The Care Quality Commission (CQC), has rated the London Borough of Lewisham as requires improvement, in how well they are meeting their responsibilities to ensure people have access to adult social care and support under the Care Act (2014).
CQC has a new duty under the Act to assess how local authorities work with their communities and partners to meet their responsibilities. This includes promoting the wellbeing and independence of working age disabled adults, older people, and their unpaid carers to reduce their need for formal support where appropriate. Where support is needed it should provide people with choice and control of how their care needs are met.
CQC looked at nine areas spread across four themes to assess how well the authority is meeting their responsibilities in order to create their 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: 3
3. equity in experience and outcomes: 2
4. care provision, integration and continuity of care: 2
5. partnership and communities: 2
6. safe pathways, systems and transitions: 2
7. safeguarding: 3
8. governance, management and sustainability: 2
9. learning, improvement and innovation: 3
Mary Cridge, CQC’s director of adult social care, said:
“During our assessment of the London Borough of Lewisham, we found a mixed picture of people’s experience accessing adult social care. While we found a number of strengths, we also identified areas where Lewisham needed to improve people’s experiences.
“Lewisham has built an inclusive and positive culture of continuous learning and improvement, with staff given ongoing access to training. When things go wrong, the local authority ensures lessons are learned and shared. Leaders also made co-production a priority, working with people with lived experience to shape services and plans for future improvement.
“However, people’s experiences of assessment and care planning were inconsistent. Some people felt listened to and involved in decisions about their care, while others told us they felt disconnected from the process and that support didn’t always reflect their individual needs. Delays to assessments and reviews meant some people were waiting too long to receive the support they needed.
“We also found that people didn’t always experience equitable access to care and support. Unpaid carers didn’t always receive the support they needed, and some communities, including autistic people, people with learning disabilities, people with mental health support needs and people from ethnically diverse communities, didn’t always receive services that fully reflected their needs or experiences.
“People using mental health services didn’t always experience joined-up support. Gaps in mental health pathways and management of them meant the authority couldn’t always be assured people were receiving timely and appropriate support.
“Lewisham understands where it needs to improve and has already begun taking action across a number of priority areas. We look forward to returning to see how this work develops and the difference it makes for people across the borough.”
The assessment team found:
- The authority didn’t always identify and respond to unmet needs promptly. Delays to assessments and reviews limited its ability to proactively monitor people’s changing circumstances and manage emerging risks.
- Unpaid carers didn’t always receive the support they needed. National data from 2023/24 showed that 44.29% of carers found it easy to access information and advice, below the England average of 59.06%. Some carers said respite provision was not practical or culturally appropriate.
- The authority needed to improve equity and accessibility across some services. People from groups whose voices are seldom-heard often felt underrepresented in strategic decision-making, services didn’t always reflect the needs of Lewisham’s diverse communities, and commissioned home care services weren’t always representative of the borough’s diversity.
However, the assessment team also found:
- People described occupational therapy and enablement services as life-enhancing and said they helped them regain confidence and independence.
- Staff demonstrated a strong commitment to supporting people well, and we found several examples of effective partnership working that helped people maintain their independence.
- The authority strengthened partnership working across health and social care, helping neighbourhood teams identify people at increased risk earlier and coordinate support more effectively.