CQC rates North Somerset Council adult social care provision as requires improvement

The Care Quality Commission (CQC), has rated North Somerset 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 – 2
4. Care provision, integration and continuity of care - 2
5. Partnership and communities – 2
6. Safe pathways, systems and transitions - 3
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:

“North Somerset Council had leaders who understood the issues its community was facing. Our assessment revealed a service facing significant challenges amid growing demand due to an ageing population, with a 22% increase of residents aged 65 and over since 2011. They monitor quality effectively and 84% of care homes they commission packages of care to are rated as good by the CQC. However, the borough’s ageing population has created specific challenges that will need them to plan ahead for prevention, dementia care, mobility support, and chronic disease management.

“North Somerset demonstrated a real commitment to innovation through collaborations with external partners. They’ve developed impressive initiatives like delegating insulin delivery to residents by staff in care homes rather than external partners, and work in the home to improve the arrangements for blood tests. All of which empowers staff, and makes people’s care and treatment quicker.

“Their website had been designed to enhance accessibility to resources and easy-read materials, with user-friendly, trackable referrals. However, the geographical disparities across the borough have created a system that disadvantages those in rural areas without digital access or literacy who still struggle to access support information.

“We found concerns about their reablement services which help people to remain at home following a hospital discharge. Only 0.61% of older people receive this vital support compared to the national average of 2.91%. The authority and partners had identified one of the biggest causes of not being able to provide reablement was caused by challenges in sourcing care.  

“However, they were utilising innovative technology to support people in hospital in other ways. This included reducing the amount of time people spent in hospital, and also resulted in 5% more people being able to be discharged home without formal care support.

“The authority faces some challenges in providing culturally appropriate care, such as a lack of support for people whose first language isn’t English. Although they have a dedicated asylum seeker support officer who provides specialist assistance to vulnerable individuals navigating complex systems, disparities were impacting access to people’s care within adult social care.

“Additionally, the council needs to strengthen its co-production approach as some people including carers report their feedback doesn’t consistently lead to meaningful change.

“North Somerset Council have built a good foundation and must now focus on addressing these shortfalls. We look forward to returning to see how their plans mature and the positive impact it has on residents.”

The assessment team found:

1. The safeguarding team was less responsive during evenings, weekends, bank holidays, and nights. One partner reported they were told to wait for the core hours team which left them unsure on how to keep the vulnerable person safe at the time.
2. The authority is aware that gaps exist in capturing the perspectives of seldom heard communities and was working to hear more from these diverse voices.
3. National data indicated levels of carer satisfaction with social services at 27.05% were worse than the England average of 36.83%. This suggests that carers in North Somerset had challenges in accessing the support they need. Other data showed as of October 2024 there were 245 carers waiting an average of 89 days for an assessment. Partners told us there were long waiting times for carer assessments and carers were unsure how to access support to reduce risks while they waited. Carers involved in helping to design services also reported their feedback did not consistently lead to meaningful changes. Senior leaders told us they needed to get better at identifying, assessing, and timely reviewing the needs of unpaid carers.
4. Several care contracts were returned to the authority in the past year, many for unspecified reasons, which potentially indicated instability in care provision in the borough.
5. The Safeguarding Adults Board admitted they could benefit from more data, information, and intelligence to identify risks and prevent abuse. Of 316 neglect and acts of omission safeguarding enquires, 191 of these showed a care service provider was a source of risk. However, there was evidence of North Somerset applying statutory guidance to deal with organisational abuse to improve outcomes for people.
6. It took the authority an average of 715 days to authorise Deprivation of Liberty Safeguards, with 1,035 requests still pending as of June 2024. The local authority acknowledged the waiting times for DoLS applications was challenging to manage but had seen a reduction following some focused project work, with other work planned in future.

However, the assessment team also found:

1. The council has implemented an innovative service called bridge the gap, to flexibly address care provision shortfalls while maintaining the quality of residential, nursing, and supported living services.
2. Leaders tracked the impact of early intervention and preventative services to drive improvements and measure outcomes across both individual services and the entire care market.
3. The Joint Strategic Needs Analysis (JSNA) which is a collaboration between public sector partners to collaboratively assess the current and future health and social care needs of a local population. It provided detailed insights into North Somerset’s health, social, and economic challenges, helping identify key priorities including the growing demand for dementia care and chronic disease management.
4. Staff told us homelessness, drug and alcohol use, mental health needs, and hoarding were all concerns that put adults at risk in North Somerset. One senior leader told us safeguarding measures were integrated into health initiatives, such as community mental health programs and substance use services, to support people with these needs. Staff told us historically there were gaps in services for people with mental health needs, but the MINT (mental health and wellbeing integrated network team) team was set up to meet this now and was having a positive impact.
5. North Somerset Council demonstrated a strong and inclusive culture of continuous learning and facilitated regular team meetings that fostered collaboration.
6. The authority has an impressive 100% rate of people who lacked mental capacity receiving advocacy support during safeguarding enquiries, significantly better than the England average of 83.38%.

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