Lack of a shared language or methods for improvement in adult social care, report says

A new report exploring how local authorities make improvements and measure success in adult social care has shared examples of good practice, as well as areas for development.

The King’s Fund conducted 27 interviews with those involved in improving adult social care in local authorities, as well as exploring the adult social care improvement ‘stories’ in five local authorities to compare them against established approaches and principles of quality improvement in other sectors.

Researchers found examples of “excellent work” on improvement and local authorities drawing on the support offer that is provided through ‘sector-led improvement’. They said adult social care staff shared best practice through this programme as part of a strong regional community for improvement.

Examples of local authorities doing excellent work in very difficult circumstances, including building capacity and capability, such as by borrowing staff with specific expertise from neighbouring areas and inviting staff to regular senior management discussions to expose them to quality issues. Local authorities were praised also for creating a culture for improvement to thrive, for example, by creating a safe environment where staff feel comfortable raising concerns.

However, researchers also said they saw “huge variety in approach and a lack of a shared language or codified set of methods for improvement. At times, the absence of a shared quality improvement approach appeared to lead to improvement activity that was reactive, focused on short-term fixes and one in which the data and measurement were lacking.”

“While there is good work going on across the five local authorities we selected, many of the markers of a quality improvement approach were missing – for example, being able to define and agree what quality includes, a clear theory of change, measurement of impact or continual efforts to continue and sustain improvement,” the report said.

“There are good reasons why those working on improvement in adult social care in local authorities may struggle to adopt and put into practice some quality improvement principles. In particular, in addition to severe pressures on resource and capacity to do this work, local authorities also lack a national framework to guide their efforts or in many cases control the levers to effect the change on the ground – with a lot of care being delivered by independent care providers.”

The discussion around local authority adult social care improvement is apt because it is widely expected that the Government will increase funding for improvement activities to support its sector reforms. The Care Quality Commission (CQC) also plans to introduce a new assurance framework to assess local authority performance in delivering all their adult social care functions.

The Association of Directors of Adult Social Services (ADASS) welcomed the commentary, saying: “Our surveys of Directors of Adult Social Services show that there are increasing needs from hospital activity (or people waiting for hospital), carer breakdown, mental ill health, and domestic abuse. Against this, the workforce is shrinking due to inadequate pay, exhaustion, and lack of recognition, and care markets are extremely fragile, leaving people with fewer choices and more distressing disruption as providers close or hand back contracts.”

“Demonstrating improvement in an environment where needs are increasing and resources (funding and workforce) to meet them are decreasing, is of course a challenge and the investment in improvement is also, of course, a tiny proportion of the investment in NHS improvement – even though more people work in social care than in the NHS.

“We are keen to support cohesive, focussed, and effective programmes of improvement that build on, nurture, and support this incredible commitment and vital contribution. We equally challenge the next Prime Minister to seriously address the short and longer-term workforce and resources shortfalls that so tragically impact everyone needing or working in care and support and, because health and care are so critically inter-dependent, any one of us that needs or may need health care or treatment in the winter to come and beyond.”