Building capacity and capability for improvement in adult social care

25 August 2022


  • It is a time of great change in the adult social care sector, with plans to introduce a new Care Quality Commission assurance framework and integration with health services under way. This moment of change is an opportunity to rethink the approach to improvement in adult social care and the support that is offered.
  • Local authorities spend £23 billion a year commissioning adult social care services and put huge effort into trying to improve the quality of adult social care both locally and nationally. This improvement activity aims to enhance the quality of life of those who draw on social care and can also focus on improving the experience of the workforce or putting the finances on a more sustainable footing.
  • To explore how local authorities make improvements and measure success, and what type of support they use to make improvements, we conducted 27 interviews with those involved in improving adult social care in local authorities. We explored the adult social care improvement ‘stories’ in five local authorities and compared what we heard with established approaches and principles of quality improvement used in many sectors.
  • We found examples of excellent work on improvement and local authorities drawing on the support offer that is provided through ‘sector-led improvement’. Adult social care staff shared best practice through this programme as part of a strong regional community for improvement.
  • We also saw huge variety in approach and a lack of a shared language or codified set of methods for improvement. At times, the absence of a shared quality improvement approach appeared to lead to improvement activity that was reactive, focused on short-term fixes and one in which the data and measurement were lacking.
  • In this discussion paper, we don’t make recommendations. Instead, we ask some questions, intended for the adult social care sector, about what the future should look like.

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