CQC rates West Berkshire Council’s adult social care provision as good

The Care Quality Commission (CQC), has rated West Berkshire 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 – 3
2. supporting people to lead healthier lives – 2
3. equity in experience and outcomes – 2
4. providing support (care provision, integration and continuity) – 2
5. partnership and communities – 2
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:

As part of this assessment in West Berkshire, people told us their experiences of accessing and using adult social care services was largely positive. People also told us their social workers were supportive, listened to them and developed care plans that met their needs and respected their human rights.

This was reflected in the emphasis we saw staff place on listening to people’s experiences. They told us this approach helped them to consider the needs of those with protected characteristics and worked particularly well for younger adults and people living with mental ill health.

Staff told us they liked working for the authority and we saw a strong, positive culture, with good systems in place to develop their skills and support them to learn from people’s feedback when things went wrong.

Although we saw the cost of care was transparent and fair, the high cost of care generally in West Berkshire did impact on their ability to always place people locally. In order to manage this we saw the local authority use a flexible approach to pay for residential care which allowed them to adjust for the market rate.

We heard positive feedback from carers on the support they received to help them manage their responsibilities. Although there was a low uptake of the good services they provided and were working towards identifying more carers to make them aware of the support available to them.

We did also see some areas where West Berkshire needs to prioritise improvements. They need to put much more focus on people’s wellbeing to delay or prevent them from needing to access long term care. We found a higher than average number of people whose short term care became long term, and a high number of working age people accessing long term care. This told us the short term care wasn’t always successful at promoting people’s independence. This was unusual in a relatively healthy and affluent area with low levels of deprivation.

Going forward, the authority also needs to make sure they’re addressing some of the digital barriers to accessing care where people, particularly in rural areas, didn’t have access to computers or the internet. They could utilise voluntary groups to do this as well as support them with understanding local needs and planning services. And looking to the future they need to prioritise the development of strategies around market shaping, prevention and co production including links with the voluntary sector in order to meet future care needs and respond to changing demands.

Overall, West Berkshire Council should be 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. The way the local authority assessed and charged adults for care and support was clear, transparent, and consistently applied. Decisions and outcomes were timely and there were no waiting times for financial assessments.
2. People told us they could easily access services, were involved in their assessments, and their wishes and feelings were considered, with people feeling like they had more control over their daily life than the England average of people using the same services.
3. Teams were aware of different cultural, and diversity needs and accessed translation and interpreter services to provide support and care plans in people’s own language. There were also able to access specialist staff and information for autistic people and people with a learning disability, those needing mental health support and for young people transitioning to adult services. Where they didn’t have the skills in house, the teams worked with specialist staff, for example in relation to sensory needs or when carrying out assessments in the Gypsy, Roma and Traveller community.
4. Teams worked well across the local authority which ensured people’s support was planned and coordinated across different agencies and services, with safeguarding in particular working effectively to keep people safe at all stages of their care journey.
5. The needs of unpaid carers were recognised as distinct from the person with care needs. Carers were identified early through initial assessments of people’s needs and got timely support. However, only 19.66% of carers in West Berkshire were accessing support which is below the England average of 34%. The local authority could do more to identify carers and support them to access support.
6. The local authority was providing some support that was effective at reducing the need for long term support. For example, smoke alarms and doorbells adapted for deaf people to keep them safe in their homes.
7. 89% of people over 65 who received reablement/rehabilitation services were still at home 91 days after discharge from hospital which is higher than the England average. This was down to good access to equipment without waiting, and minor home adaptations to help people continue living in their own homes.
8. Transitions from children to adult services worked well. Young people also told CQC the process worked well and they felt supported to achieve their goals and maximise their independence.

However, the assessment team also found:

1. There was online information and access to support, but people told CQC it was clunky, and wasn’t always accessible for autistic people or easily translatable.
2. Although West Berkshire was helping some people avoid or delay long term care needs, there were negative trends in the data for the number of people who have short term care that becomes long term. This indicated that where short term care was put in place, it wasn’t always supporting people’s return to independence. In addition, there were high numbers compared to neighbouring authorities, of people of working age with long-term care needs. This was unusual in a relatively healthy and affluent area with low levels of deprivation.
3. The local authority had identified they needed to develop their work with the voluntary sector to create more formal, structured partnerships with clearer outcomes. This view was also shared with CQC by partners and people across West Berkshire. This would help them to better understand the community needs of people who are at risk of experiencing poorer health and social care outcomes as a result of one or more protected characteristics and those people who are seldom heard. They could also use these relationships to help design those services with their input.
4. West Berkshire should do more to use more specific data than just general population data to reduce inequalities and plan for future service needs. Smaller communities and particularly isolated groups’ needs may be missed by the wider data. CQC heard from front line teams about their awareness of certain groups, such as recent migrant communities, and travellers but did not always see this reflected in data and this did not enable future demographic pressures of an aging population to be predicted and addressed.
5. The local authority had a low uptake of direct payments. Only 16% of people received direct payments which is low compared to the England average of 27%. There was also a backlog in the waiting time for reviews of direct payments. However, there were examples of direct payments being used well to support independence in hospital discharge, people’s cultural needs and young people’s specific needs.
6. The authority acknowledged they needed to take more concrete action around equality, diversity and inclusion. They had commissioned a report to create a framework for this action using people’s lived experiences. A report they commissioned identified themes for focus such as disability and accessibility, neurodiversity, rurality, socio-economic and age-related exclusion, digital exclusion for older people, Gypsy, Roma and Traveller communities and displaced individuals including refugees and asylum seekers. West Berkshire also need to make sure this work isn’t just focused on ethnicity and nationality. There was less focus considering the needs of LGBTQ+ population or how gender impacted needs in particular communities, other than at an individual level.
7. There was not always sufficient care and support available to meet demand for services for autistic people and people with a learning disability, or for people requiring complex dementia care. The local authority was starting to address this and building relationships with housing teams to plan for the future development of services.