North Somerset Council: local authority assessment

The local authority engaged with stakeholders to understand current and future care needs. Staff told us they signposted people to social prescribers and the equipment demonstration centre, who understood local needs well. However, there was a recognised need for enhanced community engagement.

The Adult Social Care Commissioning Strategy (2024-2031) aligned with the vision of the local authority to ensure people stayed independent for as long as possible, supporting people to live healthier lives, promote wellbeing, support people to make informed choices and to provide care in ‘the right way at the right time’. This was co-produced in consultation with people, local groups and providers, alongside their Market position statement 2024/2025 to meet the needs of their increasingly diverse communities and increasing number of people living with multiple complex conditions. There was a focus on the cultural change needed to implement the current strategies and how this would be achieved, such as through a review of existing provider contracts. It identified a shortage of extra care and supported living options, while also highlighting the oversupply of residential care places. The local authority recognised this as a priority area, Staff gave us positive feedback about the development of bespoke accommodation with home support, following targeted commissioning to address gaps in the market.

The local authority in North Somerset used a variety of sources and methods to understand the current and future care and support needs of their communities. For example, Population and Needs Assessment System for Integrated Care (PANSI) databases, and Office for National Statistics data such as Census.

The Joint Strategic Needs Analysis (JSNA) provided a detailed view of the population’s health, social, and economic challenges, enabling the local authority to identify key findings. For instance, North Somerset’s population included a significant aging demographic, with 22% increase since 2011 of residents aged 65 and over, identifying a growing demand for dementia care, mobility support, and chronic disease management. The local authority recognised to meet this need they required sufficient and culturally appropriate provision.

Staff told us rurality was a key accessibility issue for adult care delivery in North Somerset. About 65,000 people in total live rurally in a variety of villages, hamlets, and isolated areas resulting in disparities in terms of people's experience of access to community resources. Additionally, social determinants of health, including housing issues, unemployment, and low educational attainment in areas like Weston-Super-Mare, were identified as significant drivers of poor outcomes.

The Joint Health and Wellbeing Strategy 2021-2024 had an action plan to improve health and wellbeing outcomes for people and to reduce health inequalities. There was a focus on prevention, early intervention and thriving communities. The strategy recommended more focus was needed on holistic support for people with mental health needs, such as through dissemination of information and signposting to community services that support skills development, employment opportunities, and address other issues such as housing, isolation, and financial challenges.

The local authority’s Commissioning Strategy 2024-2031 aimed to create a diverse range of high-quality, affordable care options. There was mixed feedback from people and unpaid carers in relation to how much choice they had in the local area, particularly around care home and short breaks, such as respite options. For instance, a carer told us respite, support groups and sitting services were needed and the local authority were not providing the funding required to meet these needs. The local authority acknowledged a significant gap between the percentage of people satisfied with services 60.92%. This was significantly worse than the national average of 70.28% (ASCS 2023-2024).

Some partners informed us strategic commissioning did not always consider or prioritise the needs of carers. Leaders acknowledged these concerns and told us carers were a priority, particularly in terms of expanding respite services. Staff told us that they were working to better understand people’s experiences to inform and shape the delivery of services. However, further work was needed to ensure the voices of carers were reflected in commissioning decisions and that their needs were consistently met.

National data indicated a concerning shortfall in support for unpaid carers, as only 7.88% could access support or services allowing them to take a break from caring at short notice or in an emergency which was somewhat worse than the England average of 12.08%, highlighting a need for improved resources. The data for unpaid carers accessing support or services, allowing them to take a break from caring for more than 24 hours showed 21.30%. This was somewhat better compared to the England average of 16.14% (Survey of Adult Carers in England SACE, 2024). The needs of unpaid carers were central to market shaping, seen in the development of the ‘All age Carers strategy 2024-2028 and there was a focus on trying to improve the offer to carers. Some people described working with staff to choose accommodation with support which met their needs as being a supportive experience, for others choice for their cared for person's move to residential care was limited.

The local authority had identified several gaps in service provision. For example, there was a gap in the home care market for people with a high level of mental health needs, learning disabilities and a need for more specialist care homes. Plans included improving recruitment and retention of home care workforce and developing more flexible accommodation options. The annual Market Position Statement detailed these commissioning proposals. Work also began on analysing the quality of services for people with learning disabilities. The increase in people with multiple needs prompted the development of more responsive commissioning approaches in collaboration with brokerage and Integrated Care Board (ICB) procurement teams to secure more suitable providers.

The local authority recognised the need to improve access to care in rural areas and launched initiatives such as the 'Be Proud to Care' campaign and job fairs to tackle recruitment and retention challenges in the care sector. Work experience opportunities for school students were also promoted. Joint commissioning initiatives, such as the 'Response 24' first response service for falls, aimed to improve service integration and efficiency. The local authority remained committed to supporting people to maintain independence for as long as possible. They worked with home care providers and actively utilised TEC solutions. A partner told us, it was hard to get care support in rural areas due to limited transport and the local authority were looking at developing a good neighbour transport scheme.

The local authority had clear arrangements to monitor the quality and impact of care and support services to ensure sufficient local capacity within the adult social care system to meet the diverse needs of the residents, minimising the need for out-of-area placements, except where this was a matter of personal choice. We heard the efforts to achieve this involved a multi-faceted approach, proactively identifying and addressing gaps in service provision. A key area of focus was the development of more robust long-term community-based support for people living with dementia. Working with strategic domiciliary care providers to establish new, more responsive pathways within the Support to Live at Home contract. This aimed to prevent hospital and care home admissions.

Another area of focus was the development of a framework for commissioning services to support people with multiple or high levels of need or risk around mental health and learning disabilities needs. This addressed a gap in the existing domiciliary care market.

The local authority recognised the need to move beyond ad-hoc support from existing staff and charitable organisations, working to commission dedicated services for people who hoard and those needing support with drug and alcohol misuse. If providers had restricted capacity, a service called "Bridge the Gap" ensured no one was left without necessary support. The local authority provided a snapshot of data on care package allocations, highlighting significant improvements in the care market. As of 6 April 2024, there were 48 packages awaiting placement, representing 7% of total placements, with some rural areas experiencing pockets of delay. This highlighted the need for continued efforts to address these disparities and improve service accessibility across the district. The local authority also detailed a significant number of providers operating in the North Somerset area, indicating a range of choices for people who require domiciliary care support, including two strategic providers, 23 domiciliary care providers, 13 complex health providers and 53 specialised care and support providers.

The local authority actively worked to ensure sufficient capacity within local residential and nursing care homes. The local authority reported minimal waiting times for people to transfer to care homes. Senior leaders told us they had sufficient flow in and out of the care home market to sustain demand, with minimal waiting times.

There was a need for a greater provision in extra care and supported living, with all six existing extra care schemes operating at full capacity and a waiting list. The local authority was exploring options to address this including the possibility of in-house delivery of extra care services and was actively working with a range of providers to expand supported living options.

New commissioning was taking place to deliver supported living and respite services for adults, to improve the use of assistive technologies to support people’s independence. One staff member gave an example of a project between the local authority and a local developer in efforts to enhance the development of bespoke accommodation options. This involved the creation of three flats providing onsite support, designed to help people develop their independence and tenancy skills.

Staff told us people used services or support in places outside of their local area. When these services and support were being accessed, there was good support from the brokerage team who tried to keep costs down. Staff described good relationships with providers to negotiate third party top up fees to try and keep people in the area. We heard there were differences in costs and availability of provision in the North and South areas of the local authority. Data provided by the local authority highlighted there were 211 out of area placements, and 148 were made for the reason of 'care provision' with majority of these on the borders with neighbouring authorities and 63 made because of 'choice'. There had been some success in supporting people to move back into North Somerset, although many of the out of area placements were often due to personal preference or a lack of specialised provision within North Somerset. There remained work to address challenges in managing borough out-of-area placements and ensuring sufficient capacity in the area.

Staff told us identifying places for autistic people had been a challenge as many of the mental health services were based in neighbouring authorities. Staff told us they had worked with housing associations, other local authorities, and the Integrated Care Board (ICB) on the Transforming Care project, which focused on managing out-of-county hospital placements for some people. The brokerage team supported approaches to minimise the costs associated with out-of-area placements, negotiating with providers to reduce third-party top-up fees and maintain local placements whenever possible. However, challenges in addressing these issues persisted and required ongoing work to secure more appropriate and responsive care for people with care and support needs.

The local authority monitored the quality of a range of commissioned services, including home care, and addressed gaps through using a "Bridge the Gap” service. They also had oversight of residential and nursing care homes, carrying out annual assessments and reviewing CQC data. Supported living services were monitored with an emphasis on resolving capacity issues and improving housing conditions, while extra care housing was reviewed to address high occupancy rates and waiting lists. The local authority tracked the impact of their early intervention and preventative services, such as community meals and the wellness service, to drive improvements and measure outcomes both at the individual service level and across the entire care market.

Analysis of Care Quality Commission (CQC) data revealed a largely positive picture of care home quality across North Somerset, overall rated as 84.38% good. The majority of both nursing and residential homes were rated as 'good', however, a higher proportion of residential care homes 24.59% received a more positive rating compared to nursing homes, 15.63%.

The local authority had developed an in-house system for monitoring care homes and other regulated services utilising a framework for quality assurance, which was closely aligned with the principles of the Care Act 2014.This involved undertaking annual assessments against key quality standards, promoting transparency and accountability within the sector. The compliance process focused on safeguarding individuals and ensured that care provision was person-centred and of a high quality. It effectively identified areas for improvement, enabling care homes to develop and implement action plans with clear timelines to address these issues. An escalation process was embedded within the system, enabling the local authority to fulfil its legal duty to intervene and protect individuals from harm or neglect. This approach ensured that the local authority met its obligations under the Care Act 2014 in relation to oversight, safeguarding, and the ongoing improvement of quality within the adult social care sector. The strong working relationship between the Quality Monitoring Team and the Safeguarding Adults Board was reported as having positively contributed to a more unified response to safeguarding concerns identified within contracted care provider settings.

The local authority’s commitment to quality was further strengthened by promoting quality through provider feedback forms and effective provider forums, which providers reported were to support quality assurance and collaborative working. The close partnership with health and other partner agencies ensured a consistent approach to addressing quality concerns, with information shared effectively across the partnership. The local authority’s use of contractual mechanisms, such as service embargoes and the return of contracts due to financial instability, staffing shortages, or inadequate infrastructure, further evidenced the local authority’s commitment to maintaining high quality and sustainable care provision within the adult social care sector.

The local authority actively worked to ensure the long-term sustainability of its adult social care services. They worked closely with care providers to make sure that the costs of care were clear and fair to everyone. To help providers plan, the local authority used longer-term contracts, giving them more stability. This meant providers could plan their work better, knowing how much money they would have available over a longer period. The local authority also kept in regular contact with providers and other important groups to check in on how things were going and to find out about any problems early on. This allowed them to be prepared for any potential disruptions to services, if a provider had difficulties. They also had plans to make sure that people continued to receive the care they needed if something went wrong with a provider. Over the past year, the local authority had to deal with several contracts being returned. This happened for various reasons, such as providers not having enough money, not enough staff, or not having sufficient contingency plans in place.

The local authority worked to make sure there were enough skilled and qualified staff to provide care. They did this by working with care providers, personal assistants, and other agencies. They invested in training and development to help support external providers to improve their staff skills and offered incentives to providers to help encourage staff to stay in their jobs. They also ran campaigns to encourage people to consider a career in social care and held job fairs in areas where it was difficult to find staff.

Despite the generally positive CQC ratings, the local authority recognised there were significant environmental challenges in many older externally commissioned care home buildings. Many homes were assessed as to their long-term suitability. The local authority’s proactive approach to environmental improvements within the care home sector indicated a commitment to ensuring that care environments were safe, comfortable, and fit for purpose. Senior leaders told us they were already investing in making improvements to the buildings used to provide care, recognising that some buildings present adaptation challenges due to environmental constraints. This identified risk was reflected in their commissioning plans, ensuring a strategic approach to addressing these issues.