Local authorities must better engage with the voluntary sector and community groups if they are to address known inequalities in their areas, according to a new report.
Today, the Care Quality Commission (CQC), which regulates and inspects health and social care providers in England, published its State of Care report 2023-24.
Every year, the CQC assesses the state of health and social care in the country, looking at the trends, sharing examples of good and outstanding care and highlighting where care needs to improve.
This year, the CQC found that local authorities that engage and work with voluntary, community and social enterprise organisations (VCSEs) tend to achieve better health and social care outcomes, particularly for people experiencing most inequality.
Need for greater engagement with voluntary sector
The CQC looked at the key challenges integrated care boards face – finance, joint forward planning and workforce depletion – as people struggle to access the care they need.
It said that systems currently focus on tackling health and care inequalities and “need to understand their populations to address issues that affect everyone”.
There are “mixed views among integrated care systems about their capability to address local health inequalities”, with challenges and barriers around data and analysis skills, governance and accountability and capacity and capability in the system.
Its report says: “Carers play a vital role in millions of people’s lives. At all the local authorities we have assessed so far, there is work needed to identify carers – and raise awareness that carers are entitled to an assessment and services to support them in their role. This was needed more for people in ethnic minority groups.
“Local authorities have taken steps to address known inequalities and understand the demographics of local populations. But there is a need for better engagement with the voluntary sector and community groups, which have seen some success in identifying groups that are seldom heard and at greater risk of inequality.”
Lack of ‘strong links’ with sector leads to ‘patchy coverage’
The report says the actions local authorities take to understand or address inequalities are not always clear, notably where there are small minority groups within the wider population.
“For too many local authorities, the main focus in tackling inequality was around race, culture and ethnicity as single issues, rather than considering how different protected characteristics might affect people in combination – also called ‘intersectionality’.
“Or, in predominantly affluent areas with a mostly white ethnic population, the focus was on urban/rural inequalities and deprivation. There was limited intersectionality analysis.”
It notes that “engagement with the voluntary sector was mixed”, possibly due to resource constraints.
“Where engagement with the voluntary sector was linked to strong governance processes, including co-production and participation in partnership boards, this was more effective and supported the local authority in understanding local communities – this resulted in targeted commissioning to meet needs.
“However, even where these relationships were effective, local authorities didn’t always have sufficient resources to commission the necessary services.
“Also, a lack of strong links with the voluntary sector led to patchy coverage because local authorities didn’t have the knowledge or intelligence about local community needs.”
Improving safety and quality through collaboration
The CQC heard “how safety can be improved where local systems work collaboratively, bringing together health services, housing and probation services, and VCSE”.
“Shared data and information improved safety because it was made available across services and care pathways,” it wrote in the report.
Some local authorities told the CQC that “the voluntary sector could help in terms of monitoring the quality of services and supporting them to understand people’s experience within services – as well as supporting them to better understand people’s needs”.
On waiting lists, the CQC said the most affected individuals tend to be those with more complex needs including nursing needs or complex mental health needs, as well as services for autistic people and people with a learning disability.
Its report says that gaps in services can result in people being placed out of their local area, either nearby a long way from home.
“Where solutions have been found to some access problems, they often involve collaboration – for example, with housing organisations and the voluntary sector, and particularly for those groups experiencing most inequality.
“Local knowledge was used to identify gaps in provision and work with those at most risk of being unheard.”
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