Hammersmith and Fulham: local authority assessment

Hammersmith & Fulham had some protected characteristic data highlighted within the Joint Strategic Needs Assessment (JSNA), the demographic data was analysed at the primary care network level, and there were further detailed chapters including one on learning disability published in 2023. This data was used in many ways by the local authority and partners. For example, local Primary Care Networks used this data to make decisions about local priorities and adult social care commissioning used this data to inform its market position statement and procurements.

The local authority had multiple communities in the borough representing a rich diversity, however, the depth of equalities analysis did not always reflect this in adult social care. For example, we heard about the lesbian, gay bisexual, and trans community, asylum seekers community, and traveller community but these communities were not identified in the adult social care data or population profiles. Partners recognised that adult social care was seeking to reach out to a range of communities but felt sometimes it did not have a depth of understanding about different cultures and differences within groups.

There was a corporate equality plan for 2021-25 and the council had an Equality Diversity and Inclusion (ED&I) Lead who understood the areas of development required in adult social care. However, there was no specific equality plan for adult social care and though it had some information about people receiving services captured in its care records system, this did not cover all protected characteristics and was not analysed to understand if inequality existed in the provision of social care.

The local authority had regard to its Public Sector Equality Duty (Equality Act 2010) in the way it delivered its Care Act functions, there was some community work happening to understand people’s experience of social care, but more work was needed to fully embed strategic intentions consistently into front-line practice and service delivery in a timely way.

For example, there was the Building Trust project completed with the NHS North-West London and the local authority in response to health inequality highlighted during COVID, and concerns about vaccination uptake. 13 listening events took place in 2023 to build trust with members of Black, Asian and Minority ethnic communities, where people shared their experiences of health and social care. Within these events led by community leaders people opened up about issues of racism and unconscious bias, and gave reasons why they struggled to engage, especially over the phone, with services due to the language barriers and lack of translators. Some people said they had good service but there was a strong sense of injustice. Issues of intersectionality were highlighted, where 2 or more protected characteristics combine to create unique inequalities, for example, the intersection of race/ethnicity and sex. The rich information from these 13 workshops produced 21 recommendations then stalled, but a new chair was appointed in May 2024 to oversee the implementation sub-group. A community event was held in June 2024 and chose four themes to take forward which were: racially, culturally and trauma-informed mental health care, the creation of a Black health panel, improvements to maternity services and prostate cancer awareness work.

The local authority had collaborated closely with disabled people since 2014 and as a result, a political commitment was made to provide home care and daycare without charge across the borough. In 2017 there was a commitment to co-producing an Independent Living strategy and ‘Doing things with residents, not to residents’. In 2022 a vision for independent living was published, which took a social model of disability approach and indicated language that the group felt should be used in care assessments. Within adult social care teams and in the assessments completed the social model of disability and language of independent living had not been fully embedded, as assessments were sometimes written in a task-orientated way instead of a strength-based way.

There were many good examples of cultural competence Care Act assessments, however, this was not consistent. Senior adult social care managers referred to the diverse staff groups they had when asked questions about inclusive practice but did not demonstrate an awareness of the wider issues facing the diverse population in the borough. There was equalities training for all staff and cultural competency training had been commissioned for 80 staff members, most of whom were managers, and there was a plan to roll this out to the wider workforce.

There were some inclusion and accessibility arrangements in place so that people could communicate with the local authority in ways that worked for them. The local authority told us that there were people from 150 different countries in the borough. People’s first language was noted on the care system when contacting adult social care, 73% of the data was recorded, and 18% of people in contact with adult social care reported that English was not their first language, with a complete data set this number may have been higher. There was a contract in place for interpretation services, but it was not monitored for assurance it was being used appropriately, and quality of service was good. Staff had a mixed approach to using this, with some relying on providers, friends, family or Google Translate, there was no guidance for staff on when interpreters should be used or assessments offered in different languages.

There was a range of materials, reports, and surveys in easy-to-read format. There was a specialist sensory team to support people with hearing and sight loss, providing accessible information and advice while identifying barriers to access and providing appropriate equipment and support. There was no provision of appropriate training to carry out Care Act assessments for those who are Deafblind as staff told us this was beyond the scope of the sensory team.