Councils must improve commissioning of adult social care, says regulator

Councils must drive up care standards by purchasing from providers more effectively, the Care Quality Commission has said.

The regulator also warned that it would be introducing tougher assessments of local authority performance next year in a bid to hold them to greater account.

In its first major statement on adult social care, the commission said councils – which spend a combined £16.5bn a year in this area – are improving their overall provision of adult social care. Some 95% of local authorities are now commissioning adult social care either “excellently” or “well” – up from 87% the previous year.

The CQC nevertheless has concerns about specific aspects of their performance. One in four councils have only been awarded an “adequate” rating when it comes to giving people choice and control over their care, while a third need to improve in terms of caring for people with dignity and respect.

The report reveals that providers’ ratings are on the up too, with only one in six rated as “poor” or “adequate”.  However, this still means that some 3,900 providers fall into these two categories.

“Looking specifically at care homes and agencies, the minimum standards with lowest levels of compliance concern some of the basics of care,” the commission found. “Issues highlighted include planning for individuals’ care, how medication is managed, staff supervision and promotion and protection of people’s health, safety and welfare.”

The CQC said some councils continue to purchase a significant proportion of residential and nursing home care from providers with low ratings. “This raises important questions about whether commissioning is as effective as it could be,” it argued.

Although the commission acknowledged constraints on commissioning (such as limited availability of care provision) and the role of patient choice, it added: “Councils have a responsibility to develop markets over the long-term so that the right care is available.” The regulator plans to hold a dialogue with local authorities on the issue.

Care homes, home care agencies, nursing agencies and shared lives schemes run by councils and voluntary organisations perform better than those in private ownership, the CQC’s research suggested.

Eight councils have meanwhile been identified as “priority improvement councils”, and will be subject to greater scrutiny going on. Another 16 will be subject to in-depth service inspection.

In 2010, the CQC will introduce a new registration system for adult social care providers, NHS providers and independent healthcare. It will also have tougher enforcement powers.

Cynthia Bower, the commission’s chief executive, said: “It is good to see the steady improvements and this should be recognised. [But] there are serious issues for councils to address in areas such as giving people more control over their care, treating people with dignity, and ensuring commissioning is as effective as possible.”

Bower added that she was “deeply concerned” about the possible impact of lower spending on social care, and the prospect of councils raising eligibility criteria as public spending is squeezed.