Agenda item

The Committee considered a report of the Director of Adults and Communities which provided an overview of the Care Quality Commission (CQC) assessment of Leicestershire County Council, and an overview of the Department’s draft improvement plan to deliver improvements identified in the CQC assessment report.

The report further provided background information in relation to the responsibility of the CQC to review the performance of local authorities in their delivery of adult social care duties under part one of the Care Act 2014. The report further outlined the CQC assessment framework and process, and the timelines of the CQC’s assessment of Leicestershire from initial notification to report publication. A copy of the report marked ‘Agenda Item 8’ is filed with these minutes.

The Chairman welcomed Fiona Barber, Healthwatch Leicester and Healthwatch Leicestershire, to the meeting.

The Chairman further welcomed Mr. C. Abbott, Cabinet Lead Member for Adult Social Care to the meeting.

Arising from discussion the following points were made:

i.          A Member questioned that, with a CQC score of 53, under which quartile would Leicestershire County Council fall when compared to other councils. The Director of Adults and Communities responded that the CQC did not publish a league table, but had baselined all 153 authorities since 2024, but Leicestershire was likely to be in the third quartile ‘Requires Improvement’.

ii.          In response to a question as to why external improvement support was being sought and if the Council had the resources to deal with the issues identified, it was reported that in terms of improvement, the external support was provided by Partners in Care and Health, which was funded by the Department of Health and Social Care (DHSC), a combination of the Local Government Association and Association of Directors of Adult Social Services. Improvement support that could be drawn upon covered areas such as workforce and safeguarding.

iii.          With resource requirements for improvements estimated to be £3.5 million, again it was asked if identified issues were to do with process, which could be managed by the Council rather than using external support. It was explained that some, but not all, issues were not about process, but capacity related where increased spending was required, for example, occupational therapy required additional staffing to meet demand and reduce waiting lists.

iv.          Members were disappointed that the authority had a rating of ‘Requires Improvement’. Members sought assurance that, with a £90million efficiency target and a global consultancy engaged, improvements would be funded to achieve a ‘Good’ or ‘Outstanding’ rating, and there would be sufficient resources to avoid remaining in ‘Requires Improvement’ and prevent DHSC intervention. Members were informed that some improvement resources would be one-off, with others ongoing, but amounts could not yet be confirmed. Early work had shown Care Act assessment waits had halved with short-term funding, while occupational therapy still required permanent staff. Each year, the Medium-Term Financial Strategy (MTFS) set growth and efficiency plans which the improvement partner would review and suggest further actions, including demand management, as ultimately a balanced budget must be delivered.

v.          A Member questioned how much of the waiting list of people waiting for assessments was due to increased demand versus the NHS discharging patients too quickly, causing cost-shunting to social care. Members were assured that the Council worked with the NHS to manage care end-to-end. Around 30% of social care cases came from hospital discharges. The authority was expanding intermediate care for short-term rehabilitation to reduce admissions. Leicestershire was also piloting the national neighbourhood health programme to shift care from hospital to home.

vi.          A Member noted that demand for adult services had risen while funding and staffing had fallen, making Leicestershire one of the worst-funded councils, and it was questioned how services could be improved if costs were cut, and had the closing of council elderly care homes that provided reablement been a mistake. The Director reported that staff reductions had occurred, saving around £4million since 2017/18, but it was hard to say if that had affected the outcome of the report given there had been unforeseen and unprecedented demand, which had doubled post-pandemic.

vii.          With regards to care homes, the Director stated the decision had been right at the time as they had been more expensive to run than private sector homes, with care now purchased from 180 homes. He added that to reopen homes would come at a premium. Investment in intermediate care with NHS partners had been made, with University Hospitals Leicester opening new intermediate care beds, with more planned. On carer support, a new service offer was being commissioned, and a new strategy was being developed which was informed by engagement with carers.

viii.          A Member reported that communication with Adult Social Care was difficult, for example, long telephone wait times, and if carer support was a priority, then communication needed to be fixed. Officers reported that communication was a known concern that that telephone access and user experience would be reviewed to improve contact.

ix.          Members were disappointed that the CQC report had not included reference to underfunding and rural deprivation. The report had also warned that the ageing population would rise by 28% by 2035, which Members found alarming. Members requested that the improvement plan include improved GP collaboration, improved rural communication, and address hidden deprivation. The Director reported that GP collaboration was key, and that Leicestershire was piloting the Neighbourhood Health Program with care coordinators in surgeries. Rural engagement would involve local area coordinators and voluntary partners. Alongside the improvement plan would be a risk register. Demographic growth would be built into MTFS projections over four years.

x.          A representative from Healthwatch reported that, of the 10,000 enquiries made over 2024, most were health-related, with social care concerns centred on carers, communication, and waiting times, and noted the CQC report had reflected this which in turn had enabled improvement discussions. It was noted that people mainly wanted advice in order for them to remain independent, information on respite care, and that having someone to talk to on the end of the phone was essential. It was reported that the Health and Wellbeing Board was updating its strategy to build community resilience, aligning with social care delivery, to which the neighbourhood care model would help long-term. Healthwatch welcomed the report and urged engagement with service users to refine the Improvement Plan.

The Cabinet Lead Member for Adults and Communities supported any improvements that could be made to communication methods when contacting adult social care services.

RESOLVED:

a)    That the report on the Care Quality Commission Assessment of Leicestershire County Council’s delivery of Care Act 2014 duties be noted.

b)    That the overview of the Department’s draft improvement plan to deliver improvements identified in the CQC assessment report be noted.