Nottingham City Council is experiencing significant challenges in providing appropriate housing for adults requiring social care, following a damning report from the Care Quality Commission (CQC).
A report released today to the council’s Health and Adult Social Care Scrutiny Committee ahead of its meeting on 24 October outlines actions and challenges.
This scrutiny comes after the council’s Adult Social Care Service was reviewed as part of a pilot Care Act Assessment in May 2023, revealing critical areas for improvement in housing and accommodation provisions for individuals with complex needs.
The CQC’s findings, published in November 2023, highlighted the council’s over-reliance on residential care, as well as a fragmented system that lacks coordination. The report noted a particular shortage of supported housing options, which are crucial to helping people live independently. Over the 2022/23 period, around 5,900 adults in Nottingham were accessing long-term social care support, with a further 1,320 receiving short-term support. Despite these efforts, the council was deemed to have fallen short in several areas, ultimately receiving a verdict of “requires improvement” from the CQC.
Key Findings from the CQC Assessment:
• Housing Shortages Impacting Care Delivery: A shortage of appropriate
housing for people with complex needs was identified, which delayed care
transitions and increased risks for vulnerable individuals: “A shortage of housing,
particularly for people with complex needs, was a recurring issue affecting staff’s
ability to move cases forward effectively. This shortage delays care transitions
and increases risks for vulnerable individuals.”
• Over-reliance on Residential Care: Due to limited supported housing options,
there was an overuse of residential care for younger adults with complex needs:
“The issues around housing could also lead to the over-use of residential care,
particularly for younger adults.” Due to limited supported housing options, there
was an over-reliance on residential care for younger adults with complex needs.
• Fragmented System Pathways: The CQC highlighted a lack of coordination
between health, social care and housing services, particularly regarding
transitions from hospital care to housing: “Staff identified the lack of coordination
between health, social care and housing services as a barrier to smoothly
transitioning individuals from hospital to appropriate housing. This fragmentation
leads to delays in care pathways and causes difficulties in managing cases.”
In response to these concerns, Nottingham City Council has introduced a detailed Action Plan aimed at addressing the shortcomings. This plan focuses on expanding supported housing options, reducing reliance on traditional residential care, and improving service coordination across different sectors. Central to the new approach is the development of a robust framework for “Extra Care” housing, where residents can live independently while receiving care and support as needed. A multi-disciplinary panel has also been set up to improve coordination between the different services that assist people with complex needs.
Key to this initiative is the “All-Age Accommodation Strategy,” which aims to ensure that Nottingham’s housing services can meet the evolving needs of its most vulnerable residents. This strategy reflects the council’s broader ambition to promote independent living, ensuring that people can remain in their own homes for as long as possible, a vision aligned with national trends towards more personalised and community-based care.
In a February 2024 review, the council’s Health and Adult Social Care Scrutiny Committee discussed the CQC findings in detail. They acknowledged the systemic issues contributing to housing challenges, notably how housing shortages directly impact the effectiveness of care provision. The council’s reliance on residential care, described as an outdated model, was a particular point of concern. Committee members agreed that further scrutiny would be needed, both to assess the long-term effectiveness of the council’s plans and to ensure that additional improvements are made in the future.
The CQC’s assessment framework, co-produced with care partners and individuals with lived experience of the care system, identified four core themes requiring attention: working with people, providing support, ensuring safety within the system, and strong leadership. Nottingham’s performance was reviewed against these standards, and while some progress was noted, the overall conclusion was that the council must significantly enhance its capacity to meet the needs of adults with complex care requirements.
This situation highlights broader problems within the UK’s adult social care system, where councils across the country face financial pressures and housing shortages, hindering their ability to provide adequate care and accommodation. Nottingham’s case is typical of the challenges local authorities face when trying to balance financial sustainability with high-quality service delivery, especially in areas such as social care, which is resource-intensive and highly regulated.
Despite the challenges ahead, the council says it is determined to turn things around. The adult social care sector remains a priority, with the council recognising the need for well-run, efficient services to meet the community’s needs. Ongoing improvements are being closely aligned with the council’s strategic goals, particularly the “Living Well in Our Communities,” “Better Housing,” and “Serving People Well” outcomes of the Strategic Council Plan.
Councillors have voiced their support for the new measures, but remain cautious. While the Action Plan and associated strategies mark a positive step forward, there is a recognition that real change will take time and sustained effort. Further scrutiny of the council’s progress is expected, and the Health and Adult Social Care Scrutiny Committee is likely to play a key role in ensuring the reforms are implemented effectively.
