CQC rates London Borough of Camden’s adult social care provision as outstanding

The Care Quality Commission (CQC), has rated the London Borough of Camden as outstanding, 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 outstanding 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.

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

“At this assessment, we were very impressed to see the exceptional levels of service being provided by the London Borough of Camden. Their clear commitment to equity, making sure everyone was able to access services in a way that suited their needs, and reduce inequalities was at the heart of everything they were doing. This is especially important in Camden, which is more ethnically diverse than the England average with 40% of people identifying as Black, Asian, or another ethnic group. The borough also has pockets of affluence and deprivation with a 20-year difference in life expectancy between the most and least deprived areas.

“Against this backdrop, it was incredibly impressive to see the high-quality and person-centred support they were providing, and the work to reduce these inequalities changes people’s lives. Behind the outstanding work was strong partnership working, a commitment to equity, and a focus on prevention which was embedded across all of their services.

“This exceptional partnership working had resulted in no waiting lists across essential services including hospital discharge, care placements, social care and safeguarding assessments. It also enabled smooth transitions between services without delays, avoiding unnecessary stays in hospital or gaps in support.

"Staff described a workplace culture of seamless communication with partners including the NHS. They consistently spoke with one voice about their shared culture and joint working practices. Staff felt their professional skills were valued by supportive managers and were trusted to make decisions. They were encouraged to access training, including around cultural awareness, all of which benefitted people accessing services.

“The local authority placed equity at the forefront of its vision, strategy, and workplace culture with leaders actively sharing decision making power with the communities it served. This approach ensured access to information, care and support, was all tailored to individual needs.

“There were no waiting lists for advocacy support, ensuring immediate support for seldom-heard groups to navigate care systems. Autistic people were involved in reshaping this access for their own community, leading to a better experience for autistic people. The authority had also accessed national funding to tackle inequalities in the Bengali and Somali communities.

“The local authority ensured communications were inclusive and accessible. Staff were trained in using easy-read formats, British Sign Language (BSL), and talking mats enabling them to communicate effectively with people needing support, helping them understand their rights and make informed choices about their care.

“Despite very positive accounts and no delays to assessments, Camden has recognised the need to make further improvement in some areas, notably they are focusing on ensuring that more family carers are satisfied with their services. 

“Overall, Camden should be extremely proud of this assessment and the outstanding care they’re providing to people. Other local authorities should look at this report to see if there’s anything they can learn.”

The assessment team found:

1. Person-centred care was evident in planning. People were consistently supported to have choice and control over their care.
2. There was a co-design group involving people with drug and alcohol services as experts by experience.
3. Carers with diverse needs including LGBTQ+ carers had been involved in designing the carers action plan.
4. There was no waiting list for reablement services and national data showed more people aged 65 and over (87.18%) were still at home 91 days after discharge from hospital than the England average (83.70%). This was thanks to a higher than average rate (4.74%) of people receiving reablement or rehabilitation services, than the national average (2.91%).
5. Camden worked with partners to develop community-based initiatives that provided social connections and reduced isolation in response to high levels of loneliness among young people and home care users. This support delayed or prevented the need for formal support.
6. The local authority’s vision was co-produced using a citizens’ assembly and reflected their commitment to person-centred, self-directed support and empowerment for people using services.
7. The direct payments process for people in receipt of care services was well understood by staff and a direct payment was easy to set up.
8. The local authority intended to strengthen the offer for people experiencing multiple disadvantages, due to issues such as poor mental health, and drug and alcohol misuse.
9. There was a significant effort to support people informally before the need for formal support was required tailored to the specific needs of their local population, like housing, refugee and asylum and mental health support.
10. Very innovative art-based projects which supported autistic people in shaping services.

However, the assessment team also found:

1. While most carers felt supported, others found the assessment process and available support to be inconsistent. Only 27.7% of carers reported satisfaction with social services, which is slightly lower than the national average of 36.83%.

The assessment will be published on CQC’s website on Friday 28 February.  

Notes to editor

Scoring key:

1. Evidence shows significant shortfalls
2. Evidence shows some shortfalls
3. Evidence shows a good standard  
4. Evidence shows an exceptional standard

General demographic information

• Camden is an inner north London borough with a population of 210,100. The population had decreased by 4.6% since 2011, with those aged over 65 increasing by 3.4% and those aged 18-64 decreasing by 4.7%. It is one of the country’s most unequal boroughs, with highly affluent areas and significant areas of deprivation. The gap in healthy life expectancy between the most and least deprived parts of the local authority is very high, at 20 years. It has an Index of Multiple Deprivation score of 5. Camden is within North Central London (NCL) NHS Integrated Care Board area, which spans 5 local authorities.
• The population of Camden is more ethnically diverse than the England average (19%) with 40% of residents from a Black, Asian or other ethnic group, this has increased from 34% in 2011. There are more than 85 different languages spoken and 17% of people identified as LGBTQ+ in comparison to the national average of 14%. There are fewer disabled people (15.2%) as a share of the population than the national average (17.3%). 35% people were economically inactive, which was higher than the London average (30%).
• Camden is a Labour-led unitary council with 55 elected councillors. There are 43 Labour councillors, 5 Liberal Democrat, 3 Conservative, 1 Green and 3 vacant councillor positions.