Islington Council: local authority assessment
Assessing needs
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.
I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and goals.
The local authority commitment
We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.
Key findings for this quality statement
There were several ways in which people could access information about the local authority’s services, this included online via their website or telephone through the Access team. Staff described how the Access team and the First Point of Contact Team were the front door for adult social care. The Access team provided early interventions such as signposting, information and advice to people. The team was a multidisciplinary team which included a social worker, district nurses and speech and language therapists. The team triaged contacts and referred to the First Point of Contact Team if people were not already known to adult social care for an initial Care Act assessment.
The approach to assessment focused on people’s strengths and what was important to them. Staff and leaders gave examples of strength-based, person centred practice and this was reflected in people’s feedback. People told us they felt respected, listened to and given choice during assessments. The approach reflected people’s right to choose, built on their strengths, reflected what they wanted to achieve and how they wished to live their lives. The assessments were then used to develop personalised care plans. The examples seen showed people’s human rights were respected and protected, including responding to any protected characteristics as defined under the Equality Act 2010. For example, ensuring people had access to advocacy if needed and providing information in a way people can understand and make informed choices.
People we spoke with told us they felt included in their assessment and were given the opportunity to be involved in the decision making of their own care and support. One unpaid carer told us the assessment was carried out over several weeks to suit the needs of the cared for person and allow them to be able to take in the information and make an informed choice which was person centred, and strengths based.
National data from the Adult Social Care Survey 2023-2024 showed 56.60% of people were satisfied with care and support. This was slightly worse than the England average of 62.72%. 76.26% of people felt that they had control over their daily life. This was similar to the England average of 77.62%. 41.01% of service users reported that they had as much social contact as they wanted with people they like. This was slightly worse than the England average of 45.56%.
Staff articulated examples of good strengths based social work practice. We heard examples of people being supported to achieve outcomes in different areas of their lives, such as maintaining important relationships, being more active in the community, or gaining employment. Leaders were proud of the strengths-based approach frontline staff used, and this was evidenced in quality assurance audits.
Pathways and processes ensured people’s support was planned and co-ordinated across different agencies and services. Staff were positive about their multi-disciplinary working and how good partnerships supported people to get the best outcomes, by reducing the need for people to tell their story repeatedly. Leaders listened to frontline staff when processes were not working smoothly, and more resources had been allocated to support teams when required. For example, the First Point of Contact Team had vacancies within their team which was impacting on their workload. In response, the local authority recruited agency staff to support the team in the short term whilst continuing with the recruitment process.
The local authority had assessment teams who were competent to conduct assessments, including specialist assessments. Staff were qualified in their area of specialism such as Learning Disabilities, Approved Mental Health Practitioners, Sensory Impairment and Occupational Therapy. Staff told us they were provided with lots of opportunities for specialist training, practice development and career development opportunities.
Assessment and care planning arrangements were not always timely and up to date. There were inconsistencies across the local authority in relation to waiting lists. For example, some teams told us their waiting lists were minimal or non-existent whereas other teams had significant waiting times. The reviewing team and the Occupational Therapy team had longer waiting lists as did some Mental Health community teams. People we spoke with told us they received Care Act assessments in a timely manner. The local authority worked with partners to ensure people received care and support in a timely manner for example, processes were in place to support people with a timely hospital discharge.
Data provided by the local authority in July 2024 showed there were 184 people waiting for an initial Care Act assessment via the First Point of Contact Team with a median wait time of 42 days and the longest wait time being 1 year 8 months. Data provided by the local authority in January 2025 showed these waiting lists for Care Act Assessments had reduced to 143 people waiting for a Care Act Assessment, with the longest wait being 4 months. Actions were taken to improve waiting lists such as a duty system to support with the screening process, regular monitoring of risk to ensure people were waiting well, and the implementation of a community support officer who carried out low level welfare visits and supported with access to food, heating and community services, and the recruitment of agency staff.
There were waiting lists for people waiting for a review of their care and support, data provided by the local authority in January 2025 showed there were 607 people waiting for a review of their care with an average waiting time of 1.8 years for an annual review. Staff told us they managed waiting lists through a triage process and an escalation policy. They risk assessed cases and prioritised people at risk, with safeguarding concerns taking priority.
The local authority was acting to manage and reduce waiting times for assessment, care planning and reviews. This included actions to reduce any risks to people’s wellbeing, while they waited for an assessment for example, the First Point of Contact team told us they would regularly contact people to ensure they were safe and had the appropriate support in place to minimise risk whilst waiting for a Care Act Assessment. The local authority told us they had identified that difficulties in recruiting social workers had meant reduced capacity had impacted on waiting lists and these were being closely managed by team managers.
National data on Short and Long Term Support 2023-2024 (SALT) showed 55.70% of people receiving long term support had been reviewed (both planned and unplanned reviews) this was similar to the England average of 58.77%.
The local authority had an Occupational Therapy team (OT) who worked closely with adult social care teams and housing to promote independence and prevent, reduce and delay care needs. Data provided by the local authority in July 2024 showed 428 people were waiting for an OT assessment with the median time waiting for assessment being 3 months and the longest time 1 year 8 months. The local authority had an OT service improvement project which had been implemented to reduce waiting times, leaders told us this was yet to fully embed and improve the waiting times for those people who had waited longest for assessments.
The local authority had newly appointed to a Principal Occupational Therapist post to support with oversight and quality assurance. Staff told us they felt supported by the Principal Occupational Therapist and that changes made had already started to have an impact on the waiting lists. For example, streamlining the referral form had made it easier for people to refer themselves and made referrals quicker to screen. There had also been improvement to the screening process, ensuring more in-depth information was gained at first contact. The local authority had also introduced trusted assessors to support with low level equipment provision and occupational therapy assistants to support with less complex referrals. This enabled OTs to carry out more complex assessments, such as for people who required Disabled Facilities Grant funding and housing adaptations to remain independent in their own home. The OT team also told us about a community drop-in service where people could be referred and assessed in a drop-in facility for standard equipment such a bath aids, this reduced the length of time they would need to wait for an assessment and equipment and allowed people to maintain their independence and skills.
Unpaid carers received a separate assessment to the person with care needs and staff understood how the needs of unpaid carers were distinct from the person they cared for. Staff understood the impact of caring for someone and the effect this could have on the unpaid carer, understanding their individual needs whilst looking holistically at their support network and community. The local authority commissioned the Islington carers hub which delivered advice, guidance and information, support groups, activities, breaks for carers and carers assessments, staff in adult social care teams also carried out carers assessments when required.
Leaders told us they felt the carers offer was strong however, they identified there was room for improvement and were working in a whole family approach to assessment, meaning the carer and the cared for would be considered equally in their own right looking at their individual support networks and ability to live their lives how they wish.
Feedback about unpaid carers assessments was mixed some people told us they received a carers assessment in a timely manner whilst others told us they waited a significantly long time to receive a carers assessment. Once a carers assessment was carried out feedback from unpaid carers was positive with unpaid carers telling us they felt listened to and supported. The joint commissioning of a carers hub with the ICB meant waiting times for unpaid carers had improved. The local authority told us there were currently no waiting lists for people waiting for a carers assessment. There was a waiting list of 118 people waiting for a carers annual review with an average wait time of 2.7 years.
National data from the Survey of Adult Carers in England (SACE) 2023-2024 showed 45.61% of carers were satisfied with social services. This was slightly better than the England average 36.83%. SACE 2023-2024 data also showed 29.11% of carers were able to spend time doing things they enjoy. This was significantly better than the England average of 15.97%.
People were given help, advice and information about how to access services, facilities and other agencies for help with non-eligible care and support needs. Partners told us the local authority worked well with the voluntary sector and supported people with non-eligible needs to access the correct advice and support. The local authority worked with the voluntary sector to improve outcomes for people for example, working with asylum seekers, refugees and migrants in the community to ensure they were aware of the support available to them. The local authority communicated well with partners, information was shared regularly in relation to the issues and gaps in the community such as domestic violence and the cost of living crisis to ensure people with non-eligible needs were correctly signposted to appropriate services. Staff signposted people to other council services, partners and external agencies for help and support for needs that were not eligible under the Care Act. Islington had a large voluntary and community sector and staff were aware of the services available in the community and had built positive relationships with the voluntary sector.
Examples were shared of how the community support worker would work with people who may not be eligible for a Care Act assessment but required some low level support to prevent, reduce and delay needs developing. For example, supporting people to ensure they had heating and electricity in their property.
Partners told us the local authority had invested in a referral platform whereby social care and health workers could make referrals into one system for people who may benefit from voluntary and community-based services.
The local authority’s framework for eligibility for care and support was transparent, clear and consistently applied. Decisions and outcomes were timely and transparent.
The local authority had a ‘Adult Social Care Eligibility Policy’ for staff (reviewed April 2023). The document provided clear guidance to staff, outlining the local authority’s responsibilities under the Care Act. It described people’s rights under the Act and how to proceed if eligible.
National data from the Adult Social Care Survey showed 69.78% of people did not buy any additional care or support privately or pay more to 'top up' their care and support. This was slightly better than the England average 64.39%.
The local authority’s framework for assessing and charging adults for care and support was clear, transparent and consistently applied. Decisions and outcomes were timely and transparent. Data provided by the local authority July 2024 showed there were no waiting lists for people waiting for a financial assessment. Data provided by the local authority showed there had been no complaints regarding the charging process in the last 12 months. People told us they were supported throughout the charging process.
The local authority had an online charging calculator to help people work out how much people may need to contribute towards their care and support.
The local authority had commissioned an independent advocacy provider to deliver all statutory advocacy services in the area. An advocate can help a person express their needs and wishes, weigh up and make decisions about the options available to them. People told us they were given enough time and information to make informed decisions and were offered support when needed either via a family member or independent advocate when required. Safeguarding Adults Collection data 2023-2024 showed 87.50% of people who lacked mental capacity were supported by advocates, family or friends. This was similar to the England average of 83.38%.
Local authority staff told us there was good access to independent advocacy and gave examples of when advocacy had been used to support decision making and gain people’s voice. They can help them find services, make sure correct procedures are followed and challenge decisions made by local authorities or other organisations.