Adult social care service ‘requires improvement’ in Lancashire
The CQC found sufficient evidence of “shortfalls”
Lancashire County Council’s adult social care services have been ordered to improve after an inspection found residents left waiting for support and staff struggling under the weight of “unsustainable workloads”.
The Care Quality Commission (CQC) assessed the authority’s performance in relation to its duty to help those in need of assistance with their day-to-day lives.
While inspectors praised several aspects of the service on offer – including the commitment of staff and the positive experiences of many of those receiving support – they found sufficient evidence of “shortfalls” to give the county council a 50 percent overall score and a ‘requires improvement’ rating.
The county council – whose patch excludes Blackpool and Blackburn with Darwen – provided long-term support to almost 23,000 people during 2023/24, while more than 5,500 required shorter term help. The cost of the service that year stood at £496m – around 45 percent of the authority’s net annual budget.
The inspection examined the performance of County Hall’s adult social care provision between October 2024 and February 2025, culminating in an on-site visit.
The authority – which has been run by Reform UK since May, but was then under the control of the previous Conservative administration – says it has taken significant steps to address the issues highlighted by the CQC and is already seeing results in some areas.
However, at the time of the inspection, the county council scored two out of a maximum four points across all nine categories under which it was assessed – including assessing people’s needs, safe pathways, systems and transitions, and care provision, integration and continuity of care.
James Bullion, the CQC’s chief inspector of adult social care and integrated care, said the organisation’s visit to Lancashire County Council followed “a period of change that was still ongoing”.
“We also saw ongoing reviews into leadership structures and the impact on staff was clear – they told us they had change fatigue.
“While people using services spoke positively with us about committed and compassionate staff, we had concerns about how quickly the authority was able to assess their needs. We saw staff capacity issues making these problems worse.
“However, despite these challenges, Lancashire was still able to do good work. When people did have their assessments, they were thorough and included a comprehensive overview of their needs and aspirations. The local authority was also good at managing risks to keep people safe and support their wellbeing.
“We also saw unpaid carers were well supported – significantly fewer experienced employment or financial difficulties compared to national averages.
“Lancashire County Council’s got strong foundations to build on. While the waiting times and capacity issues need urgent attention, their committed staff provide a solid platform for addressing these challenges – and there was a clear drive and desire to make improvements,” Mr. Bullion said.
Why are we waiting?
Inspectors highlighted that at the time of their visit almost 2,100 people were waiting for an initial assessment under the Care Act. The median waiting time for assessments was 27 days – which had reduced from 34 days since October 2024 – but the longest hold-up was 226 days.
The CQC acknowledged that the authority had systems in place “to mitigate risks” while people sat on the waiting list. All referrals are triaged, risk-assessed and prioritised accordingly.
Monthly check calls made to those waiting for a full assessment – and community services recommended that might be able to assist them in the meantime.
More than 3,800 residents were also awaiting an annual review of the support they were already receiving to determine whether it needed to be increased or reduced. The median wait was 441 days – almost three months longer than the yearly cycle required – while the maximum wait was 2,760 days or seven-and-a-half years.
Those with outstanding reviews will have included people living in what were described as “stable care settings”, but it was noted that there was greater potential for a person’s needs to have changed the longer they waited for their case to be reassessed.
“People were assessed and supported by committed and compassionate practitioners, but many people were waiting too long for assessments and reviews,” the CQC report said.
It added: “The local authority faced the challenge of increasing demand for assessments outweighing staff capacity.
“Long assessment waiting lists were having a negative impact on other local services. Local providers had capacity to provide services, but assessment delays meant people were waiting for hospital discharge and/or packages of care.”
However, almost 80 percent of those receiving long-term care were reviewed between February 2024 and January 2025 – more than double the proportion reviewed in the previous 12-month timeframe and well above the England average of 58 percent. The CQC said this was “a recognised area of improvement”.
But almost 1,100 people were waiting for assessment by an occupational therapist when inspectors visited – with a median wait time of 40 days and a maximum of 262 days.
As the Local Democracy Reporting Service revealed in February, the previous Conservative cabinet member for adult social care described occupational therapists as being “rarer than rocking horse dung”, saying that recruitment difficulties were contributing to the delays.
However, the CQC highlighted the speed with which many residents – once they had seen an occupational therapist – were then provided with equipment and minor home adaptations to enable them to continue living in their own homes.
Although there was variation in the service across different districts within the county, the authority issues over 10,000 pieces of equipment each month – with no waiting list for ‘low-level’ kit, which can be provided in as little as four hours.
Staff ‘overwhelmed, but determined to keep going’
Inspectors reported that they met “many well-established staff with many combined years of experience and an in-depth understanding of the needs of Lancashire people” during their visit. “Many had worked at the local authority for a long time and felt a strong sense of pride, loyalty and determination to keep going and deliver services for people they support.
“Practitioners were supportive of each other…but many staff, however, reported low morale, feeling demoralised and overwhelmed by their workloads,” the CQC report noted.
It went on to highlight how “major system changes, increased demand, high vacancy levels, plus changes in senior leadership had negatively impacted staff trust, morale and confidence”.
“Senior leaders acknowledged the need to improve this.”
‘Service is often good once you get it – but far from perfect’
The CQC said most people they spoke to reported that they “felt listened to and could express their wishes and preferences”. Residents generally had “positive interactions with supportive and competent practitioners who kept them informed by regular contact” and “most carers told us they felt well supported and listened to”, the inspectors acknowledged.
The authority was praised for its approach to safeguarding and protecting people from abuse and neglect – a responsibility which was described as being “everybody’s business”.
It was also noted that the county council had acted to speed up – and make more consistent – the process of arranging care packages for those ready to be discharged from hospital.
Such packages were often funded ‘without prejudice’ so that any wrangles over which part of the health and social care sector should pay for what did not result in patients languishing on the wards unnecessarily. Nevertheless, variations in the quality of the service to facilitate hospital discharges remained.
Inspectors also received “common feedback” from those dealing with the adult social care service about “limited continuity of care and regular changes of practitioners”.
“People gave examples of having to repeat themselves frequently to different staff. Some people and families found it difficult to access practitioners and felt unsupported as a result.
“There was consistent feedback that the local authority telephone service and website were difficult to navigate,” the CQC report said.
How has the county council responded so far?
Since the CQC inspection, Lancashire County Council says it has recruited more than 50 social workers and 14 occupational therapists, along with a further 18 social care support officers.
The authority has also:
***reduced the number of older people waiting for a care assessment from around 1,850 in April to 1,075 in July – with a 48 percent reduction in those waiting more than 28 days;
***increased care assessment review by eight percent compared to the same point last year;
***cut by half the number of people waiting over 28 days for an occupational therapy assessment.
Executive director of adult services, Helen Coombes – who joined the county council two months before the inspection – said: “While the result…is disappointing, we fully accept the inspectors’ findings.
“I am pleased to say that significant progress to solve many of the issues identified in this report has been made over the last six months and we will continue to drive forward these improvements.
“Staff are driving our change – and we are making sure that they are supported to deliver improvement. We’re now better supporting their wellbeing and improving their morale with earlier interventions to tackle stress. Recruitment and retention have improved, reducing our reliance on agency staff and ensuring greater continuity for those we support.
“We’re also enhancing social care recording, communications, customer service, and our website to improve the experience for people who contact us for support. Further improvements are planned in the coming months.
“It is pleasing that the inspectors felt that we ‘have strong foundations to build on’ and many encouraging areas. Over the past few months, I have seen just how committed and passionate our staff are, and how able they are to adapt and rise to challenges.
“We know there is still much work to do, but we are in a good position to build on the foundations we now have in place,” Ms. Coombes said.
Politicians react to critical care report
Lancashire County Council’s Reform UK leader Stephen Atkinson stressed that the CQC’s findings related to an assessment of the service under the previous Tory administration.
However, he added: “We accept the inspectors’ findings and want to assure residents that significant work is continuing to ensure that the people we support every day receive the best service possible.
“We understand there will be concerns and want to reassure people who use our services, as well as their loved ones and our partners, that we will not stop until all of the recommendations raised in this report are addressed.
“While there were many areas we can be proud of, we know the council needs to do better in other areas.
“Our aim is to support people to live independently for as long as possible, with the right level of support for them and their carers.
“I’d also particularly like to thank our dedicated and knowledgeable staff for going above and beyond, focusing on prevention and person-centred care through our ‘Living Better Lives in Lancashire’ model,” County Cllr Atkinson said.
That method of adult social care practice – introduced in Lancashire last year – is centred around three distinct steps: promoting independence, regaining independence and living with care and support. It is designed, in part, to prevent, reduce or delay the need for formal social care support.
Meanwhile, County Cllr Aidy Riggott, leader of the Conservative group on the authority – and a former cabinet in the administration that was in charge until May – said that the CQC’s ‘requires improvement’ rating was “disappointing”, but added: “I do think there are lots of positives that can be taken from the report.
“The county council has always strived to provide good services to the residents of Lancashire.
“I would like to thank the staff for their commitment and the passion they have shown in the care and support they have provided to the residents of Lancashire. I know the county council can build on that – and all areas of good practice highlighted in this report – for the future,” County Cllr Riggott said.