Hartlepool Borough Council: local authority assessment

The local authority worked with health partners, the voluntary and community sector, police, public health, neighbouring authorities and joined Teeswide approaches to align strategic priorities. They collaborated with communities and stakeholders and jointly agreed priorities, aligned plans, and focused on collective outcomes.

There was regional and sub-regional work around specialist provider networks, Teeswide Safeguarding Adults Board, and the Tees Community Equipment Service. Hartlepool Borough Council were part of the Health and Wellbeing Alliance (HWA) which included adult social care, NHS Trusts, primary care networks and public health. The HWA raises awareness of opportunities for people and works together to maximise those opportunities.

The Health and Wellbeing Board had good engagement with partners. The voluntary sector, North Tees, and Hartlepool NHS Foundation Trust, Healthwatch, Public Health, Integrated Care Board (ICB) place lead (who was also Vice Chair of the Board), and adult social care were all represented. People with lived experience also sat on the Board. A voluntary sector partner involved in the Health and Wellbeing Board and Health Scrutiny Board told us the local authority were receptive to scrutiny, listened and were supportive.

We heard from health leaders that relationships with the ICB were good, the ICB covered 14 local authority areas. Hartlepool Borough Council is the smallest authority within the ICB and we heard from an elected member the local authority had a strong voice, with senior leaders chairing working groups within the Integrated Care Partnership. There was an integrated care strategy developed by the partnership with a focus on better health and wellbeing for all. There were partnerships in place to ensure the integration of care and support provision, contribute to prevention and delay of needs for care and support and work together to improve the quality of care.

There were strong relationships with public health which sits within Hartlepool Borough Council. The Health in all Policies (HIAP) was a council and system wide approach to consider health issues in all policy and decision making. Adult social care was using this approach to identify and link public health and social care priorities and work to the Council Plan.

The local authority had integrated care and support functions with partner agencies to improve pathways for people. The Integrated Single Point of Access draws on different expertise and skills from health and social care to work together. Senior leaders told us the ISPA continued to develop and the local authority were involved in the development of a platform which was accessible by both health and social care staff to give real time information on people’s pathway through the health and social care system. Adult social care’s ambition, alongside the Foundation Trust, was to extend this platform beyond hospital into community care and support.

Partners and staff talked about the improved hospital discharge pathways and wider coordination of care. For example, where partners raised issues around communication, these were addressed by the local authority with partners.

The LA had several effective operational partnerships that supported the community led support approach. Autistic people and people with a learning disability who were in crisis or high risk of crisis were regularly reviewed through the Dynamic Support Register. The approach was coordinated between with Tees Esk and Wear Valley NHS Foundation Trust (TEWV) learning disability team co-located with local authority’s Young Adults Transitions and Learning Disability Team. There was a daily police huddle to join up adult social care with neighbourhood police intelligence and enabled, for example, care and support staff to provide timely support or address safeguarding concerns.

When the local authority worked in partnerships with other agencies, there were clear arrangements for governance, accountability, monitoring, quality assurance and information sharing, with clear roles and responsibilities.

The Health and Wellbeing Board had oversight of the Better Care Fund (BCF). Plans for the BCF were developed collaboratively between Hartlepool Borough Council, North Tees & Hartlepool NHS Foundation Trust and the Northeast and North Cumbria Integrated Care Board. The local authority had formal and informal partnership working relationships to support delivery and used pooled resources to effectively deliver better outcomes for people. There was a Pooled Budget Partnership Board, and an operational group met regularly to plan, monitor, and evaluate delivery. A senior leader in the ICB told us Hartlepool Council worked positively with the ICB and were open to change and new ways of working.

For example, the local authority said there has been a reduction in length of hospital stays with 9.2% (2022-2023) lasting for 14 days (down from 9.9% in 2019-2020) and 4.1% lasting over 21 days (down from 5.3% in 2019-2020). Leaders spoke of how the strong partnerships and integrated delivery had helped to keep focus on reducing the length of hospital stays.

The local authority had agreements in place under Section 75 (NHS Act 2005) for the complex care framework and Tees Community Equipment Services. The local authority delegated some Care Act related duties through commissioning for example, carers assessments and specialist sensory loss assessments. A partnership agreement with a neighbouring authority provided the adult social care emergency duty team on behalf of the five Tees Valley local authorities.

The local authority partnered with TEWV and secured Better Mental Health Funding, to fund a number of projects. One project focused on wellbeing of men aged 18-35 who were isolated and struggling to cope, the men formed a group and came together weekly helping each other to restore feelings of belonging and purpose.

The local authority also worked with TEWV to deliver transformation of community mental health services which developed the weekly virtual huddle, building on the work of community led solutions and community hubs. Staff told us this brought teams across organisations together to facilitate good conversations to enable people to access the right support at the right time with the appropriate practitioners. A voluntary sector partner told us this had been a positive relationship, and they could discuss issues and be involved in the muti-disciplinary approach.

The local authority had used funding from the Community Pot to support Covid 19 recovery to invest in community provision, for example the Community Led Inclusion Partnership (CLIP) to advance the social model of disability and bring the voice of disabled people into partnership with health and social care. The model looked at ways of removing barriers which restricted life choices for disabled people caused by the way society is organised, rather than by a person’s impairment or difference.

The local authority and partners monitored their partnership working and the impact it had on outcomes for people. Effective use of pooled resources was also monitored. For example, there were measures against BCF outcomes which showed hospital discharge data, estimated and actual, over quarterly periods. The local authority BCF end of year submission for 2023-2024 showed avoidable admissions, discharge to normal place of residence, falls and reablement were on target. The rate of admission to residential care was not meeting their planned target in 2023-2024. However, the local authority told us that the target for 2024-2025 was improving with the rate of admissions for the second quarter at 266.2 against a whole year target of 626.7. The local authority used wellbeing tools to evaluate outcomes for people using care and support services and the value of a strength-based approach. Wellbeing outcomes had also been used in a cost comparison exercise produced by the National Development Team for Inclusion (NDTi). The exercise followed a person receiving care and support and compared the monetary value of interventions against how things might have been without multi-agency community support. The results showed the cost benefit of maximising a strengths based and a multi-agency approach.

One person told us how the multi-agency approach to supporting them after discharge from hospital enabled them to build independence and re-establish relationships. We saw from assessment paperwork a social worker had worked with a community nurse colleague to support a person to understand relationships, consent and safety.

The local authority funded and commissioned voluntary and community organisations to understand and meet local social care needs and there were strong relationships with some voluntary partners. We heard, however, this was not consistent for all voluntary and community groups and there was more to be done to improve relationships.

We heard some groups views were not well listened to or their services not well utilised, thereby limiting the availability or access to support for seldom heard people. One group told us they were unsure if enough staff within the local authority knew they existed or what they did. We heard the length of commissioned funding gave some stability. However, the level of funding had an impact on services having the capacity to deliver.

The local authority provided funding and other support opportunities to encourage growth and innovation. Groups told us the local authority were proactive when working with voluntary sector organisations. For example, there was good engagement with the sector to decide how to use the Long Term Plan for Towns fund. Another organisation told us about the food bank strategy, supporting people to move from food banks to low-cost subsidised community shops bringing affordable food into communities to reduce the cost of a weekly shop. Voluntary sector organisations embedded in community hubs told us they were seen by local authority staff as partners and maintained strong links both operationally and strategically.