The Care Quality Commission (CQC), has rated the London Borough of Redbridge 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: 2
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: 1
8. governance, management and sustainability: 1
9. learning, improvement and innovation: 2
CQC’s assessment gave the quality of London Borough of Redbridge a rating of one in some areas. As a result of this, under Section 50(2) of the Health and Social Care Act 2008, CQC has sent a notification letter to the Secretary of State for Health and Social Care outlining the areas where improvements are needed.
Chris Badger, CQC’s chief inspector of adult social care and integrated care, said:
“During our inspection of the London Borough of Redbridge, we found a mixed picture of people’s experiences accessing adult social care. While we found some pockets of good practice, the local authority needs to do more work to keep people safe.
“People told us their assessments were person-centred and captured their views and those of their families. We also saw good access to interpreters, easy-read information, and advocacy to help people understand and take part in decisions.
“The local authority has a stable and well-trained workforce, with staff turnover much lower than the national average. It has also been working closely with its health partners through integrated teams and is using direct payments well to give people more control over their care.
“However, people are still facing delays in getting the help they need. We found long waits for assessments, especially for occupational therapy, with some people waiting almost three years. This risks people becoming more unwell or losing independence while they wait.
“Unpaid carers told us they weren't routinely offered the opportunity to receive an assessment of their own needs. While they provided positive feedback about assessments which had been undertaken with the person they cared for. They also felt unrecognised and unsupported in their role by the local authority.
“The local authority used strict referral criteria that limited who could access its reablement service. Although people who used it achieved good outcomes, the service wasn’t available to everyone who may have benefited. It made few referrals for people living in the community, so it didn’t routinely offer reablement as an option to help people stay independent before arranging support.
“The period of instability in senior leadership has made it challenging to implement the work needed to drive improvements at Redbridge. However, leaders understand what needs to change and have started building the right foundations to deliver better support. We look forward to returning to see how their plans mature and the impact this has on their community.”
The assessment team found:
- Leaders ensured staff received training to build confidence discussing people’s identities, particularly with LGBT+ people, and showed good local knowledge of the community.
- The local authority updated training to improve the quality of assessments and outcomes.
- People were involved in some aspects of designing services and information, including a redesign of the adult social care website, which made them feel valued and understood.
- The local authority worked with a partner agency to run a Department for Health and Social Care funded technology pilot using sensors in care homes and extra care settings to detect early signs of health deterioration.
However, the assessment team also found:
- People told CQC their experiences of leaving hospital differed. Some were discharged quickly with appropriate support, while others had to challenge the system to secure the help, they needed beforehand.
- The local authority responded to safeguarding enquiries with long delays, and the pathway for triage and allocation to a worker was unclear.
- Staff across the local authority didn't always use the hub for adult safeguarding consistently. Local and specialist teams often handled enquiries for people they already supported, leading to inconsistent practice.
- Staff applied safeguarding assessment processes inconsistently, and the processes themselves lacked clarity.