The Adult Care and Well-Being Overview and Scrutiny Panel met on Thursday 8 October 2026 to discuss the Care Quality Commission (CQC) Improvement Plan, progress on the Adult Social Care Prevention Strategy and Delivery Plan, and the Adult Social Care Strategy 2023-2028. The panel also reviewed the Quarterly Performance and In-Year Budget Monitoring report and the Work Programme.

Care Quality Commission (CQC) Local Authority Inspection - Improvement Plan

The panel received an update on the progress of the Care Quality Commission (CQC) Improvement Plan for Adult Social Care (ASC) in Worcestershire. The council's ASC service had previously received an overall rating of Good from the CQC, with specific areas for improvement identified in Equality in experience and outcomes and Care provision, integration and continuity.

Mark Fitton, Strategic Director for Adults & Communities, explained that the comprehensive improvement plan addresses these areas and also focuses on continuous improvement in other themed areas. He noted that while a full CQC assessment might not be expected for another three to four years, focused assessments could occur at any time.

Councillors raised several points regarding the plan. Councillor Sue Eacock questioned the assurance mechanisms for achieving the 85% target for recording protected characteristics, to which Kelly Palmer, a representative from ASC, explained that data collection points had been embedded into staff assessments and reviews, and that EDI training was being rolled out. Councillor Eacock also inquired about the scope of the CQC report, specifically whether it covered directly employed carers or subcontracted ones. Mark Fitton clarified that CQC assessments focus on how the council ensures services are provided through commissioning and market oversight, rather than assessing individual paid carers. Rebecca, another officer, added that care market providers are themselves CQC assessed.

Councillor Eacock also raised concerns about a low percentage of satisfaction with social services, citing data from a national survey. Kelly Palmer responded that a local carer survey in 2025 showed 45% satisfaction, and this was not currently being taken as an area for improvement.

Regarding communication standards for frontline staff, Kelly Palmer outlined plans to set a checklist standard for staff, review outgoing letters, and revise the customer journey to reflect CQC findings.

Councillor Andrew Cross raised questions about rural access and transport, asking how success would be measured. Kelly Palmer stated this would involve collaboration with transport colleagues, focusing on residents' ability to access services. Rebecca highlighted existing transport initiatives, including an on-demand service and bus services, and noted that councillors had voted to allow pass holders with learning disabilities to use transport before 9:30 am. Mark Fitton added that the transport issue was broader than just accessing ASC services and required cross-council work.

Sue Eacock also asked for more information on how the Living Life Well initiative, related to mental health and prevention, would be implemented. Mark Fitton indicated that progress was dependent on grant funding applications.

Anthony Upton requested a detailed schedule for the 60 improvement actions, including original completion dates, current status, responsible officers, and reasons for any delays. Kelly Palmer confirmed that this information was available in Appendix 1 of the CQC Improvement Plan, and that currently, no actions were overdue.

Councillor Richard Morris discussed rural transport, advocating for more routes into towns and expressing difficulties in getting a response from the County Council regarding a £1 per trip offer. He also noted a drop in take-up for a local charity's rural transport service. Mark Fitton committed to speaking with the Strategic Director for Economy and Infrastructure regarding the £1 per journey arrangement and exploring the drop in demand with public health colleagues.

Andrew Cross raised concerns about insufficient respite and replacement care, referencing CQC findings. He questioned the performance data on breaks over 24 hours and the number of registered carers compared to the census data. Kelly Palmer explained work was underway with carers' associations to identify carers and that a dedicated carer section had been included in needs assessments. She also stated that while access to respite wasn't the issue, booking far in advance was challenging due to a lack of provision and funding for block purchasing beds. Rebecca confirmed that a questionnaire on carers had been widely distributed and would feed into the refresh of the all-age carers strategy. Mark Fitton mentioned that the council had taken back a contract for replacement care and was awaiting CQC registration for a new facility, Green Hill Lodge.

Michelle Hulme inquired about the reach of the community services directory and suggested promoting it through libraries and providing physical copies to social workers. Kelly Palmer explained that the directory's growth was being monitored, and that advisors had professional accounts. She also confirmed hard copies were available in social work team offices. Hulme also asked about the revisions to carers' assessment documentation and processes, which Kelly Palmer explained aimed to create a single, intelligent form to capture more detailed information.

Andrew Cross specifically asked about learning disabilities, inquiring about placement breakdowns linked to a lack of emergency or replacement care and the number of people with learning disabilities placed outside Worcestershire due to local provision gaps. Mark Fitton stated that specific data on the impact of lack of provision on crisis situations was not readily available, but the figure for out-of-county placements could be provided.

Richard Morris raised concerns about out-of-county spending and the need to understand supply limitations. Mark Fitton acknowledged the complexity of the picture, including choice and other circumstances influencing placements.

Sue Eacock asked about pathways under review for homelessness, referencing Living Life Well and assisted technology pilots. Mark Fitton mentioned a letter from the Department of Health and Social Care encouraging directors to be involved in initiatives for rough sleepers and an upcoming event in Worcestershire.

Progress on the Adult Social Care Prevention Strategy and Delivery Plan

Charlotte, Business Development Manager for the adult front door, presented the progress on the Adult Social Care Prevention Strategy and Delivery Plan. She highlighted that the strategy, now 18 months old, focuses on preventing, reducing, and delaying escalating demand into ASC, with three pillars: reducing social isolation and loneliness, living life well, and information, advice, and guidance. A key challenge identified was establishing baseline data to evidence prevention.

Councillor Tor Pingree asked for examples of how Community Wellbeing Grants had been spent to reduce loneliness and isolation. Charlotte provided examples such as befriending services, walking groups, and dementia-friendly groups, and directed members to the Worcestershire Wellbeing Insights website for case studies. Pingree also questioned why Making Every Contact Count was not included in monitoring data. Charlotte explained that it was no longer commissioned as a service, but the council was focusing on a no wrong door approach with specialist support and advice.

Councillor Andrew Cross inquired about investing in areas noted in an LGA analysis of early action support interventions. Charlotte acknowledged the report's value in showing cost avoidance but noted that the areas highlighted were not Worcestershire-specific. She explained that early action and support are embedded in their work, but they wouldn't simply replicate models from other authorities.

Regarding the difference between a full refresh and a time-limited readiness plan for the strategy, Charlotte suggested looping back after Laura Carroll's presentation on the ASC Strategy.

Councillor Andrew Cross also asked about performance measurement for loneliness and which groups were most likely to report social isolation. Charlotte acknowledged the difficulty in measuring impact and the distinction between loneliness and social isolation. Carrie, another officer, mentioned that loneliness and desired social contact are part of ASC surveys, allowing for benchmarking. Mark Fitton, putting on his public health hat, stressed the importance of this issue across the entire population and noted Worcestershire was likely one of the least lonely counties. Andrew Cross then explored the potential use of AI for gathering anecdotal evidence on loneliness. Charlotte expressed excitement about trialling AI through Beam for transcription and conversational data gathering. Kelly Palmer added that they were also considering drop-in centres and library buses to reach digitally excluded residents.

Councillor Richard Morris suggested a slow the flow campaign for branding and image, mirroring environmental initiatives, and proposed matrix management approaches involving various sectors. He also referenced the Active Bodies, Active Minds branding from Yate, combining leisure centres and libraries. Charlotte welcomed these marketing ideas and mentioned a Preparing for Care event that highlighted cultural change as a barrier. Mark Fitton agreed with the need for cultural change and the idea of wrapping initiatives under a marketing-focused umbrella. He also noted the challenge of robustly evidencing prevention for funding purposes.

Sue Eacock asked if the Community Services Directory and Love Volunteering Portal were accessible on the Worcestershire County Council website. Charlotte confirmed they were and that Age UK and other befriending services would be listed. She also credited Dr. Lisa McNally for her work in promoting health across Worcestershire. Anthony Upton inquired about the growth of the Community Services Directory and whether it was capturing everyone, and if data on age and benefit from the directory could be provided. Charlotte explained the directory lists organisations, not unique users, and that further investment was needed to increase its reach. She also mentioned exploring options for library staff training and desktop access. Carrie offered to share the Tackling Loneliness in Worcestershire Action Plan. Mark Fitton echoed the need for broader community support beyond ASC.

Andrew Cross asked about the Targeted Adult Support Teams, specifically if they assisted people with assets or only those eligible for free ASC. Charlotte confirmed the service was not means-tested and was largely funded by public health and ASC funding, benefiting the system broadly. She agreed to provide a written breakdown of the proportion of self-funders. Councillor Evans, the Chair, suggested looking at initiatives like multi-generational living blocks, similar to those in Japan, to foster community approaches. Mark Fitton commented on the challenges of implementing such initiatives in a unitary authority compared to a combined authority.

Progress on the Adult Social Care Strategy 2023-2028 and the Delivery Plan

Laura Carroll, Head of Service for the area social work team, presented the progress on the Adult Social Care Strategy 2023-2028 and its Delivery Plan. She reported good progress against strategic objectives despite a challenging environment, with a focus on supporting independent, healthy, and fulfilling lives. Key themes included strengthening prevention, improving transitions, expanding specialist support, and listening to service users and carers.

Councillor Tor Pingree asked if local volunteers and community champions were trained. Laura Carroll stated that while the Love Volunteering Portal did not yet have a training section, district teams had their own training.

Councillor Sue Eacock raised concerns about safeguarding, noting a reported increase in waiting times for initial allocation and inquiry work. Laura Carroll acknowledged the spike in safeguarding concerns, attributing it partly to increased identification and reporting, and partly to workforce reductions. She assured the panel that additional investment had been identified to address this, and that critical risks were acted upon immediately. She also mentioned the impact of large-scale safeguarding concerns on resource diversion.

Eacock also asked if safeguarding was included in the paragraph about improved access to support. Laura Carroll confirmed that safeguarding was included across all service areas, with a focus on early intervention and prevention, even when dealing with potential safeguarding concerns, as these could stem from loneliness and isolation.

Andrew Cross asked about the neurodiversity team, specifically the number of people waiting for support and for how long. Laura Carroll stated that approximately a month prior, there were only 14 people waiting, and the team was managing demand well. She confirmed that the current customer journey aimed for assessment within 28 days.

Jenny raised a point about an informal discussion with Professor Keith Brown on safeguarding, which had not yet materialised, and suggested pushing for it to happen. Mark Fitton committed to following this up.

Quarterly Performance and In-Year Budget Monitoring Report

Katie presented the performance information, noting that it was broadly stable from the previous quarter. Key indicators discussed included:

• DAS 313 (Outcomes of short-term services): Performance was 87.7%, exceeding the target of 84%, and had improved from the previous quarter. Investment in Pathway 1 was supporting discharge and system flow.
• DAS 444 (Admissions to permanent care 18-64): The rate was 17.7 per 100,000, above the target of 13.4. This was attributed to increasing acuity and demand, with all placements scrutinised. The indicator had moved from red to amber.
• DAS 306 (Admissions to permanent care 65+): The figure had dropped to 601, within the target of 645, but an upward trend was noted. Drivers included self-funding pick-ups and delayed financial assessments.
• DAS 314 (People aged 65+ at home following rehabilitation): This ASCOF measure was reported as 61.4%, below the target of 83%. However, this was attributed to a data quality issue, and performance was known to be better.
• DAS 413 (Annual care package reviews completed): Performance was 82.7%, below the target of 95%, but had improved from previous quarters. The service was exploring trusted reviews, self-reviews, and assistive technology.

Councillor Tor Pingree asked for deeper insight into the driving factors behind admissions to permanent care for 18-64 year olds. Katie explained there wasn't one single factor, but complexities in the service and residential care being a more appropriate option when needs couldn't be met in the community. Rebecca added that Worcestershire had low rates of admission to long-stay hospitals for people with learning disabilities and autism, meaning more people with higher needs were supported in the community. She also highlighted the ageing population and carers becoming unable to continue providing support as contributing factors. Mark Fitton mentioned that the council might be funding placements that health services would typically fund. Tor Pingree then questioned if the costs of supporting complex needs in the community were reflected in national funding. Mark Fitton responded that current central government funding was not always sensitive to local needs.

Andrew Cross expressed concern about the backlog in annual care package reviews (DAS 413) and the risks to service users. Carrie explained that overdue reviews still had oversight and that the council was trialling AI tools like BEAM to improve efficiency. She noted that achieving the 95% target was challenging and that Worcestershire was performing well compared to regional authorities.

Mel raised a point about national care service proposals, clarifying that free personal care would not include bed and board costs.

Richard Morris discussed continuing healthcare, expressing concerns about Worcestershire receiving its fair share of funding. He also felt that the integration of children's and adults' services following Worcestershire Children's First could be more effective. He suggested exploring joint services with neighbouring councils like Herefordshire and greater collaboration with the voluntary sector.

The panel then discussed the work programme, with Michelle Hulme suggesting future scrutiny items on CQC improvement plan progress, the Baroness Louise Casey Independent Commission on Adult Social Care, and a report on the council's monitoring of providers, particularly home care, to ensure value for money.

Richard then presented the financial information for Quarter 1 (Period 3). He reported a forecast overspend of £8 million across all service areas, with the main drivers being adults and children's social care. The £12.1 million contingency fund was expected to be fully used. He noted that savings targets were largely on track, with only £187,000 rated as amber. The Dedicated Schools Grant (DSG) presented a significant pressure, with a forecast deficit of £40 million by the end of 2028-29. Sensitivity analysis showed that a 1% increase in care fees for adults could result in a £3.2 million financial impact. The council's debt position stood at £36.7 million, a reduction from the previous year. Reserves were forecast to decrease to £9 million by March 2027.

For Adult Services specifically, a forecast overspend of nearly £12.8 million was reported, primarily driven by the cost of care for Worcestershire residents. Residential and nursing care for older people was the largest pressure, with over £5 million overspent. Supported living was the driving factor for the learning disability overspend, with an increase in one-to-one hours needed. Physical disability and mental health services also showed overspends. Richard highlighted that the care market was the main driver of the overspend, with an increase in the number of individuals requiring care packages and higher average costs.

Mitigation strategies included reviewing supported living contracts and one-to-one costs, investing in the Continuing Health Care (CHC) team to push forward assessments with the NHS, and reviewing high-cost packages. He noted that the CHC team had already produced £700,000 in cost avoidance. Work was also underway on transitions between adult and children's services and reducing agency staff spend. He confirmed that the council's cost of care for over 65s was below the England average.

Councillor Andrew Cross inquired about income generation through selling expertise. Mark Fitton mentioned involvement in forums like the West Midlands Adults Association of Directors of Adult Social Services (ADAS) to share good practice. Katie added that ASC was part of the ADAS performance and knowledge share. Kerry highlighted that Worcestershire's front door service was considered advanced, and they regularly shared their strategies with other authorities. Rebecca noted that while Worcestershire had high levels of innovation, they lacked the resources to be paid for sharing expertise. Mel mentioned an upcoming seminar on budget proposals. Mark Fitton reiterated the need to talk more positively about ASC, while acknowledging the current service was not gold standard. Andrew Cross suggested exploring monetizing expertise in areas like AI for combating isolation.

Councillor Tor Pingree asked about the cost of care for the 18-64 age group, and Mark Fitton responded that while older people's care costs were below the England average due to a framework, the 18-64 group was more complex. Rebecca added that comparisons needed to be made carefully due to different cohorts of people with varying needs. Tor Pingree expressed pride in the number of people in supported living rather than residential care, highlighting the better quality of life.

Richard Morris raised concerns about continuing healthcare funding and the integration of children's and adults' services. He also suggested exploring joint services with neighbouring councils and greater collaboration with the voluntary sector.

The panel then discussed the work programme, with Michelle Hulme proposing future scrutiny items on CQC improvement plan progress, the Baroness Louise Casey Independent Commission on Adult Social Care, and a report on provider monitoring.

The meeting concluded with the Chair thanking everyone for their contributions.