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

The Care Quality Commission (CQC), has rated Surrey 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. how the local authority works with people – 2
2. supporting people to lead healthier lives – 3
3. equity in experience and outcomes – 3
4. providing support (care provision, integration and continuity) – 3
5. partnerships and communities – 3
6. how the local authority ensures safety in the system – 3
7. safeguarding – 2
8. leadership (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 we found staff who were proud to work at Surrey County Council and were passionate about serving local people. The local authority was very aware that although Surrey is an affluent county, there are pockets of deprivation where residents have high levels of need and disadvantage. The authority knew of these very differing needs of its population and were doing some creative work to meet those needs and help people keep their independence.

For example, they had an ambitious programme to increases supported living capacity by least 500 spaces to promote people’s independence, choice and control. Their innovative approach included offering ex-council properties to developers who had plans to turn them into care accommodation. There was also a focus on building supported living flats for people with complex mental health needs, helping them to live independently.

Staff also supported people to keep or regain their independence in a variety of other ways. One person was able to move out of a residential care home into supported living because the authority had improved communication with them to help them make informed decisions. The authority was also doing some great work to keep people in their homes for longer and avoiding unnecessary hospital admissions. This reduced pressure on local A&E departments and fostered a more person-centred approach to care.

Staff worked well with other organisations to support people and prevent harm. For example, in one case where an individual had been subjected to cuckooing*, staff brought the person back into a supported living environment with mental health assistance so they could remain living independently but protected from abuse.

However, we also found that staffing challenges meant people’s care needs weren’t always assessed or reviewed in a timely way. Surrey was aware of this and had started work on reducing the backlog which was having a positive impact on the number of people waiting. There was also negative feedback from unpaid carers who didn’t always feel they were offered the right support and weren’t always sure about the outcomes of assessments.

Overall, Surrey County Council should be proud of this assessment and the foundation they’ve created on which to build improvements and further innovation. We look forward to returning to see how their current plans mature.

The assessment team found:

1. People could easily access the local authority’s care and support services through multiple channels, including online and self-assessment options. There was also clear signposting to other community services when people first got in touch if this was more appropriate.
2. Although waiting times could be improved, when people joined waiting lists for care assessments, they had a system to prioritise and manage immediate risk. They also made appropriate referrals and ensured immediate support services were provided to keep people safe.
3. The local authority had placed advisors in each support team to help promote services for unpaid carers. Staff were able to describe in some detail about the kind of support unpaid carers could access. This included support with training, for example moving and handling, respite breaks and access to a one-off payment carers crisis fund.
4. Partners gave positive feedback about how the local authority worked with them to support people's independence. Data for Surrey showed 86% of people who have received short term support didn’t need ongoing longer-term support which is positive compared to the England and regional average of 78%.
5. The use of direct payments was seen as a way of offering choice to people who may not want a commissioned service and the rate of people using direct payments was just above the national average in Surrey.
6. External partners confirmed placing young people with complex needs could be difficult, however acknowledged the local authority was trying to address this collaboratively. One good example was a property had been commissioned for six young people to address a housing gap and enabled them to develop their skills and independence.
7. The local authority used public health information to gather people’s experiences and influence change. The local authority would check with the voluntary sector to see if the research collected was reflective of what people were expressing to them. Feedback showed the local authority was active and attended many community engagements. For example, one Ukrainian group had a dedicated local authority worker to support them.
8. There were strategic plans to address recruitment challenges which had been produced in collaboration with staff. The local authority stated they were making improvements to manage risks until staffing levels had improved, by making better use of existing resources.

However, the assessment team also found:

1. People gave varied feedback in relation to their experiences of receiving care and support in Surrey. For example, one person was assessed and felt listened to, achieving the outcome they wanted, which was to return to live at home. However, other areas of feedback included not always getting the same person to speak to, people waiting for a response sometimes, and not always feeling like they were offered options.
2. Feedback from unpaid carers was fairly negative with typical comments including assessments not being offered, not being accurate, or people not always being sure what the outcome of an assessment was.
3. Safeguarding processes were inconsistent, and partners shared concerns with CQC that staff did not fully understand the process. This included not always understanding mental capacity issues and taking too long to investigate and act on safeguarding concerns.
4. The timeliness of assessments and reviews was an area that Surrey were aware needed improving. Staffing challenges included vacancies meant that some of reviews were not carried out in a timely way and there was a backlog. However, the local authority had focussed on these recently and the waiting lists were starting to reduce. External partners also noted Surrey was an expensive place to live, and felt more help for care and support workers including higher pay could help address some of these issues.
5. Staff reflected there was a high turnover of senior staff, and frequent re-organisation which meant some organisational memory was lost which had an impact on the effectiveness of the authority’s offer to people.
6. External partners said at times local authority staff cancelled meetings at the last minute and often provided agendas on the day which gave little time for preparation. Partners felt they were not always equally valued. However, some praised working with other stakeholders through the local authority. Partners felt they had access to senior commissioners to discuss complex cases.
7. Partners said commissioning processes could make working with the local authority difficult at times. Contract documents were not always sent promptly, and funding could be delayed which put more pressure on the partner trying to plan ahead in relation to their own workforce.

The assessment will be published on CQC’s website on Wednesday 20 November.