Blackpool Council: local authority assessment
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Partnerships and communities
Score: 2
2- Evidence shows some shortfalls
What people expect
I have care and support that is coordinated, and everyone works well together and with me.
The local authority commitment
We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.
Key findings for this quality statement
Challenges were not limited to the local authority within partnership working arrangements. The local authority worked with the Integrated Care System (ICS) and demonstrated a commitment to the ethos of partnership working. Senior leaders and partners told us the ICS faced significant challenges particularly around fragmented services, workforce challenges, poor outcomes and overspend of budgets. The NHS integrated care board (ICB) had been placed at the highest level of NHS oversight indicating a requirement for mandated intensive support, and the NHS acute trust was in special measures and hospital rated inadequate overall by CQC. Key system partners consistently told us they took a shared responsibility for the situation and spoke positively about working relationships with the local authority. However, these collective difficulties were negatively impacting people’s experiences and outcomes in Blackpool. There was a real risk there could be further negative impact on service delivery due to pressures around resource capacity and capability. All senior leaders and partners told us investment was needed particularly in community and preventative services in Blackpool.
Blackpool had an all-age joint local Health and Wellbeing Strategy (2024-2028) held by the NHS integrated care board and the local authority. All partnership organisations that contributed to Blackpool health and wellbeing board were aligned to the published strategy as a common purpose and members of the public could see where action would be focused. Many of the priorities remained as set in the last strategy including housing and tackling addiction. The strategy highlighted people experienced significant disadvantage in Blackpool, and this could be seen across many determinants of health. It acknowledged Blackpool to have significantly higher levels of harm for people particularly around drug use and poor housing quality, than England averages. The four priorities were starting well, education, employment and training, living well and housing. There were no overarching objectives around early intervention and prevention, and optimising technology and data. There were aspirations to enable the health and well-being board to monitor delivery and link with the integrated care partnership place-based partnership board around this. However, there was mixed feedback about board attendance. For example, one senior leader told us some key system partners were ‘slipping away.’ Whereas a key partner told us attendance had improved and there were partnership discussions across the police, NHS trust, Healthwatch, adult social care, integrated care board (ICB), citizens advice, housing, public health and commissioning.
The Director of Adult Social Services (DASS) in Blackpool held a dual role as the NHS Integrated Care Board place (Blackpool) director. This had started from 2022 when the ICB was formed, the aim was to bringing funding and services together to improve outcomes local people. However, arrangements to align governance, accountability, and strategy had not progressed as planned. The DASS believed in the benefits of partnership working within Blackpool and had awareness of the health and social care challenges local people in Blackpool faced from an all age perspective. The local authority had some pooled budgets and jointly fund services through the use of the Better Care Fund (BCF) to achieve better outcomes for people. The DASS was the chair of the partnership emergency care board and told us agreements around joint working and funding had been in place even prior to the introduction of BCF. Senior leaders told us partnership working was based on some key shared values including trust and respect, communication, shared vision and goals, flexibility and shared accountability.
There were inconsistent experiences and outcomes for people and unpaid carers. Senior leaders, staff and partners told us more needed to be done to integrate with health, the voluntary and charity sector and progress preventative approaches to make a difference to people’s outcomes. A senior leader told us there remained to be some ‘silo’ working although relationships had improved from ‘tense’ to ‘from strength to strength’. The local authority was leading a research project to better understand the overall health of the community and what they and partners could do to improve it. However, there was more to do to ensure current partnership working was effective and care and support was coordinated. For example, senior leaders and partners were aware more needed to be done to improve mental health services in Blackpool. Senior leaders told us the mental health transformation in Blackpool was an ongoing programme of change, improvement and commitment to an integrated approach from key partners across health, social care and the voluntary and charity sector. There were 5 mental health transformation social work roles working across community and hospital health services to reduce barriers to joined up working and improve people’s outcomes. This included an enhanced weekly meeting where people and unpaid carers could attend (virtually) to support people to access services. There was a draft Community Mental Health Team Transformation Collaboration Agreement which aimed to address the need to improve mental health services. The collaboration aspired to transform the way mental health services were delivered by improving colocation of teams and creating new community based integrated multi-disciplinary mental health teams to lead to greater integration of across partners.
There were examples of current partnership working not being effective. For example, the local authority’s Joint Strategic Needs Assessment (JSNA) had identified sight loss as a concern in Blackpool. An estimated 4,890 people in Blackpool were living with sight loss in 2022 (3.5% of the population), which had been projected to rise to 5,500 by 2032. The local authority identified sight loss could be linked to deprivation and poor health. Additionally, high levels of deprivation and poor health could also increase people being affected by sight loss. The JSNA referenced a report from a multi-agency project, identifying priority issues and strategic recommendations for action to improve eye health and prevent sight loss within the integrated care system. The JSNA stated work paused due to the COVID 19 pandemic, however in 2023 the NHS trust had made a specific recommendation for further work needed. Senior leaders told us engagement with people with disabilities including people with sight loss had been a long-term corporate priority. There was a new Disability Forum, which was chaired by a person with sight loss and a councillor was a champion for ‘disability’ and was said to maintain links with a sight loss support charity. Despite this there was currently no joining up of resource to ensure support was coordinated and everyone worked well together to improve outcomes for people. In contrast, there were examples of more positive partnership arrangements. There was a local Learning Disability Partnership Board and Autistic People Partnership Board with a joint-funded strategic plan. The board was co-chaired by people with care and support needs and membership extended to unpaid carers. However, adults within this board told us their impact was limited.
There was also good operational partnership working across police and safeguarding, health and learning disabilities, intermediate care and hospital discharge services. Approved Mental Health Professionals (AMHPs) had agreed partnership working processes with local authorities within the area to carry out assessments on behalf of each other. The learning disability team had access to health databases, and health used the local authority digital recording system so everyone could use the same records and contribute to assessments together. However, staff told us this was due to end and the learning disability nurses would not be using this going forward. Staff told us there was more to be done to maintain working partnerships and without this future arrangements could have a negative impact on people’s outcomes.
There were health neighbourhood teams aligned to primary care networks and health led priorities. These were not specifically aligned to local authority community or specialist adult social care teams, but they did have a local authority social worker assigned to each to support partnership working such as taking referrals, and sharing expertise and information as required. There was adult social care staff also aligned within the health led 2-hour response team. Senior leaders told us joint visits could take place and staff had direct access to Blackpool’s in-house home care provider to avoid unnecessary hospital or care home admissions. Staff and partners gave negative feedback about how effectively the neighbourhood models were working, and it was felt more needed to be done to align strategic aims and evidence of any positive impact of partnership working in this way. For example, a partner told us, there was duplication of care coordination and support, and data issues which was a barrier to evidence any impact. Staff told us there were improvements needed to include social care priorities and values such as strength-based approaches and a home first ethos.
There was mixed feedback from people and unpaid carers about the impact of partnership working in Blackpool. For example, a person told us that different agencies involved in their care and support worked well together. They felt that information shared between agencies was done appropriately and they understood why the information needed to be shared. In contrast, an unpaid carer told us communication between services had been poor and this had resulted in services that did not meet need and the cared for person being unsafe.
The joint Health and Wellbeing Strategy had been approved within the last year. However, there had been no formal monitoring or evaluation around priorities that impacted adults with care and support needs or their unpaid carers at the time of the CQC assessment. The Health and Wellbeing Board chair told us there were plans for every quarterly meeting to look at one of the priorities, and this had only started in the last week around priority 1 ‘Starting Well’ which focused on pregnancy, infants and children.
Priority 3 ‘Living well’, had more of a focus on adult social care than the other priorities. It set out ambitions to influence system change by supporting effective commissioning and sustainability. It focused on better meeting the needs of people experiencing multiple disadvantages alongside drug and alcohol treatment services, working towards being a trauma informed town, and providing equity in support for people (with drug and alcohol addictions, people with mental health needs and people with learning disabilities, and isolation particularly young adult males). In terms of monitoring to inform ongoing development and continuous improvement, there was a considered target to ‘maintain’ deaths from drug use acknowledging it being a significant cause of premature mortality in Blackpool. This was to be evidenced alongside ensuring the quality and accessibility of specialist substance misuse services. There was an ambition to decrease alcohol consumption as a contributing factor to hospital admissions and deaths, however there was no action aligned to this. There was an ambition to increase the number of people in contact with specialist substance misuse services identifying there were more people living in Blackpool that could benefit from support from specialist services, however there was also no action aligned with this. There was an ambition to reduce the proportion of people with a low ‘life satisfaction’ score to improve people recovering more quickly, and positively impact people’s physical and mental health, however there was also no action aligned to this.
Actions to monitor priority 3 overall included public health ambition to undertake a suicide audit, evaluate local mental health support, develop a trauma-informed charter mark and co-production of service provision, mobilise a service for people living with multiple disadvantage, and develop a recovery from addiction hub. Following the CQC site visit there was an interim monitoring summary published on the JSNA website. The local authority had estimated the rate of drug related deaths in Blackpool was likely to increase. Therefore, identified it was not meeting targets set within the Health and Wellbeing Strategy so far. For people with needs relating to alcohol use, this was a more negative trend identified by the local authority, they had seen a rise in alcohol related hospital admissions over 2023- 2024 and based on the trend analysis targets would not be met. For people with a low ‘life satisfaction’ score the local authority also predicated this target may not be met. The update also stated the milestone ‘Develop a trauma-informed organisational charter mark with [a local university] and people with lived experience to support trauma-informed service provision’ would be removed from plans. Senior leaders told us the partnership decision was made not to proceed with establishing a charter mark but to work more closely with the Violence Reduction Network (VRN) Trauma Informed toolkit. The Violence Reduction Network is a Pan-Lancashire programme with participation from all key stakeholders including the Police, Local Authorities, Health and Education providers. All other actions listed had been completed despite the strategy aiming to span until 2028, and there was no current analysis of impact.
There was a lack of market shaping with the voluntary and charity sector groups in Blackpool and missed opportunities around shaping a prevent, reduce and delay offer. The local authority understood that working together with the voluntary and charity sector was central to their efforts in helping to improve people’s outcomes in Blackpool. However, there was no unified strategy for engaging with the sector, and partners told us the level of support often depended on which team was involved. When partners had raised concerns, the local authority acknowledged that their relationship with the voluntary sector could be improved but noted a lack of funding to improve these relationships. There were voluntary and charity services, facilities and resources in Blackpool, not all were listed on the local authority’s online directory of services. Senior leaders told us they held virtual meetings that all members of the voluntary and charity sector were able to attend to understand and meet local public health needs and hear updates about the local authority. Senior leaders and partners told us the local authority did not actively seek out organisations to attend and the meetings were not specific to social care. However, it was said that every organisation was welcome.
The local authority provided funding and grants. For example, grants for the sector to start ‘warm hubs’ as warm places for people to come to during the day particularly for people who experienced social isolation. Staff told us men’s health was a concern in Blackpool and we heard about the value of the organised support groups run by the local football club and men’s suicide prevention and talking groups they could access.
Senior leaders told us about joint work with the voluntary and charity sector around hospital admission avoidance processes and how there was further work to be done with partners to evidence impact on people in relation to all health and care services.
Partners gave negative feedback about the extent to which the local authority involved or made use of them. For example, a partner told us there were ambitions for the local authority to work with the voluntary sector, but this was not being done extensively. Another partner told us, the voluntary sector was not supported well by the local authority. Although charitable organisations had good relationships with the local authority, they told us that support did not extend to the broader voluntary sector, and as a result many voluntary organisations in Blackpool did not have meaningful connections with the local authority.