CQC publishes report on London Borough of Hammersmith & Fulham’s care act responsibilities

The Care Quality Commission (CQC), has rated the London Borough of Hammersmith & Fulham 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 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 – 2
3. Equity in experience and outcomes – 2
4. Care provision, integration and continuity of care - 2
5. Partnership and communities – 2
6. Safe pathways, systems and transitions - 3
7. Safeguarding - 2
8. Governance, management and sustainability - 2
9. Learning, improvement and innovation - 2

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

“Hammersmith and Fulham, were committed to providing good access to care but their plans hadn’t been fully implemented or matured enough to show effective results yet.

“For example, the authority knew people were waiting too long to have their care needs assessed, with an average wait time of 2 months, with some people waiting more than 18 months. The local authority had started a new screening process to manage people waiting and prioritise those most at risk, but there is still significant work to do.

“We heard from unpaid carers who told us they faced delays in assessments but once assessed they found the experience positive, feeling heard and valued.  However, Hammersmith & Fulham need to make sure that support is effective. Carers in the borough experienced higher levels of financial hardship, and less of them were in employment or able to enjoy social contact than the national England average because of their caring responsibilities.  

“The authority didn’t always provide accessible information, and some people struggled to understand the care system, particularly those without digital access or those whose first language wasn’t English. This was especially important in this richly diverse borough that had residents from over 150 different countries.  

“Our inspectors saw areas where the authority was performing well. The council ran their own service helping people regain independence after hospital stays, which was rated as outstanding by the CQC in a separate inspection. It was impressive that 96% of people aged 65 and over were still at home after hospital discharge with the authority’s support, which was much higher than the England average. This support played a key role in preventing unnecessary hospital re-admissions and the need for more formal support or long-term residential care.

“We were also pleased to see the local authority's commitment to involving people using services to help design them. One of the co-production groups had been recognised nationally for its innovation which had provided opportunities for disabled people to voice their concerns and drive changes.  

“Hammersmith and Fulham’s recent strengthening of senior leadership arrangements will help them to act more quickly on the risks they’ve identified and make faster progress on their improvement strategies. They understand the areas for improvement and have built an effective foundation on which to make them. We look forward to returning to see how their plans mature and the impact this has on their community.”

The assessment team found:

1. Hammersmith & Fulham had started work to improve access to services and internal processes so they could define good standards and hold themselves accountable to them. This was already improving the information they held about risks, inequalities and performance to help allocate resources, and deliver the actions needed to improve care and support outcomes for people in the community
2. The local authority offered non-means-tested home care and daycare services without charge for all residents with eligible care needs for the last ten years in a bid to reduce inequalities by removing deprivation as a barrier to access care.
3. The local authority used direct payments to improve people’s choice and control in managing their own care. Unpaid carers who had used direct payments gave positive feedback.
4. In 2023, the local authority opened a Centre for Independent Living, which was designed with local disabled people, for local disabled people. The centre now acted as a hub and provided direct payments support, employment, welfare benefits services and training. 

However, the assessment team also found:

1. Occupational therapy assessments were delayed, preventing people from accessing equipment and adaptations that could help them stay independent.
2. People receiving services and unpaid carers reported feeling less safe than the national average.
3. Carers in Hammersmith and Fulham had comparatively poorer outcomes when compared to national data. Data from the Survey of Adult Carers in England (2023/24) showed that carers in Hammersmith and Fulham experienced financial difficulties (65.82%) and a large proportion were not in paid employment (45.76%) because of their caring role, with only 18.99% had as much social contact as they wanted. These were all significant negative variations from the England average (46.55%, 26.70% and 30.02% respectively).
4. Hammersmith & Fulham ran another outstanding service providing short stay respite care and emergency accommodation to autistic people and people with a learning disability. But they had more to do to improve the wider offer to autistic people and people with a learning disability who live in the borough. Although there were strategies in development, their implementation had slowed.
5. There was a corporate equality plan for the authority overall, but there was no specific equality plan for adult social care. Data held didn’t cover all protected characteristics and wasn’t analysed to understand if inequality existed in the provision of social care. This is important in an area where 37% of people identify themselves as non-white ethnic minorities, with others identifying themselves as white ethnic minorities.