CQC rates Hertfordshire County Council’s adult social care provision as good

The Care Quality Commission (CQC), has rated Hertfordshire County Council as good, in how well they are meeting its responsibilities to ensure people have access to adult social care and support.

CQC has a new responsibility to assess how local authorities meet their duties under Part 1 of the Care Act (2014).

CQC looked at nine areas to assess how well the authority is meeting its 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. how the local authority works with people – 3
2. supporting people to lead healthier lives – 3
3. equity in experience and outcomes – 3
4. providing support (care provision, integration and continuity) – 3
5. partnership and communities – 4
6. how the local authority ensures safety in the system – 3
7. safeguarding – 3 
8. leadership – 3
9. learning, improvement and innovation – 3

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

At our assessment of Hertfordshire County Council, we found a strong leadership team who had a good understanding of the adult social care needs of people living in the area. They also had a good grasp of what was working well and also where they needed to focus their attention on improvement.

They were supported by committed and passionate staff who were delivering services that people generally spoke positively about to CQC. People told us that front line staff listened to them, understood their needs and developed care plans which reflected these. Staff were also aware of the needs of different community groups and had access to interpreters and translation teams where needed.

We also heard similarly positive feedback from carers who told us their needs were assessed separately to the people they cared for and they were given good support when they accessed it. Although more could be done to help mitigate the impact unpaid caring responsibilities had on people’s own employment and financial situations.

Whilst Hertfordshire is considered to be a mostly affluent county, there are pockets of deprivation. Staff had a good understanding of the impact this had on people and were rolling out a new equality, diversity and inclusion strategy to address it, as well as better cater for the 28% of people in the county who don’t describe themselves as White British.

It was impressive to see the focus Hertfordshire placed on work to prevent or delay people needing more formal support, with the creation of a new service last year providing initial assessments and support for people, including signposting to other organisations who may be best placed to provide that support.

It was also encouraging to see the impact some of this work was having on reducing demand on the local healthcare system. They had initiatives which had reduced the need for some people be admitted to hospital or needing an emergency ambulance called out, reducing pressure on the local NHS.

They were keeping one eye on the future, and worked closely with others to understand the changing demographics and the impact it will have on services and plan for it accordingly. For example input into housing strategies to plan supported accommodation for the anticipated higher number of adults with a learning disability aged 65 years and over and less of working age.

However, we did see waiting lists for assessments in all areas which was linked to a 10% increase in support requests in the last year. We saw the authority had a clear plan in place to reduce these and was already taking action which was having a positive impact. They were also monitoring people who were waiting for support carefully, to make sure they were safe whilst waiting and their care needs hadn’t escalated.

They knew they could be doing more to understand and reduce inequalities in outcomes. They had launched a new strategy, but not all senior staff were clear yet about the focus, and this needs time to embed.

Overall, Hertfordshire County Council should be really pleased with this assessment. They’ve built a great foundation on which to build their future plans and make improvements. We look forward to returning to see how they’ve done this and how their current plans mature.

The assessment team found:

1. There was a wealth of easily available information to help people understand what support was available for them. There were videos, and information was available in other languages including British sign language. It also included signposting to other organisations who might have been more appropriate for support, which people told CQC they found helpful.
2. People told us their care and support were specific to their needs and the local authority staff had taken time to understand them and what was important to them.
3. The local authority was committed to hearing the views of people with specific needs who use services. The local authority had eight co-production boards which were all co-chaired by someone with lived experience. These covered a range of needs, and all linked to the overall strategic co-production board. This helped the authority use people’s experiences to design services and receive feedback to make continuous improvements.
4. A real strength of the local authority was their excellent partnership working. This was in place across the teams within the local authority and with their external partners. There were clearly long term, strong, effective relationships with the NHS Trusts and the Voluntary, Community, Faith, Social Enterprise (VCFSE) sector which was improving the offer of support available to people. Staff were encouraged to work creatively with partners to find solutions to improve people’s outcomes where this may be proving a challenge. For example, we heard about an innovative solution for the support for someone from the Gypsy/Roma community which enabled them to maintain their cultural lifestyle as well as having specific social care needs met.
5. The local authority’s framework for assessing and charging adults for care and support was clear and transparent. Staff teams received training about financial assessments and the need to ensure people using services, and unpaid carers were aware of the availability of direct payments.
6. The local authority had clear plans on focusing on supporting people to lead healthy, purposeful lives, with the aim of preventing and reducing formal care and support needs. They were already doing some effective work in this area, for example, one person told CQC that equipment they had been provided with enabled them to maintain their independence and return to work. Formal data showed that 78.35% of people who had received short term support from the local authority no longer required ongoing support and 83.65% of people aged 65 years plus remained at home 91 days after being discharged from hospital into a reablement or rehabilitation service. Both of these figures were higher than the England average.
7. The local authority had a new service to speed up direct payment requests and provided training to all frontline staff so they could support people to make informed decisions about whether to choose to use direct payments. Staff could easily access a direct payment for people to pay for a one-off service or piece of equipment that would support people. CQC had heard one-off direct payments had enabled a carer to have a break, and another person facilitate having culturally appropriate food whilst in hospital. These were really positive outcomes for those individuals.
8. They had a dedicated team supporting young people transitioning from children’s to adult social care. Planning for the transition usually started when the young person was 14 years old, and the aim was for them to have moved to adult services by the time they were 25. They felt that this longer period of time for staff to get to know the young person enabled them to fully understand their needs. In addition, they felt that it was best to transition people to adult services at 25 rather than 18 years of age as by then, other transitions for people had usually already happened, such as leaving school or college and possibly leaving home and living more independently.
9. The local authority staff were able to access health records and vice versa as part of arrangements with Hertfordshire and West Essex Integrated Care Board. Staff told us that this really helped with reducing the number of times someone had to repeat their story and also improved integrated working.
10. Frontline staff spoke very positively about the early intervention vehicle which could travel to people and enabled staff to provide immediate support and equipment to people where emergency support is not needed to help them remain at home. This initiative was having positive outcomes for people, as well as helping reduce admissions to hospital and prevent ambulance call outs.

However, the assessment team also found:

1. People who spoke with us had varying experiences of how easy it was to find information about assessments. All spoke highly of the staff who had carried out the assessment once this had taken place.
2. There has been a 10% increase in requests for support over the last year which had led to longer waiting lists for people. The local authority had clear plans in place to assess people’s needs and manage risk to people whilst they waited. Occupational therapy assessments had the longest waiting lists, most of which were housing related requests, which the authority relied on an external contractor to carry out. Average waits were 27 days, but some people waited several months. The authority had taken steps to tackle this which was having success with waiting times down since last year. The team were also better at communicating the potential wait to people to manage their expectations, which had been a source of complaints.
3. Whilst Hertfordshire County Council had a good offer for carers, and some people had found the process simple and easy to access, other people told CQC they waited long periods of time before receiving an assessment. CQC saw 30.42% of carers in the area surveyed weren’t in employment and 45.88% were experiencing financial difficulties due to caring responsibilities, both of which are slightly higher than the England average. The authority was aware of this and had a strategy to work with partners to better identify and meet the needs of carers, including young carers.
4. The waiting lists for financial assessments was the highest that it has been since January 2023. On average people were waiting 13 days for a financial assessment but some people were waiting for longer. The income and finance team had an action plan in place to improve this, including offering people telephone assessments.
5. Whilst there were many strategies in place which talked of people at risk of inequalities with regard to health and social care there lacked one overall strategy which linked all of those together and clearly identified the work taking place with different groups and communities. Not all senior staff were entirely clear about what the priorities were in terms of the equality strategy.
6. The average wait for a homecare service was 14 days out of 1889 referrals during a three month period. The longer waits were all due to the specific locality where people lived as in some areas, for example, rural areas, it was harder to recruit staff. The upcoming recommissioning of the homecare contract was expected to improve this. People gave us mixed views about how easy it was for them to find a suitable service for themselves or a relative.