The Care Quality Commission (CQC), has published a report indicating that Birmingham City Council is ensuring people have access to a good standard of 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 have been piloting its approach to these new assessments in five local authorities who volunteered to participate. This assessment of Birmingham City Council was part of the pilots. CQC will be incorporating any learning from the pilots and evaluation into the formal assessment approach.
CQC looked at nine areas to assess how well the authority is meeting their responsibilities in order to create their indicative good rating. CQC has given each of these nine areas an indicative scoring out of four with one being evidence shows significant shortfalls, and four showing an exceptional standard:
- how the local authority works with people – indicative score of two
- supporting people to lead healthier lives – indicative score of three
- equity in experience and outcomes – indicative score of three
- providing support (care provision, integration and continuity) – indicative score of three
- partnership and communities – indicative score of three
- how the local authority ensures safety in the system – indicative score of two
- safeguarding – indicative score of two
- leadership – indicative score of three
- learning, improvement and innovation – indicative score of three.
James Bullion, CQC’s chief inspector of adult social care and integrated care, said:
During our assessment of Birmingham City Council’s adult social care responsibilities, it was really impressive to see the ways they were using their existing resources to design a better system.
By shifting away from a model which provides services that people come to, and to one that is more creative and invests proactively in the community, Birmingham is encouraging resilience among its residents and fostering community engagement.
It was clear that staff leaders and partners were all passionate about supporting the people of Birmingham to achieve better health outcomes. They had created a culture of accountability, and a focus on improved outcomes, which was helping people to stay independent for longer, and reducing a dependence on formal services.
Leaders had also created a strong culture called owning and driving performance, which encouraged everyone to be accountable. Staff we spoke with understood the culture and told us about how they applied it every day in their work.
Birmingham City Council were able to show us how partnership working was bridging the gap between health and social care services, resulting in improved experiences for people using services. They were able to minimise discharge delays and ensure people had access to a diverse range of social care providers.
Despite these strengths, Birmingham's adult social care system is not without its challenges. Some people, carers, and providers have faced difficulties accessing social workers, leading to delays in assessments and reviews. Some of these challenges were due to difficulty recruiting into teams, but they were committed to addressing this issue.
They also had a backlog of investigations into safeguarding enquiries, and there were some issues with the quality of investigations where they had taken place. We saw a lack of evidence of professional curiosity and of decision making that could be well defended. Birmingham knew they needed to improve in this area and were able to show us they had a plan to do so.
Also, in a city where more than fifty percent of the population identify as being from an ethnic minority background, more needs to be done to make sure everyone is receiving equitable care.
However, Birmingham should be really pleased with this assessment, and it means they have a great foundation on which to build more improvements. We look forward to returning to see how they’ve done this.
The assessment team found:
- Birmingham's adult social care services were underpinned by strong and effective leadership.
- There was a strong culture of accountability which was well-embedded among staff and created continuous improvement. Leaders had clear strategies and oversight which allowed them to identify issues and work towards finding a resolution.
- Birmingham City Council were very effective at working with partners to improve people’s experience as they navigated through what can be a complicated system to those that aren’t familiar with it, to provide better outcomes.
- When assessments and reviews took place, assessors saw good, person-centred care, where professionals built good working relationships with the people they were assessing and as appropriate, those who were important to them.
- Delayed discharges from the acute sector were rare, and there were multiple, effective pathways, which were tailored to meet people’s specific needs and circumstances.
- Most people in Birmingham had access to a variety of organisations who provide social care services, and there was enough supply of both domiciliary (home-based care) and residential care to meet demand.
However, the assessment team also found:
- Some people, carers and providers told assessors that access to first line information and support, social workers and commissioners at the local authority could be difficult. The local authority has taken steps to address this, but further work is needed to measure the impact of their changes.
- There were some delays in assessments and reviews. Birmingham City Council advised the assessment team this was due to recruitment issues which they had a plan to address.
- Birmingham is a city where people from ethnic minority groups are the majority of the population, and there was still a high degree of inequity of outcomes and experience. The local authority was aware of this and their commitment to change this through their equality, diversity and inclusion strategy, Everyone’s Battle, Everyone’s Business, was a golden thread through everything they did.
- The local authority had a backlog of investigations into enquiries which they have determined meet the threshold for investigation under Section 42 of the Care Act. There had also been qualitative issues with work undertaken, a lack of evidence of professional curiosity and of defensible decision making.
- The local authority acknowledged that their safeguarding practice needed to improve and were able to demonstrate that a plan was in place to address identified shortfalls in practice.