard communities and overcome challenges in supporting people.  

“Overall, London Borough of Harrow has demonstrated a clear understanding of the areas requiring improvements and are committed to making improvements. We look forward to returning to see how their plans mature and the positive changes this will have on the community of Harrow.”

The assessment team found:

1. Most of the people CQC spoke with were unaware that direct payments were an option available to them, despite the local authority staff telling CQC they discussed the option of a direct payment with everyone when planning their support. The national data survey results (SACE) have shown that 23.63% of eligible people in Harrow had chosen to take a direct payment, while this was lower than the England average of 26.22% for people who use services
2. National data have shown that 40% of carers living in Harrow were not in paid employment because of caring responsibilities, this is much higher than the England average of 28.14%. However, CQC were told about an example where support was put in place to find employment which benefited the whole family
3. Some unpaid carers told CQC there were few supportive services available to them, and particularly noted a shortage of respite services. The local authority told CQC in 2022/23, 23% of unpaid carers in Harrow had some form of respite. The national data survey results for short notice/ emergency breaks, breaks for 1-24 hours and over 24 hours showed 12.5% of carers surveyed accessed support or services which allowed them to take a break from caring at short notice or in an emergency, which is slightly higher than the England average of 10.76%. In addition, 24.41% of carers surveyed accessed support or services which allowed them to take a break from caring for over 24 hours, which was significantly higher than the England average of 13.56%
4. The local authority aimed for a seven day wait time for care assessments for people being discharged from hospital. However, we saw that some people were waiting up to seven weeks. Their neighbourhood teams are working to reduce these waiting times
5. The authority’s website didn’t always have information in accessible formats that met people’s needs. For example, some information was presented on the website in PDF forms that could not be read out on a screen reader, and other sections had poor colour contrast, potentially creating challenges for any visually impaired people wishing to read them
6. There was no guarantee to homecare providers of new care packages and the local authority recognised the need to address homecare through a new procurement exercise. 52% of care staff in Harrow were on zero-hour contracts and the local authority did not pay London minimum wage.

However, the assessment team also found:

1. There was a wide range of services used to engage with unpaid carers whose voices are seldom heard, such as the development of a network of 140 carers champions which included representatives from local community groups, such as Gujarati and Romanian. There were also champions in voluntary community organisations to reach diverse communities within Harrow to support them to access information and advice
2. Senior leaders told CQC of the challenges to maintain a stable workforce which they were addressing by the development of a new strategy which was launched in Spring
3. A workforce development programme in adult social care was underway to make sure staff had the skills they needed to provide good care. A learning and development officer had been recruited to support learning and development programmes
4. The local authority were aware of the need to reduce waiting times for care assessments. They had implemented Access Harrow, a service to carry out routine information and advice work which reduced the need for people to be referred to the integrated neighbourhood teams, freeing them up to deal with people with the most complex needs
5. The local authority had identified they needed to engage seldom heard community groups more effectively. Plans were underway for those groups to be represented on the Safeguarding Partnership Board, so they were more visible to others and able to contribute to learning around safeguarding. The transitions team spoke about working with seldom heard communities and the different approaches they used, such as staging visits over a long period of time, extensive family work or adapting to an initial virtual meeting to gain access to families in communities where they may be a suspicion of social workers. They told CQC this was making a positive impact on the people they worked with as it meant better engagement with them
6. The local authority had a good working relationship with providers. They invested in free training and upskilling of care staff. This included working in partnership with the NHS who delivered training to providers on challenging behaviours in dementia and managing frailty
7. CQC found the local authority worked well with the voluntary sector. This view was shared by most partners. For example they commissioned external groups to provide support to unpaid carers directly including support to maintain their health, wellbeing and resilience, support with completing forms, access to preventative support and benefits advice. A strategy, created with partners was in development to strengthen this work further
8. The local authority recognised the need to invest in new technology, which would need to align with an understanding of data and be used to improve and shape services to need the needs of the population.