CQC: What good and outstanding looks like in adult social care

Introduction and strategic context

Outstanding and high-rated local authorities share distinctive features of scale, pace, and culture:

This document presents eleven characteristics of good and outstanding local authorities in adult social care, based solely on analysis of CQC-published local authority assessment reports. It aligns the characteristics to the four CQC local authority assurance themes and the nine quality statements that underpin those themes. It does not draw on any external programmes or organisational perspectives; it is a synthesis of what CQC has reported as strong or exemplary practice across councils.

This analysis focuses on:

• embedding prevention, reablement, and enablement as the operational core.
• integrating equity and co-production into all decision-making.
• recognising Occupational Therapy as a strategic driver of transformation.
• applying strengths- and asset-based principles to every level of practice.

Methodology

Dataset: 83 local authorities analysed (as of 6 November 2025). Of these, 57 local authorities (68.7 per cent) achieved a rating of Good or Outstanding, with two (2.4 per cent) rated Outstanding overall and six (7.2 per cent) achieving one or more Outstanding quality statements.

This analysis draws on a detailed review of CQC local authority assessment reports for councils rated Good or Outstanding. The review followed a structured, multi-stage approach:

1. Initial document review: All relevant CQC reports were reviewed to understand each local authority’s context, demographics, and overall performance profile.
2. Thematic analysis: Key themes, strengths, and examples of good/exemplary practice were systematically extracted and compared across reports. The analysis involved qualitative coding to identify recurring concepts such as leadership, partnership working, and peoples lived experiences.
3. Defining core characteristics: Insights from the thematic analysis were synthesised  to define the core characteristics of Good and Outstanding local authorities. 

Eleven characteristics of good and outstanding local authorities

Each characteristic below contributes to strong performance against one or more of the nine quality statements within the CQC assessment framework.

1. Flow and access
   Outstanding/Good systems maintain seamless pathways from first contact through review. They operate a "no wrong door" approach, use rapid triage and risk stratification, eliminate/significantly reduce waiting lists for assessments/reviews, reablement and occupational therapy, complete at least 95% of assessments within 28 days (with a median of ten days or fewer), and review daily performance through visible flow dashboards
2. Prevention, reablement and enablement
   Reablement and enablement function as the default operating model across front door, community, and hospital pathways. Immediate access is available with urgent starts within 24–48 hours. Eight in ten people completing reablement require no further support, and at least 85 per cent of older people are at home 91 days post-discharge. Occupational therapy leads trusted assessor pathways for equipment/adaptations and reablement/enablement outcomes are monitored weekly
3. Equity, inclusion and co‑production
   Equity and lived experience shape strategy, commissioning and practice. Authorities co‑produce strategies with residents, conduct equality impact reviews for major decisions, publish disparities in access and outcomes alongside corrective actions, and develop targeted pathways with people who draw on services, including autistic adults and people facing multiple disadvantage.
4. Partnerships and place
   Integration is embedded through shared governance, data and delivery. Place‑based partnerships connect adult social care, health, housing and the voluntary sector; neighbourhood teams are co‑located; shared care records and single‑view data enable coordination; and discharge is timely and well‑coordinated. Occupational therapy roles are integral within neighbourhood and intermediate care teams.
5. Market shaping and sustainability
   Sustainable, ethical markets underpin continuity and quality. Authorities pursue neighbourhood home‑care models, uphold fair contract terms, achieve high provider quality with no embargoes or contract hand backs, operate early‑warning systems for provider risk, and align commissioning with workforce and financial sustainability.
6. Safeguarding and liberty
   Safeguarding is timely, relational and prevention‑minded. Initial concerns are addressed within five working days and Section 42 enquiries within 28 days. Advocacy is offered wherever eligible. Making Safeguarding Personal is embedded, and multi‑agency audit and learning cycles are routinely reported to scrutiny.
7. Carers and families
   Carers are recognised as partners and system stabilisers. Co‑produced strategies, discharge toolkits, rapid assessments, flexible breaks, financial and wellbeing advice, and primary care liaison are in place. Authorities track and improve carers’ wellbeing and employment outcomes year on year.
8. Personalisation and direct payments
   Personalisation is evidenced through choice and control. Dedicated teams and streamlined onboarding support direct payments, including tailored offers for older adults and personal assistant market support. Uptake is reported routinely, segmented by cohort and locality, with outcomes described narratively as well as quantitatively.
9. Data, learning and digital capability
   Data is used for learning and improvement, not blame. Authorities operate weekly dashboards and quarterly deep dives, deploy predictive analytics for demand and capacity, invest in data literacy for managers and frontline leaders, and publish regular “you said, we did” updates.
10. Occupational therapy as a strategic enabler
    Occupational therapy is treated as a leadership discipline that operationalises the Care Act’s focus on wellbeing, early intervention/prevention and independence. Principal and practice leadership roles are embedded in governance, commissioning and assurance. Leadership behaviours emphasise clarity, courage, curiosity, connection and consistency. Occupational therapy leads reablement and enablement pathways, integrates with health, housing and the voluntary sector, and features prominently in maturity dashboards through measures of timeliness, responsiveness and outcomes.
11. Strengths‑ and asset‑based practice
    A strengths‑ and asset‑based mindset is explicit in assessment, planning and review. Practice focuses on what matters to the person, their capabilities and networks; risk is enabled collaboratively; community assets are mapped and used; and practitioners apply conversational models and solution‑focused techniques. Local Accounts showcase strengths‑based outcomes and lived experience stories.

Achieving and sustaining good/outstanding practice

Achieving and sustaining Good and Outstanding practice is through focused, evidence-based actions that translate principles into daily practice. The following enablers outline practical steps local authorities can implement to mirror the eleven characteristics of good and outstanding performance, embedding prevention, equity, and person-centred leadership across the system.

A. Flow and Access (Front Door → Review)

Design features:

• Multi-channel access with a “no wrong door” approach and rapid risk stratification.
• Embedded no-wait culture across assessments, reablement, and OT pathways.
• Daily visual management and same-day prevention offers to maintain system flow.
• OT and reablement as first-line interventions, ensuring early enablement.
• Clear handovers between assessment, reablement, and review functions.
• Proactive review culture, ensuring needs are reassessed when circumstances change

Illustrative Good/Outstanding thresholds:

• 95 per cent of assessments completed within 28 days; median wait ≤10 days.
• Reablement access with no waits; urgent OT responses within 48 hours.
• 91-day reablement outcome ≥85 per cent of people aged 65+ remaining at home.
• Short-term support effectiveness ≥80 per cent of people requiring no further support.
• 90 per cent of annual reviews completed on time.

B. Prevention, Reablement/Enablement and Independence

Design features:

• Reablement/enablement as the default early intervention across all pathways (front door, hospital, and community).
• Next-day starts for reablement; step-down flats provide transitional support.
• Functional goals agreed at admission and reviewed weekly.
• Trusted assessor model led by OT for equipment, minor adaptations, and assistive technology.
• Neighbourhood-aligned reablement providers sustaining recovery post-discharge.

Illustrative Good/Outstanding thresholds:

• Reablement access with no waits; urgent starts ≤48 hours.
• 80 per cent of people exiting reablement need no further support.
• 91-day outcome ≥85 per cent of older adults at home post-intervention.
• OT median wait ≤28 days; urgent ≤48 hours.

C. Equity, Inclusion and Co-Production

Design features:

• Board-level equity frameworks integrated into corporate governance.
• Co-production embedded in strategies, commissioning, and procurement.
• Two to three priority cohort pathways co-produced annually (e.g., autism, multiple disadvantage).
• Mandatory equality impact reviews for major decisions and service changes.
• Resident advisory boards and lived-experience roles within commissioning.

Illustrative Good/Outstanding thresholds:

• Co-production evidenced in all major strategies.
• Equity-segmented data on access and outcomes published annually.
• Visible reduction in inequalities across priority cohorts. 

E. Market Shaping and Sustainability 

• Design features: Neighbourhood home-care models promoting continuity and workforce stability.
• Ethical commissioning with fair contract terms, pay, and travel time standards.
• Monthly quality reviews with resident participation. Early-warning systems for provider quality, finance, and workforce risk.
• Workforce pipeline development and innovation funding aligned with system plans. 

Illustrative Good/Outstanding thresholds: 

• ≥90 per cent of providers rated Good or Outstanding.
• Zero embargoes or contract hand backs in preceding 12 months.
• No unmet demand across key care markets.

F. Carers

Design features:

• Co-produced carers strategy linked to local wellbeing plans.
• Standardised carers’ discharge toolkit in all hospital pathways.
• Rapid assessments and flexible breaks available on demand.
• GP liaison roles embedded in every neighbourhood.
• Carers’ wellbeing, employment, and inclusion data reviewed quarterly.

Illustrative Good/Outstanding thresholds:

• No/limited waiting lists for carers’ assessments.
• Improved year-on-year outcomes in carer wellbeing, financial resilience, and employment.

G. Safeguarding and liberty

Design features:

• Co-located, multi-agency safeguarding response teams.
• Clear timeliness standards: initial concern in 7 days, Section 42 in 28 days.
• Advocacy offered in 100% of eligible cases.
• Monthly multi-agency learning sessions embedded in audit cycles.
• Culture of relational safeguarding and risk enablement.

Illustrative Good/Outstanding thresholds:

• 100 per cent safeguarding referrals triaged within five working days.All Section 42 enquiries concluded within 28 days.
• Safeguarding themes reported to scrutiny with evidence of improvement.

H. Direct Payments and personalisation

Design features:

• Dedicated Direct Payment (DP) team with streamlined onboarding.
• Simplified processes and improved digital access for service users and carers.
• Strengthened Personal Assistant (PA) market and peer-support networks.
• Co-produced DP guidance with lived-experience groups.
• Targeted outreach for older adults and underrepresented communities.
• Illustrative Good/Outstanding thresholds:
• 26 per cent of people overall and 20% aged 65+ supported through Direct Payments.
• Annual increase in uptake and satisfaction across all age groups.

I. Data, learning and assurance

Design features:

Weekly flow dashboards and quarterly deep dives into performance themes (e.g., inclusion health, loneliness, substance misuse).

• Routine “You said, we did” publications demonstrating transparency.
• Data literacy embedded across leadership and frontline roles.
• Resident-reported outcomes triangulated with national indicators.
• Psychologically safe supervision and reflective learning culture.

Illustrative Good/Outstanding thresholds:

• Real-time data dashboards available to all operational leads.
• Quarterly public updates on performance improvement and learning.
• Visible audit and scrutiny reporting cycles.

J. Cross-cutting enablers and leadership culture

Design features:

• Visible, values-led leadership creating a culture of openness, trust, and accountability.
• Psychologically safe supervision that promotes reflection, professional curiosity, and continuous learning.
• Workforce resilience planning with clear succession pathways, local recruitment pipelines, and wellbeing support.
• Digital maturity embedded through shared care records, predictive analytics, and assistive-technology integration.
• Data-driven decision-making linking performance, finance, and outcomes in real time.
• Financial governance that prioritises prevention and reinvests savings into community capacity.
• Collaborative learning with partners, scrutiny, and residents to maintain momentum after inspection cycles.
• Quality assurance loops combining audits, peer review, and lived-experience feedback for continuous improvement.
• Leadership visibility through regular “leaders-on-the-floor” engagement and follow-up learning actions.

Illustrative Good/Outstanding thresholds:

• Workforce vacancy rate below 8 per cent; turnover below 10 per cent; sustained improvement in staff survey results.
• Digital care-record access across all integrated partners; 100 per cent of managers trained in data literacy.
• 100 per cent of leadership teams participating in reflective supervision and quarterly learning reviews.
• Balanced adult-social-care budget with documented reinvestment of efficiency savings into prevention initiatives.
• Evidence that audit findings and resident feedback translate into visible service improvements within one quarter.
• Leadership presence observed across all operational teams at least monthly.
• Continuous year-on-year improvement across CQC quality-statement indicators for governance, learning, and improvement.

Conclusion

Being a good or outstanding local authority is not achieved through a single initiative or short-term project; it is the result of a sustained cultural transformation rooted in visionary leadership, strategic ambition, and authentic collaboration with communities. The key principles are —proactive prevention, seamless integration, co-production, and continuous learning. 

By embedding these disciplines into everyday practice, local authorities create systems that not only meet statutory duties but enable people to live healthier, more independent, and fulfilling lives.