CQC rates London Borough of Enfield’s adult social care provision as good

The Care Quality Commission (CQC), has rated the London Borough of Enfield as good, 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 good 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 – 3
3. Equity in experience and outcomes – 2
4. Care provision, integration and continuity of care - 3
5. Partnership and communities – 3
6. Safe pathways, systems and transitions - 2
7. Safeguarding - 2
8. Governance, management and sustainability - 3
9. Learning, improvement and innovation - 3

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

“At this assessment, we were pleased to see the good level of service being provided by the London Borough of Enfield. We found people were receiving largely positive, person-centred support designed to promote independence and dignity.

“Enfield Council supported people to stay well, with access to local services that reflected their needs and preferences, as well as preventative assistance. Most people could get care when they needed it, with very few people placed out of the borough. We also saw strong partnership working across adult social care, public health and local teams, which supported a joined-up, preventative approach to people’s care and wellbeing. They were also signposted to community organisations for preventative support, helping them stay connected with their communities and avoid crisis and formal support long term.

“The local authority worked well with partners to deliver intermediate care and reablement services to support people to stay independent when they were discharged from hospital and return to their optimal level of independence. Hospital discharge was well coordinated, and people were given enough notice about their discharge. It was great to see 85.19% of people aged 65 and over were still at home 91 days after leaving hospital with reablement or rehabilitation support, which is slightly better than the national average.

“We also found thoughtful support for young people preparing to move into adult lives. The local authority follows a clear Preparing for Adulthood Transition Protocol. Transitions were handled sensitively and planned in advance, with strong collaboration across social care, education and health partners. Young people and families told us they felt heard and supported during this process.

“Enfield Council had the best direct payment uptake in the country at almost 50%. Direct payments were embedded into assessments and supported people to take ownership of their care.

“Enfield Council knew it faced some delays with waiting times for assessments, particularly for occupational therapy, but people with urgent needs were being prioritised while alternative support was offered to other people who were waiting for their assessment. Some unpaid carers told us they would like there to be more respite services.  The local authority knew this was an issue and was already seeking to expand their respite services.   

“The local authority serves one of the most diverse populations in the country, with 88 languages spoken and 47.92% of people from Black, Asian and minority ethnic backgrounds. While the local authority had started working with voluntary and community sector organisations to improve access, more targeted work was needed to ensure people in these communities receive timely, inclusive and equitable care.

“Overall, Enfield should be really pleased with the many positive findings in our report and their good rating. They’ve already told us how they’re planning to build on this with further improvement plans. We look forward to returning to see how they have built on areas of good practice and how their plans mature.”

The assessment team found:

1. The local authority made sure people could easily access their care and support services through multiple channels, including telephone, online and self-referral options.
2. The local authority produced information in different formats to support accessibility. The local authority website had translation tools for over 100 languages. Information was also available in different formats such as braille, large print, audio, and easy read.
3. There was a comprehensive, cross north central London approach to support people in hospital with additional housing. This included dedicated housing support for people experiencing homelessness including recovery and rehabilitation pathways.
4. The local authority promoted the use of assistive technology to improve people's independence to remain safe and well in their own homes. Assistive technology refers to devices or systems that help maintain or improve a person’s ability to do things in everyday life that support people to live safely and independently.
5. Staff consistently highlighted the supportive learning culture in the local authority, with good work-life balance and managers who ensured manageable caseloads.
6. Most staff felt well supported in their training and development, with good induction, peer support, supervision, training and opportunities for career progression. This was reflected in the comparatively low staff turnover, which was good for staff building consistent relationships with people using the service who could get to know their preferences and likes and dislikes.

However, the assessment team also found:

1. Some people found the local authority’s online platforms difficult to use, particularly people with learning disabilities or those with limited digital access.
2. Co-production, designing services in collaboration with people using the service, was established and demonstrating some impact, but some people felt the local authority needed to do more to seek and listen to people’s views and ensure feedback was used to make improvements.
3. While safeguarding processes were responsive to risk, follow-up on learning and outcomes from safeguarding concerns could be inconsistent or slow.

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