CQC rates Warrington Borough Council’s adult social care provision as requires improvement

The Care Quality Commission (CQC), has rated Warrington Borough 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 – 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 - 1
8. Governance, management and sustainability - 2
9. Learning, improvement and innovation - 2

CQC’s assessment gave the quality of Warrington Borough Council’s safeguarding a score of 1, the lowest possible score indicating significant shortfalls. As a result of this score, under Section 50(2) of the Health and Social Care Act, CQC has sent a notification letter to the Secretary of State for Health and Social Care outlining the area where improvement is needed.

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

“At this assessment of Warrington Borough Council, we found passionate staff who were doing some positive work developing their prevention and wellbeing services, to delay or prevent people from needing formal support.  However, the local authority has a lot of work to do around how they were safeguarding residents, and this is the area we found needed rapid and widespread improvement. 

“Leaders had created a safeguarding system which didn’t structurally work to keep people safe. They had a digital triage system, that was automatically closing some safeguarding referrals without appropriate human review, creating real risks for vulnerable people. Staff also couldn’t access these rejected safeguarding concerns without making an IT request. Senior leaders weren’t fully aware of these issues until our visit, which raised some concerns about how well they understood the issues they were facing and how well they were managing safeguarding. 

“We also found no tracking system for safeguarding alerts sent to an allocated worker who was absent or busy. This meant they could remain unreviewed indefinitely leaving vulnerable adults at continued risk of abuse or neglect, sometimes we saw this was as long as 110 days.    

“While people using services talked positively about staff and described them as caring, compassionate and helpful, there were also other areas where they were waiting too long. People told us they were frustrated by the length of time they had to wait for assessments for adult care services, carers support, financial help, and assistive living assessments and equipment. One person had to wait two years to have a ramp installed meaning they couldn’t leave their house independently at all in that time. 

“However, in other parts of this assessment, we found Warrington had undergone a clear culture shift. They were embracing a prevention first approach, focusing on people’s independence and wellbeing. This was aimed at preventing people from needing care in the first place, or reducing the amount of people whose short-term care turned into long-term care. 

“Leaders had threaded this approach through all of their strategies, including listing a range of preventative services available in the statutory, voluntary, and community sectors that people could access. We found their prevention work to be cohesive, relevant and tightly focused. It was already having a positive impact, giving people in Warrington an improved health index score of 105.4 which is above the England average. 

“We have told leaders at Warrington Borough Council where they need to improve, around safeguarding which is our biggest concern and why we notified DHSC. We expect to see rapid and widespread improvements in safeguarding when we return. We also be look forward to seeing how their strategic plans become embedded, have matured and the impact this will have on their residents. Warrington Borough Council have some good foundations on which to build their improvements and continue to do the things they are doing well.” 

The assessment team found:

1. Leaders knew they needed to address waiting lists for assessments, care planning arrangements and reviews of these when people’s needs change. Most of the waiting lists had reduced in the last 12 months, which was largely down to a targeted review team which leaders told us, had also now been made a permanent team.
2. Warrington Borough Council’s adult social care services were rated lower than the England average in a number of ways. People reported a lack of local services or access to activities for their personal interests. This was reflected in national data showing only 56% of people reported being able to spend time doing things they valued or enjoyed, which was worse than the England average of 69%. Additionally, data showed a less than average number of people felt they had a choice over the services they used. 
3. There were less people in Warrington using direct payments than the England average meaning people were potentially less able to choose bespoke support options for their care and support. For example, people who did use direct payments often used them to hire personal assistants or to purchase one-off services and equipment which promoted their independence avoiding the need for more formal support.
4. CQC heard mixed feedback about the experience of unpaid carers. Some said they felt listened to, had access to the information they needed, and 28% felt they had control over their life which was better than the England average of 22%. However, many carers we spoke with reported long delays for their assessment with the average wait time being 58 days. 
5. Staff reported they had out-of-hours contingency plans in place for carers to pick up their caring responsibilities in an emergency and completed carers assessments to detail this. However, there was mixed awareness and understanding with some carers telling CQC the authority didn’t have any plans in place with them and they wouldn’t know who to contact in an emergency, but others told us they did. This highlighted inconsistencies in communications with unpaid carers. 
6. There were some gaps in the provision of services for people with specialist and complex support needs. Staff told CQC there were significant shortfalls in the provision of activities for younger people on evenings and weekends and that activities in Warrington were tailored for older people. 
7. Warrington has a largely white population of almost 94%. The local authority had limited engagement plans for seldom heard groups in their community such as Gypsy Roma and travellers and the increasing population of people from Hong Kong.
8. The authority’s assessments and provision of equipment weren’t always timely. There was an average waiting time of 98 days for people waiting for an in person or remote assessment. The local authority told inspectors a national shortage of occupational therapists and vacancies within the team, meant demand was outstripping capacity leading to long waiting times. 
9. Partners expressed concerns around the length of time people could wait for adaptations which would support people’s independence. The local authority was working on plans to use more creative ways for people to access equipment without the need for an assessment.

However, the assessment team also found:

1. The authority had implemented an intermediate integrated service with health partners, supporting people going into or coming out of hospital. This partnership working served as an effective bridge between acute hospital care and community-based services offering specialised support to keep people living well at home for longer. Stats showed that 80% of people remained at home 91 days after receiving this support and 92% of people with a portable care alarm were also able to remain at home.
2. Warrington had a clear focus on prevention, with 79% of people who received short-term support no longer requiring ongoing assistance, just higher than the England average of 78%.
3. Leaders had produced the authority’s Carers Strategy for 2025-2028 by working with partners and people with lived experience of being a carer. Carers (89%) also found the information and advice given by Warrington helpful, which was better than the England average of 85%.
4. Although there could be long wait times for assessment, Warrington had good assessment review rates with 73% of people in Warrington having their long-term support needs reviewed, which was significantly better than the England average of 59%.
5. The local authority focused on reablement, recovery and independence, and had delivered a 50% increase in short term interventions to people to support discharges from hospital. 79.21% of people receiving this short-term support no longer required any kind of formal support. This demonstrated the positive impact this focus was having on helping people maintain independence in the community. 
6. Partners told us Warrington’s falls prevention and good neighbour scheme were incredibly valued by the people who used them and was evidenced b the positive impact the services were having on people’s wellbeing. The scheme included working with people who were at risk of or have had falls, and a good neighbour scheme which offered practical support such as helping people get to health appointments. 

The assessment will be published on CQC’s website on Thursday 22 May.