Agenda item

To provide details of recent quality assurance activity carried out in Haringey.

Report to follow

The report for this item was presented by Richmond Kessie, Commissioning & Quality Assurance Officer. The report outlined the quality assurance activities across Haringey’s adult social care provider market to safeguard quality, support improvement and ensure that residents received safe and person-centred care. Richmond Kessie highlighted some key points:

• The past year had continued to be challenging for care providers with inflation and rising workforce costs, placing pressure on service sustainability. The Council had mitigated these pressures as far as possible through the annual inflation uplift.
• Engagement with the market had been strengthened, including through well-attended monthly provider forums which provided an important space for open dialogue, shared learning and early identification of risk.
• Over the period covered by the report, the Council had commissioned care from more than 220 CQC-registered providers, both in-Borough and out of Borough, and had supported over 5,300 residents.
• Market shifts had included an increase in out-of-Borough placements and a rise in unrated providers. The Council’s policy of avoiding new placements with unrated providers remained in place.
• The quality assurance team continued to play a critical role in identifying and supporting providers requiring intervention. This included those with declining CQC ratings, safeguarding concerns or operational risks. Several providers had been supported to make measurable improvements through welfare checks, improvement plans and joint working with the CQC.
• The quality assurance and contract management framework had been embedded across adult social care and this strengthened governance, risk oversight and coordination between commissioning, safeguarding and contract management functions. 

Andreas Schwarz, Operation Manager, North West & North Central London ASC Team 2 and Muhammed Koodoruth, Adult Social Care Inspector, both from the Care Quality Commission (CQC) then presented slides to the Panel which included the following details:

• In terms of CQC ratings, services in Haringey had better overall ratings when compared to the London and national averages.
• The CQC had committed to completing 9,000 assessments by the end of September 2026 and to recruit more registration inspectors.
• Current CQC priorities included responding quickly to emerging risk, examining services which had not previously been assessed, had not been assessed for a long time or were flagged as being high risk.
• Long-term plans for improvement included the redesign of the entire regulatory process. This included the use of new technology and looking at how AI could be utilised to speed up the assessment process. The online portal had been improved to make it easier for providers to communicate with the CQC.

The Council and CQC officers then responded to questions from the Panel:

• Asked by Cllr Brennan about the high number of care providers that had not been inspected, Andreas Schwarz responded that this was a national issue with a similar proportion of providers being uninspected in other similar Boroughs. Cllr Mason queried how a service could be opened without being rated. Andreas Schwarz explained that, once a service was registered, it could provide a regulated activity and take on service users. However, this would often be for private service users because local authorities would not typically place residents with unrated services. These providers still had to adhere to regulation and work within statutory requirements. He added that some unrated providers were dormant and no longer offered services.
• Asked by Cllr Connor about the Council’s approach to unrated services, Richmond Kessie said that the Council had a policy not to place residents with any provider that did not have a rating of ‘Good’ or higher.
• Cllr Opoku referred to a table in the report which showed that there were four unrated providers which had been commissioned by Haringey Council. Richmond Kessie explained that providers could sometimes change hands and so residents who had been placed under the previous provider could end up in unrated services. He added that the Council had quarterly meetings with the CQC where there could raise service providers that they felt ought to be prioritised for a future inspection. The Council could also engage with these providers for quality assurance purposes.
• Cllr Iyngkaran commented that the number of providers being used by the Council had dropped by around 30 since last year and queried the reasons for this. Richmond Kessie explained that the provider market had been difficult recently and so a number of providers had exited the market and that this was also reflected in the wider national picture. Cllr Iyngkaran expressed concern that fewer providers could lead to higher prices in the local market. Cllr das Neves commented that the system was not functioning healthily and that some providers were exiting the market due to financial challenges. Some providers were small and may struggle while others may choose to position themselves in other areas that were more profitable. Her opinion was that these circumstances did not always deliver the best value and so it was an area that she would like to see work differently. Sara Sutton added that there was an annual uplift to providers and that the Council was finalising this for the following year as part of a process that included benchmarking across the North Central London (NCL) area and focusing on what was a sustainable price for providers. At a national level there were ongoing discussions around the Fair Pay Agreement and the implications for the care workforce. Jo Baty commented that the commissioning team had good, strong relationships with providers and that it was particularly important to try to protect the smaller providers that were rated Good or Outstanding and keep them engaged in the market.
• Cllr Connor referred to the report which stated that the quality assurance team had raised concerns about the low inspection frequency for some providers and asked how the CQC could improve this situation. Andreas Schwarz responded that, since November, the CQC had reverted to specialist teams which had increased inspection activity. The team looked at services which had an older rating, no rating or was considered to be high risk and then prioritised them accordingly. There was also ongoing work to streamline the inspection process which should increase inspection activity. Cllr Connor suggested that it would be useful to see the details of how these improvements were working in practice as part of a future report. (ACTION)