CQC rates Kent County Council adult social care provision as requires improvement

The Care Quality Commission (CQC), has rated Kent County Council 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 requires improvement 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 – 3
4. Care provision, integration and continuity of care - 2
5. Partnership and communities – 2
6. Safe pathways, systems and transitions - 2
7. Safeguarding - 2
8. Governance, management and sustainability - 2
9. Learning, improvement and innovation - 3

James Bullion, CQC’s chief inspector of adult social care and integrated care, said:

“Our assessment of Kent County Council revealed the challenges of delivering adult social care across one of England’s largest and most diverse counties. With 514 care homes providing nearly 12,000 beds for older people and specialised accommodation. Despite these challenges the authority has a responsibility to improve the quality of care that people are receiving now including how people are being safeguarded, how they support carers and how they are supporting young people transitioning into adult services.

“There are about 13,000 people living with dementia in the county, and 25% of residents report some form of disability or a long-term health condition. Leaders were also aware of the pressing need on them to plan for the future. By 2036, there'll be more than 30,000 people aged 85 and over in Kent – nearly double than in 2018. Kent needs to start planning for these issues now, so they have the right support ready in place for people when the time comes.

“We spoke with enthusiastic and committed staff but also found stark contrasts between different areas of Kent, particularly between inland and coastal communities where health inequalities persist despite the authority’s efforts to address them. While Kent’s health outcomes are often better than the national average, this isn’t true for coastal areas where communities face worse health outcomes, poorer quality housing, and seasonal employment. The six-to-eight-year gap in life expectancy between the most and least deprived areas of Kent illustrates these inequalities.

“However, they were doing some good work to reduce these inequalities. When occupational therapists noticed they were mainly helping white residents in coastal areas, they used data to connect with other community groups such as residents originally from Nepal.

“Kent was also working collaboratively by involving people using services to help shape them. We were told by people they didn’t feel their attendance was tokenistic, that they led the meetings and felt like their voice was making a difference to how services are designed.

“The authority has also developed innovative digital tools like an online financial calculator which helps residents estimate personal contributions to care. One person told us that for the first time they felt they could understand what they might need to pay before having difficult conversations with their family about care options.

“Kent County Council has built strong foundations for future partnership working which will be essential to support their changing demographic. It’s clear that Kent has a commitment to reducing inequalities and learning about improvement, but our assessment found some important areas for improving outcomes. We look forward to seeing how they’ve implemented that learning and how their plans have matured.”

The assessment team found:

1. Kent didn’t always manage transitions between services well. One young person described poor information sharing between children’s and adult services, contributed to their placement breaking down.
2. There was mixed feedback from unpaid carers who valued accessing social activities like swimming through one of the authority’s services, but others reported difficulties even accessing information and support.
3. Kent County Council adult social care worked closely with housing, children’s services, and voluntary and community services to support the Live Well Kent and Medway service, which was delivered jointly with the NHS to help people address housing, social, economic, and health needs.
4. Across NHS Kent and Medway there were approximately 600 people in hospital beds who didn’t require hospitalisation and could have been cared for elsewhere in the health and social care system.
5. Partners and service users said integration between health and social was inconsistent and said they couldn’t get different teams to talk to each other. East Kent showed better joint working between the authority, integrated care partnership and primary care, but this hadn't spread countywide.
6. The authority’s market sustainability plan showed enough care home places overall, but availability varied significantly by area. As more people choose to stay in their own homes longer (aligning with council strategy), some care homes have closed meaning services are unevenly distributed across the county, with higher numbers of nursing care homes in West Kent compared to East Kent. North Kent faces a particular shortage of affordable care options, forcing residents into East Kent placements where costs are lower but families struggle to visit. The Isle of Sheppey has no nursing homes at all, making local placement impossible for residents needing a higher level of care.
7. The authority’s quality monitoring wasn’t consistent across all areas leading to varied experiences for people using services.
8. Some staff told us safeguarding staffing levels made them worry about people’s initial safety as some concerns which should have been screened in 24 hours, were taking up to ten days in some hubs. The authority anticipated once safeguarding hubs were more established and embedded, significant improvements would be seen.
9. There were 517 safeguarding concerns awaiting completion across the county with a median completion time of three days and a maximum time of 232 days. The local authority identified increased demand and repeat contacts for the same individual as contributing factors, as well as delays in care assessments and packages, that lead people and partners to escalate concerns to safeguarding.
10. Some people struggled to engage with KCC, citing difficulties with a lack of accessible online or written information and in setting up direct payments as areas needing to improve.

The assessment team also found:

1. Kent was able to solve 72% of referrals through information, advice, community referrals, or minor equipment provision without needing full assessments by using diverse access points.
2. Involving people using services in their design has created meaningful partnerships between the council and the communities they serve.
3. The authority was having success using a consultation website to engage with communities and attract participants from diverse backgrounds. However, they knew they had work to do for those facing digital exclusion. Despite efforts to provide information in multiple formats, partners reported that barriers in accessing digital systems continue to affect people’s experiences.
4. The authority works effectively with seldom-heard groups, such as the Gypsy, Roma and Traveller communities to complete their health needs assessments. They’re also developing a veterans health needs assessment with the county’s 61,000 veterans to address specific needs like mental health support and homelessness prevention.
5. Kent has invested in their staff to support them in applying strength-based approaches to people’s care needs assessments. One staff member told us this had completely changed their conversations with residents for the better, focusing on what they could do well, rather than what they couldn’t.

The assessment will be published on CQC’s website on Friday 16 May.