Introduction
This guide is designed for scrutiny practitioners, councillors on scrutiny committees and the officers who support them, to help when scrutinising adult social care.
It includes the context you need to ask good questions, and ten questions that form the basis of effective scrutiny in this area. We have also included a short ‘jargon buster’ to help you understand any unfamiliar terms.
How to use these questions
These questions are designed to be quick to read, relevant and accessible, complementing our suite of good scrutiny practice guides. Think of them as a menu of options, allowing you to choose the questions that matter most in your local context, you will not need to ask all ten.
Jargon buster
The main law setting councils’ adult social care duties, including a duty to promote wellbeing.
The Care Quality Commission’s (CQC) assessment of how well a council meets its Care Act duties (separate from its inspection of individual care providers).
The NHS body that plans and funds most health services in an area, and which the council works with on shared health and care priorities.
A pooled budget that requires the council and NHS to plan some health and care spending jointly.
Short-term support, often after a hospital stay, to help someone regain independence and reduce their longer-term need for care.
Deprivation of Liberty Safeguards. The legal process protecting people who lack capacity and may be deprived of their liberty in a care setting.
The Adult Social Care Outcomes Framework. National measures of how well care and support improve people’s outcomes.
Independent reviews carried out when an adult with care and support needs has experienced serious abuse, neglect, or death, and there is concern that agencies could have worked together more effectively.
Refers to situations where a person is medically fit to leave hospital but cannot be discharged because the necessary health, social care, community support, or care home arrangements are not yet in place.
The national context
These bullets set out the national backdrop. Your local context is just as important. LG inform can help you understand local data and benchmark against comparable councils, alongside your own knowledge and insight.
- Adult social care is one of the largest and fastest-growing areas of council spending and is under sustained pressure as more people live longer with more complex needs.
- Council duties are set by the Care Act 2014. The duties include assessing needs, promoting wellbeing, preventing or delaying the need for care, supporting unpaid carers, and shaping a sustainable local care market.
- Since 2023 the Care Quality Commission (CQC) formally assesses how well each council delivers its Care Act duties. These assessments are a ready-made, independent evidence base for scrutiny.
- Most care is delivered by independent providers, so the stability of the local care market and its workforce largely determines whether people get good care.
- Adult social care and the NHS are deeply intertwined. Most people move between the two, and how well they join up shows up in hospital discharge, delayed transfers of care and pressure on both budgets. Councils and the NHS must plan some spending together through the Better Care Fund and work closely with their Integrated Care Board, so the health relationship is central both to good care and to financial sustainability.
- Reform is firmly on the agenda. The independent Casey Commission and its ‘Big Conversation on Care’ are shaping the national direction. The timetable has been brought forward, with a single final report now expected in summer 2027.
The ten questions
1. Do we have a clear vision for adult social care at our council, and what are the biggest risks to achieving it? How do we know it is improving people’s lives?
Also ask:
- What outcomes do we measure, and do they capture what matters to the people who draw on care and support?
- What are the DASS’ top three risks, and how are they being monitored? Do they form part of the strategic / corporate risk register?
- How does our vision for adult social care link to the wider priorities of the council?
- When was our CQC assessment, what did it find, and how are we using the findings to improve people’s lives?
Why ask this?
A strong answer sets out measurable outcomes and is honest about weaknesses. The CQC assessment gives scrutiny an independent starting point.
2. How well do we prevent, reduce and delay the need for care?
Also ask:
- What do we invest in prevention, reablement and community support, and what does it achieve?
- How effective is reablement at helping people regain independence after illness or a hospital stay, and how do we know?
- How do we work with the voluntary and community sector to keep people well and connected, and how sustainable is that sector locally?
Why ask this?
Prevention supports better outcomes for individuals and is vital for financial sustainability. Look for evidence that early support reduces or delays long-term need, rather than simply stating that this is the aim.
3. Is adult social care financially sustainable, and are savings targets deliverable without harming people? And which financial risks present the greatest threat to statutory compliance?
Also ask:
- What are the main cost pressures for our council (e.g. demography, complexity, provider fees) and how confident are we in the forecasts?
- What is the impact of our savings targets on people, carers and statutory services?
Why ask this?
Adult social care is one of the biggest financial risks a council carries. Look for realism about deliverability and a clear line between each saving and its effect on people.
4. Is the local care market stable, diverse and sustainable? And where is the Council most exposed to provider failure?
Also ask:
- What is our plan if a major provider fails, and are we testing contingency or resilience arrangements? If so, how often?
- How are we shaping the market for the future, for example towards more care at home or supported living?
- How well do we understand providers’ costs, and are the fees we pay enough to keep quality care viable?
Why ask this?
People’s care depends on providers remaining viable. A strong answer shows the council understands provider costs and has tested contingency plans.
5. Do we have the social care workforce we need (now and for the future)?
Also ask:
- What are vacancy and turnover rates, and how do they compare with neighbouring authorities?
- Which services are most vulnerable to recruitment and retention difficulties?
- What are we doing on pay, terms, training and progression to attract and keep care workers?
- How reliant are we on agency staff, where are we most reliant, and at what cost?
Why ask this?
There is no good care without enough skilled, valued staff. Heavy reliance on agency staff is expensive and can fragment continuity of care, so look for a credible workforce plan.
6. How well do we identify and support unpaid carers?
Also ask:
- How many carers do we know about, and how many are we likely to be missing?
- How quickly do carers get an assessment, what support do we offer, and is it enough?
- What are we doing to reach hidden carers, including young carers?
Why ask this?
Unpaid carers are the backbone of the system, and supporting them prevents costly breakdowns in care. Look for evidence that the council finds carers early and that assessments lead to real, timely support.
7. Can people get timely assessments, reviews and support when they need them?
Also ask:
- Are there particular groups of people who are most at risk whilst waiting for an assessment or review?
- What are our waiting times for assessments, care reviews and DoLS authorisations?
- How many people are waiting, for how long, and what are the risks to them while they wait?
- How are we prioritising and managing risk within the waiting list, and how do we escalate high-risk cases?
Why ask this?
Delays can leave people at risk and store up bigger costs later. The council should know the size and risk of its backlog and be actively managing it, not simply describing it.
8. How effectively do we identify, understand and manage safeguarding risks, and what are we learning from it?
Also ask:
- What safeguarding risks are concerning us most at the moment?
- What do our safeguarding data and trends tell us about risk in the area?
- How do we know our risk assessments are effective?
- What have recent Safeguarding Adults Reviews taught us, and how have the lessons changed frontline practice?
- How do we know that safeguarding practice is improving, and that learning from Safeguarding Adults Reviews, near misses, complaints and safeguarding activity is leading to measurable change?
- What assurance do we have that the Safeguarding Adults Board is effectively fulfilling its Care Act responsibilities and making a difference to safeguarding outcomes locally?
Why ask this?
Safeguarding is a core Care Act duty. Look for evidence that the council understands its risks, acts on Safeguarding Adults Reviews, and can show that practice has genuinely changed as a result.
9. How well are health and social care joined up?
Also ask:
- What is our relationship like with the Integrated Care Board?
- How well does hospital discharge work, and what is happening with delayed transfers of care?
- Where do the greatest risks arise when people move between services?
- Do we have insight into which discharge cohorts experience the poorest outcomes?
- How is the Better Care Fund being used to deliver joint priorities, and can we see what it achieves?
- What, if any, risks are shared with our NHS partners?
Why ask this?
Most people move between health and care, and poor join-up shows up as delayed discharges and duplicated effort. A strong answer shows a genuine partnership with the NHS, such as shared plans, pooled resources and shared accountability, not two systems working in parallel.
10. What are the biggest risks facing social care locally, and are we focusing scrutiny effort on them?
Also ask:
- What keeps senior leaders awake at night?
- Are the things that keep senior leaders awake at night on the corporate / strategic risk register, and how is that reviewed?
- Where could scrutiny add the most value?
Why ask this?
Scrutiny is most effective when it focuses on the issues that present the greatest risk to residents, service quality and the council’s ability to meet its statutory duties. A strong answer will demonstrate that the council has a clear understanding of its most significant risks, that those risks are being actively managed, and that scrutiny is directing its limited time and resources towards the areas where it can add the greatest value and impact. Look for evidence that risk assessments inform work programming and that scrutiny is helping the organisation to anticipate and address problems before they become crises.
Further information and support
LG inform – is a free tool from the Local Government Association that brings together performance, demographic and financial data for local authorities in one place. You can also download a mobile friendly version as an app.
Good scrutiny practice guides – CfGS suite of practical guidance covering key aspects of effective scrutiny.
The adult social care outcomes framework (ASCOF) – the national framework used by the NHS and local authorities in England to measure how well adult social care services improve people’s quality of life, independence, and wellbeing.
Local authority assessment reports – Care Quality Commission (CQC) – search here for your own local council.
Care Act 2014 – the core legal framework governing adult social care in England, setting out local authorities’ duties to promote wellbeing, assess care needs, protect vulnerable adults, and support carers.
The Casey Commission – an independent review of adult social care in England, chaired by Baroness Louise Casey, established to recommend long-term reforms to how care and support services are funded, organised and delivered.
All resources