The new duty on the Care Quality Commission (CQC) to assess local authorities’ delivery of their adult social care (ASC) duties under the Care Act 2014 came into effect on 1 April 2023. Since then, local authorities (LAs) in England have been preparing for CQC assessments of their adult social care services.

The CQC assessment process may have the effect of boosting interest in joint working between ASC and public health teams. Directors of Public Health and their teams are expected to actively participate in the assessment, through contributing to the self-assessment and information returns and being interviewed as part of the process.

Through this closer working for CQC preparation, new opportunities for collaboration between public health and adult social care could emerge that build on areas of shared interest. Most notably, the emphasis on prevention within adult social care means there are opportunities for developing shared approaches to intervening upstream, with roles for public health, social care and wider partners across the health and care system.

“It is critical to the vision in the Care Act that the care and support system works to actively promote wellbeing and independence, and does not just wait to respond when people reach a crisis point” Care and Support Statutory Guidance

Does this new requirement open the door to other opportunities?

Public Health teams in English LAs are often located within the same directorates as Adults Social Care, but the degree to which there is close working is likely to vary.

Our SIG has been working on this area for a few years, having started by exploring primary prevention in the context of adult social care in 2022. We think there are opportunities for improving health and wellbeing at a population level that could be realised through closer working between the two disciplines. Here are some of those:

The population of residents who are assessed for and those who become clients of adult social care will tend to be one of significant need, unmet need and inequality, in which there may be potential to support health improvement..

Through working with adult social care, public health teams can provide data and insights that contextualise trends in social care service provision within broader patterns in population health and wellbeing. This framing of social care need as a whole-population question, rather than limited to those receiving support, can widen the scope for prevention-focused work and can support social care commissioners to implement interventions that address the drivers of social care need locally. Use of population health data can also help in identifying groups who may experience inequalities in social care outcomes, and population groups who may have unmet need, based on what is known about their health and wellbeing.

In addition, linked health and social care data can provide insights into the health needs of people receiving social care support, which in turn enables effective targeting of interventions to address the health needs of a group that often experience adverse health outcomes.

The common interest in prevention and in improving wellbeing at a population level lends itself to developing shared approaches to prevention, even if adult social care has traditionally had a stronger focus on those actively receiving support. This recognises both the role adult social care plays in meeting the support needs of a population group with significant health and social care need, and the wider benefits of preventing ill-health, in mitigating future demand for social care services.

Public health teams can greatly benefit from greater engagement with ASC. Insights from social care practitioners can be valuable in understanding the health needs of people in receipt of social care support, and through effective integrated working social care teams can support service users to access preventive healthcare services that can improve health and care outcomes. Social care can also play a positive role in addressing growing public health challenges such as multimorbidity and the disproportionate effects on people living in areas of higher deprivation, by providing a more holistic understanding of “need” for support that considers not just what medical treatment looks like for two or more conditions, but how people’s lives can be improved through support from across a whole system that includes social care. 

There may be other opportunities for mutual learning: the strengths-based ethos of adult social care has much to offer, and there is value in public health teams learning more about working directly with service users to deliver effective services.

There are challenges as well. The public health profession and the adult social care profession have different starting points in terms of core concepts and training. The concept of ‘social care need’ has been described as needing a consistent definition, and day to day terms such as ‘prevention’  and ‘needs assessment’ have quite different meanings

We recognise that the starting point for this blog, with its focus on CQC inspections has direct relevance only for England. We are interested in whether there are similar arrangements in the devolved UK nations, so please do get in touch to let us know. And we are always keen to hear from Faculty members who would like to join the SIG!

We are currently working on Top Tips for public health colleagues working with adult social care, which will build on the content here and is likely to address issues such as how to understand what population need for adult social care looks like, areas for mutual learning, and how can we find a shared understanding of prevention.

Liam Flannigan, Eugenia Cronin, Liam Crosby & Ellie Houlston, Members of the Public Health & Adult Social Care SIG