Learning from the first wave: Reflections from directors of adult services who have completed their CQC assessment

• This is your chance to get across the strengths of your council and your collective self-awareness. Remember the emphasis on outcomes, practice, user and care experience and voice.
• You should not hesitate to lead the CQC team towards what you consider to be excellence, particularly where this is validated by data and evidence of outcomes. You will want to highlight where this is recognised externally or benchmarked.
• Keep your self-assessment short and purposeful so it reads as a self-reflective narrative, covering all four themes and nine quality statements, that will help shape the CQC report.
• Your presentation to the set-up meeting sets the scene for the onsite activity and the final report. It is important to get the participation, content, tone and material right.
• Do not expect any informal engagement with the CQC team when onsite. Until the most recent visits, they have not agreed to end of day keeping in touch meetings (as Ofsted or peer reviews offer). Try and get catch ups in place, to help pick up on any issues of clarification or concern.
• Get preparation and debriefing arrangements in place for those meeting CQC. It is important people feel confident about talking about things that work well and how things that work less well are being addressed.
• Do not overlook the significance of people’s voice in this process. It is evident from reading reports that individual’s views can carry considerable weight in determining the judgment. Debriefing may help you anticipate this and give you the chance to explain any context during the visit or when responding to the draft report.
• Expect several factual errors or other misapprehensions in your draft report.
• Directors may also feel that the judgment of one or more areas is open to challenge.
• There is a balance for councils between accepting the judgment as a baseline assessment and pursuing a challenge through yet untested routes. Disputes could lead to delays in reporting the outcome of the assessment with associated impacts on morale and confidence of local politicians, partners, staff, and users and carers.
• If you have a Requires Improvement judgment, you can expect contact from your Care and Health Improvement Adviser and offers of support from your ADASS region and wider Partners in Health and Care.

The pace and pattern of activity by CQC have given most councils an extended period for preparation before their engagement is formalised. 

The LGA published top tips on this in 2023, based on a list developed by ADASS Northern Regions.

Notification, usually in the form of an email to the chief executive and director of adult services, signals the start of the process. It triggers a requirement to complete an Information Return. This comprises 38 ‘IR’ elements covering all aspects of the assessment as set out in CQC guidance. The expectation also includes returning a data pack, list of voluntary, advocacy and user groups, and a template to assist planning for their visit.

Local authority information return

Councils are also invited to return their self-assessment at this stage. While there is no requirement to do so, CQC recognises that it saves them time in advance and on-site. 

Having met the submission deadline, there follows a break of variable length, potentially as long as six months. It provides time for CQC to review evidence, complete an analysis of their own and other published information, and contact local groups to survey their views. The gap’s duration seems to relate to the logistics of CQC deploying their assessor teams.

Guidance requires the council to send a list of 50 coded case tracking names to CQC by week 2. Case tracking involves CQC retrospectively following the pathway of a small number of people to gather evidence for the assessment.. It involves reviewing care records, talking with the person and/or family, friends, or advocate. This may also include talking to staff at the local authority and/or with other partners and agencies if required.

This protracted break concludes with notification from CQC of the date for their on-site visit week and the request for 50 case tracking names; a further template on meeting logistics (to be returned within a week); and the proposed date in week 6 for a meeting with the adult social care leadership team.

This is an online meeting in week six, for which CQC allocates a suggested three hours. They do not specify attendance or agenda but expect the meeting to brief them on the following, to inform their confirmation of a timetable for interviews and focus groups which is done separately:

• how the leadership team is organised. For example, each deputy/assistant director’s areas of responsibility, and the strengths and areas for improvement in each area of accountability
• the lines of accountability (management arrangements) from DASS down to team managers, including job titles
• how front-line teams are set up: how many teams and where they are based – for example, locality or neighbourhood
• a person’s journey from initial contact with the local authority through to allocation to a team for assessment
• how front-line teams are set up to support people with specific needs. For example, autistic people, people with a learning disability, mental health need, or sensory need
• the pathway for young people transitioning from children to adult’s services
• any Section 75 agreements in place.
• any commissioned partnership arrangements for the provision of Care Act duties. For example, contact centre, wellbeing service, financial assessments, carers support.
• arrangements for working with housing.

Tips for pre-onsite team meeting

• Anticipate that not all CQC team members will join so make sure they have copies of the presentation and the self-assessment in their team room when onsite.
• As this sets the scene for the onsite activity and the final report, it is important to get the participation, content, tone and material right.
• Consider attendance: as well as the senior leadership team, principal social worker and principal occupational therapist and the lead member, many places have involved their director of public health, chief executive and a senior housing lead.
• CQC will give you a list of people they want to see. Be confident to suggest alternatives if people named are newly in post or holding an interim role. In the early stages they refused to meet anyone designated a manager outside certain specified roles. This has been relaxed to recognise commissioning managers are often at or close to frontline practice, and that a drop-in session for managers adds value to the exercise.
• Your own lead contact for the CQC onsite should be introduced too. • The presentation works best if it reflects the place, how things are organised, and answers the key CQC questions. It should address the four themes of the assessment and weave in equity, coproduction and best practice, supported by relevant comparative data.
• Smaller councils should point out to CQC any differences in scale and management capacity and any implications to help set realistic expectations.
• You should not hesitate to lead the CQC team towards what you consider to be excellence, particularly where this is validated by data and evidence of outcomes. You will want to highlight where this is recognised externally or benchmarked.
• Ensure all participants talk about their contribution in the presentation. There should be a natural flow, and it should not feel too scripted. Allow time for questions but anticipate there may not be many.
• Consider rehearsing your presentation with a critical friend. You may wish to record this so you can reflect on it. Watch the timings.
• Consider the use of pictures, graphics and video clips.

This fieldwork stage typically last for 3 – 4 days. The CQC team has 5 or 6 members, including a Lead Assessor and Executive Reviewer (usually a serving director or assistant director from another council). They typically start on Monday afternoon or Tuesday morning with interviews or meetings scheduled between 10am and 4pm.

In addition to a specified schedule of interviews, three drop-in sessions are arranged (there may be more for larger councils). The ones for frontline staff are on the first and last day, with a further one now introduced for managers. These are fixed timeslots.

There is no feedback offered onsite. An online meeting is scheduled between the lead assessor and the director a week after the visit has concluded. This does not give any indication of scores or overall rating. Guidance states that if CQC has any serious concerns about information that is told to them during the site visit they will arrange to speak to the DASS on that day and it will not be left until the high-level feedback.

CQC and the Department of Health have published a protocol on their actions if the assessment scores any area of review as 1 (or inadequate). If it is in any area other than the leadership domain, it would involve alerting the council immediately and referring to the Department. This is set out in a protocol for intervention using powers established in the Care Act 2014.

Operational framework for adult social care intervention in local authorities

This process has not yet been triggered.

Typically, four to six weeks after the visit, CQC send a draft report to the council for review. For the first few reports, this was before any internal CQC calibration process. It is understood that calibration now takes place before the draft is sent. This report includes scores and ratings.

The Council has a period (usual 10 working days) to review the report for factual accuracies and completeness. This should then generate a response from CQC as to whether comments are fully or partially accepted or rejected, and whether if accepted the relevant part of the score is changed. 

After any further internal processes, the report is scheduled for publication. The council is informed, there is engagement with the council’s communications team, and the CQC press release shared.

The assessment process is presented by CQC as a baseline assessment against which progress can be measured in subsequent years. There has been no follow up with any of the councils reviewed so far.

A Requires Improvement judgment will generate the expectation of an enhanced improvement plan to address areas of weakness. Most councils will already have this in hand.

If you have a Requires Improvement judgment, you can expect contact from your Care and Health Improvement Adviser and you will also receive offers of support from your ADASS region and Partners in Health and Care.