Hammersmith and Fulham: local authority assessment

Hammersmith & Fulham had a Joint Strategic Needs Assessment (JSNA) that was used by partners and the local authority to identify needs, highlight and address them. For example, it showed Hammersmith and Fulham had the highest rate of suicide in London. Office of National Statistics Data reported that between 2021 – 2023 the rate of suicide was 10.7 people per 100,000 of the population. Reducing rates of suicide was a political and operational priority. Funding had supported many initiatives including mental health workers based in ‘at-risk’ communities, and a health promotion campaign in partnership with a national brewery, targeting men to support them to speak up about mental health and seek support.

The Health and Wellbeing Strategy 2024 to 2029 was informed by residents’ feedback, best practice, and Marmot principles. Marmot principles are nationally recognised evidence-based values that aim to address health inequalities through the social determinants of health. Social determinants of health are the societal structures that impact our ability to live a healthy life, for example, our education or standards of housing.

To produce the Health and Wellbeing Strategy there was a comprehensive co-production campaign that included surveys, interviews, discussions and focus groups with 420 residents, 31 community, neighbourhood and faith groups, 63 businesses, council colleagues and NHS services. There were 4 key priorities identified to address key health issues, amplify community strengths, cultivate conditions to flourish and eliminate information barriers.

Adult social care was starting to develop a directorate preventative strategy and toolkit, they aimed to have this completed by 2025, aligning this work with the Health and Wellbeing Strategy. National data from the Adult Social Care Outcomes Framework (ASCOF, 2022-23) showed that 48.28% of people who received short-term support no longer required support. This was a significant negative variation from the England average (77.55%). This data was not readily comparable as the local authority continued to support self-funders as they did not charge for homecare or daycare, which is not the case in most areas. This meant there were no indicators to show success in delaying or reducing the need for care.

There was no link between preventative projects and a strategic intention to delay and reduce the need for adult social care, but there were numerous projects across Hammersmith and Fulham that would support this. For example, public health had invested significantly in its relationship with the local prison and the probation service to ensure people leaving prison had the right mental health support and accommodation options in the borough, this meant there was 45% continuity of mental health care which was the highest in London.

There was also a cost-of-living alliance in the borough to bring together financial support for people who may be in hardship, and partners had started the development of a financial inclusion strategy to improve access to financial information. Over 2 years because of this work,1100 people had used warm hubs and 1500 people engaged in cost-of-living information events.

The support to unpaid carers extended to peer support, participation forums, events, activities and training sessions. National data from the Survey of Adult Carers in England (SACE, 2023-24) showed that 13.33% of carers reported that they accessed training for carers. This was a significant positive variation from the England average (4.3%). Feedback from carers was positive about these activities and unpaid carers were also supported through other voluntary organisations.

Several preventative services were in review as the local authority was considering whether other ways of commissioning services would produce better outcomes. For example, there was a day service transformation programme and Public Health was analysing its funding contributions to council services in 2024/25 to make sure it aligned with the Health and Wellbeing Strategy.

The local authority provided a range of grants to the local voluntary and community sector which could prevent, and delay needs. For example, a grant was provided to an organisation that provided clubs and lunches, DIY services, and digital inclusion support for older and disabled people. There was no evidence that outcomes of these prevention grants were routinely monitored, or lessons learned where preventative work had been successful or unsuccessful.

The local authority had a therapy led in-house reablement service that was rated outstanding by the Care Quality Commission and reviewed in July 2023. This service worked in partnership with other health services, taking referrals from the hospital and the front door teams. The team worked with a person for a maximum of 6 weeks, setting goals with people to assist them in regaining independence. If after the sixth week, ongoing services were required, the team completed a Care Act assessment. There was a wait for Care Act assessment after reablement and the local authority was bringing in other teams to help with this. People receiving reablement were pleased with it and, between June 2023 to May 2024, reablement accounted for 44% of compliments received by adult social care.

National data from the Short- and Long-term support data (SALT, 2023-24) showed that 96.43% of 65+ were still at home 91 days after discharge from the hospital into reablement/rehab. This was a positive variation from the England average (83.70%) The Adult Social Care Outcomes Framework showed that 3.43% of 65+ received reablement/rehab services after discharge from the hospital. This was no variation from the England average (2.91%).

People were not receiving equipment and adaptations in a timely way, and this meant there was a missed opportunity to promote independence. There were trusted assessors at the front door and in social care teams which meant some less complex equipment and adaptation needs could be met through this route. For people referred directly to Occupational Therapy and for more complex needs, there was a wait, which meant people received a different service depending on the route they were referred along. We found evidence that people were receiving a commissioned care service instead of having access to equipment that could make them independent.

Data received from the local authority showed that in May 2024, there were a total of 292 Occupational Therapy assessments waiting. Between August 2023 and September 2024, the median wait for Occupational Therapy assessment was 107 days and the maximum wait was 819 days, the reason for the wait was that the current service could not tackle the backlog of referrals. The directorate leadership team recognised the high numbers, and action was completed to prioritise the 292 Occupational Therapy assessments and visit the high-priority cases. The leadership team had a business case, to be agreed, to fund an external Occupational Therapy agency to support assessments to reduce the waiting times.

The Occupational Therapy team prioritised assessments where cases were urgent and other teams reported that there was good joint working in these instances. There was no evidence that the service was managing long-term risk, for example, reviewing manual handling plans.

Occupational therapists worked in the housing team and once a request for a Disabled Facilities Grant (DFG) was received it was usually completed within 16 weeks. A DFG is a means-tested grant to support people with disabilities to make adaptations to their home so it can remain accessible, for example by installation of a wet floor shower room or a stairlift. Members of the voluntary sector had noticed that despite this provision people with disabilities were being housed inappropriately, and it took a long time to resolve these issues. Adult Social Care leaders in Hammersmith and Fulham were working collaboratively with housing colleagues to increase local housing stock and support living provision.

There was a lack of strategic direction to define the role of occupational therapy and how it fitted in with the Care Act assessment pathway, and this meant there was a missed preventative opportunity in the borough. The Adult Social Care Survey (ASCS, 2023-24) showed that 55.98% of people spent their time doing things they valued and enjoyed, 89.58% said their home was clean and comfortable and 88.03% said they had adequate food and drink. These were all significant negative variations from the England average (69.09%, 94.05% and 93.71% respectively).

Hammersmith and Fulham were part of a multi-agency pan-London equipment contract managed by 2 other London boroughs. The contract was awarded in 2013; data from September 2023 to August 2024 showed that they were not meeting their contracted timescales. For example, same-day orders took a median of 2 working days for delivery which impacted care pathways like hospital discharge as people could not go home till equipment was in place. The London equipment contract was a well-known issue among partners and not unique to this local authority.

The local authority had a technology offer with a pendant alarm service called Careline which was a 24/7 service. The local authority had the ambition to improve its use of technology-enabled care and had started to develop a joint strategy working with health and the voluntary and community sectors. As part of this, research was completed in partnership with the Dementia Research Institute, to test technology that alerted carers to a change in a person’s behaviours which may anticipate a change in the support needed.

Hammersmith and Fulham’s website was accessible to the Web Content Accessibility Guidelines AA standard which meant it would support accessibility applications. It had information and advice on rights under the Care Act and ways to meet care and support needs. The website signposted people to the front door team via a contact form or phone, where there were multiple phone numbers for different services. There was a typetalk facility for people who were deaf or hard of hearing, but no information in British Sign Language online. The website had multiple language options, but this did not extend to the online contact form which was available in English only.

The Adult Social Care Survey (ASCS, 2023-24) showed that 61.49% of people who used services found it easy to find information about support. This was tending towards a negative variation from the England average (67.12%). At the time of assessment, the local authority was reviewing its front door services to reduce the multiple points of access and improve the customer experience.

Hammersmith and Fulham had points of contact with the community and were working in co-production to make public buildings accessible to people, with renovations to the independent living centre and the Town Hall taking place. These were used as community hubs where people in need of support could get a range of information and advice, and in the north of the borough, 3 link workers were employed to work with GP surgeries to bolster information and advice provision. There were also several information and advice leaflets, like the Living with Dementia Guide, produced to highlight services specifically to this group; however, these were available in English only unless requested.

Community leaders and the voluntary and community sector were concerned about the local authority’s reliance on online communication methods leading to digital exclusion. Hammersmith and Fulham were aware that people wanted easier access to relevant information, and they had a working group looking at this and refreshing their website with people who used it. A digital accessibility group was working to promote the digital inclusion of disabled people across the borough and had enlisted volunteers to support people to gain digital skills.

Hammersmith & Fulham were committed to the use of direct payments to improve people’s choice and control with governance and action plans to increase the use of direct payments. For example, they had a direct payment steering group that met every six weeks and was co-chaired by a disabled person and a senior leader to ensure any improvements were co-produced. There was a direct payment support service delivered and run by a disabled people's organisation supporting 60% of direct payment users. The disabled people’s organisation had influenced practice positively by sharing their views, for example, they had reported that support plans could be quite prescriptive, and they had worked with social work staff to improve this practice.

More work was needed to support the Voluntary and Community Sector (VCS) and residents to understand direct payments, as groups were worried about the introduction of direct payments by default. The VCS felt commissioned services provided more stability.

National data from the Adult Social Care Outcomes Framework (ASCOF, 2022-23) showed that 21.59% of service users received a direct payment. This tended towards a negative variation from the England average (26.22%). Women, people from ethnic minority backgrounds and those over 65 were the most frequent users of direct payments. Between June 2023 to May 2024, 59 people stopped their direct payment, the main reasons being 32% deceased, 14% were no longer in area and, 10% became continuing healthcare funded. The local authority used Direct Payments data to set their Direct Payments Moving Forward plan for 2024 to support increased awareness raising and use of direct payments, targeting groups like those with mental health and dementia. This action plan was monitored at the direct payment steering group’. Data showed that direct payment users were increasing slowly, in March 2023 there were 494 people using direct payments and in March 2024 there were 520 using direct payments. This was not broken down by type of need.