CQC rates Westminster City Council’s adult social care provision as good

The Care Quality Commission (CQC), has rated Westminster City 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 - 3
2. supporting people to lead healthier lives - 3
3. equity in experience and outcomes - 3
4. care provision, integration and continuity of care - 3
5. partnership and communities - 3
6. safe pathways, systems and transitions - 3
7. safeguarding - 3
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, we found Westminster City Council were ensuring people and unpaid carers were able to access person-centred adult social care services quickly. They demonstrated a real commitment to effectively manage services with good systems in place for assessing people needs and planning their care.  

The local authority quickly carried out responsive assessments and reviews of people’s care needs which meant there weren’t any waiting lists. Westminster had set themselves a target to complete assessments within a 28-day period, and performance data showed that over 95% of cases were completed ahead of that target, demonstrating strong management.

People told us they felt listened to during their assessments, and their care plans were tailored to meet their individual needs. Unpaid carers also gave mostly positive feedback, particularly regarding respite care, though some highlighted the lack of specialist respite options to meet unpaid carers needs and planning for emergencies if they were unable to care for their loved one unexpectedly.

The authority made sure people had good access to the information they needed. People who needed support and unpaid carers could easily access information and advice on their rights under the Care Act and navigate the services available to them. People praised the council’s adult social care website for its clarity and ease of use. People also told us the information and advice provided was clear and concise, which helped them to understand the process as well as the support arranged for them.

Although frontline staff were discussing with people about whether direct payments were appropriate for them uptake remained low. The authority had plans in place to address this. Some carers weren't aware it was an option, and some that were aware chose not to use it as it felt too complicated. Partner organisations told us there were issues due to challenges with the local authority's system, which led to a lack of choice and control for people.

Westminster also have some work to do around reducing inequalities. There was an 18-year gap in life expectancy for men and a 9-year gap for women between the most and least deprived areas of the borough. The local authority is already aware of this and is implementing strategies to tackle it. It was encouraging to see them actively working to address these disparities by working with local residents and staff.

Overall, Westminster City Council should be really pleased with this assessment. They’ve built a great foundation on which to progress their current 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. The local authority worked with partners to quickly deliver reablement services that enabled people to live independently following hospital discharge. The council’s reablement services were highly effective, with over 90% of people who received short-term support, such as mobility equipment no longer requiring ongoing care.
2. Westminster City Council actively supported internships and development opportunities for young people with disabilities, helping them gain skills and experience.
3. The local authority recognised the need to support unpaid carers and had invested in a partner organisation to support with carers assessments and reviews.
4. The local authority showed commitment to involving people and unpaid carers in designing services, systems and reviewing practice at all levels. They even participated in the recruitment of senior staff.
5. Frontline teams shared they had a positive working relationship with all partners supporting carers and made necessary referrals when they identified an unpaid carer who required support. National data supports these findings showing that 43.90% of carers in Westminster were satisfied with social services which was higher than the England average of 36.83%
6. When the local authority worked in partnership with other agencies, there were clear arrangements for governance, accountability, monitoring, quality assurance and information sharing.
7. The senior leadership team was well established and stable. Frontline teams across the service spoke highly about the leadership team and found them approachable and supportive. Staff felt they were trusted to make decisions, and they did not feel there was a sense of hierarchy, with a working culture based on trust and autonomy.
8. As part of the local authority’s improvement plans, they intended to develop an online self-referral process to create more opportunities for access and make the process more effective.
9. Staff uptake of mandatory safeguarding training was good, meaning people were well protected from abuse. Safeguarding training had been accessible for all staff and partners.
10. Staff had access to good quality supervision and had manageable workloads meaning they had time to benefit from additional training opportunities, which in turn benefited people using services.

However, the assessment team also found:

1. There were gaps in how the authority was reaching out to carers from seldom heard groups. For example, unpaid carers within ethnic minority communities did not always seek support as their caring role was viewed as different to other cultures. The local authority had acknowledged this gap and was working with partner agencies, people and unpaid carers to address some of the inequalities.
2. Although there was good information about the services available, some people told us they felt the process of assessing their needs was confusing and didn’t know who to contact for specific services.
3. National data showed that 55.98% of people were satisfied with the care and support in Westminster, which is lower than the England average of 61.21%. Additionally, 70.44% of people felt they had control over their daily life, which is also lower than the England average of 77.21%.  
4. Partners told CQC mental health provision and support was good, but wasn’t always appropriate for all levels of needs. Whilst there was support for those with low-level needs and those at crisis, the support available was not always appropriate for those with on-going mental health needs. For example, there weren’t many places for people needing specialist dementia care. The local authority was working closely with health partners to improve support for people who required specialist mental health support.

The assessment will be published on CQC’s website on Friday 8 November.