Sefton Council: local authority assessment

The local authority worked with the Integrated Care System (ICS) in shaping commissioning intentions and ensuring they met the needs of the local population through collaboration among social care, health care and the voluntary and community sector representatives. The Director of Social Services (DASS) was also the Place Director in Merseyside and Cheshire ICB. A Sefton Partnership had been developed with membership from the local authority, NHS, voluntary and community sector, housing and police. The local authority had a shared focus on objectives such as health and wellbeing, reducing health inequalities, early intervention and prevention. Sefton Partnership priorities were strategically aligned with the Council’s Corporate plan (2023-2026) and the Cheshire and Merseyside Health and Care Partnership Place Plan (2023-2025) with the Sefton Health and Wellbeing Strategy (2020-2025) and there was partnership co-production of the Joint Strategic Needs Assessment (JSNA – 2023). System transformation plans for Sefton included Continuing Healthcare (CHC), Better at Home and Home First Projects.

A senior leader told us, the single leadership role for the DASS as Place Director had streamlined decision making and the ability to make joint funding arrangements and develop joint outcomes and relationships across the system had improved. For example, CHC process and policy as an all-age model was reviewed in 2024, supported by the Local Government Association resulting in the previously contracted out CHC being placed under the control of the local authority, staff told us this had improved the timeliness of decision making and focus on a person centred approach.

The local authority had developed a New Realities collaborative agreement with the voluntary, community and faith sectors, which included an operational framework between partners to strengthen working and delivery relationships.

Partners told us relationships across the system were strong, where the local authority had integrated functions there was evidence of monitoring demand and capacity of services with forward planning to predict future demand. Leaders told us the transformation programmes were still maturing, and it was too early to understand the impact of integration for people across the system.

The local authority, partners and other agencies worked together with clear governance, accountability with clear roles and responsibilities.

We heard of examples across system partners of close working and collaborative delivery. For example, public health, adult social care and the voluntary sector working together in drug and alcohol rehabilitation. Public health funded the Substance Misuse team and rehabilitation placements. The voluntary sector referred to and worked closely with the team and qualified adult social care staff assessed and arranged rehabilitation placements.

There were regular meetings between the Chief Executive of the ICB and Sefton Director of Place to assure progress and delivery on the focus and extent of integration. Partners told us there was a need for conversations to continue to offer true integrated care and more to be done to move to a proactive approach to outcomes in urgent care.

The Better Care Fund (BCF) was used to drive the shared priorities for maximising independence and outcomes for people and included using the BCF to embed a 2-hour urgent care response, reablement, home first, hospital discharge and bed based intermediate care. The Better at Home project had shown improvements in the average number of weekly discharges into pathway 3, which meant fewer people were going into long term residential and nursing care. The improvement plans included increased social work and care brokerage resources, investment into equipment and personal health budgets to shape interventions to improve capacity and outcomes for adult social care and health pathway 1 (support to recover at home).

There was a shared approach to quality, safeguarding and information sharing across partnerships and partners acknowledged strengths in their relationships and challenges in differing approaches, for example, a leader described health’s medical model and adult social care’s strength-based approach required more cross system discussion to achieve better outcomes for people.

We were told how partnership working for people informed development and improvement in experiences and outcomes. There had been improvements in meeting the 28-day CHC assessment target since bringing the process in-house and developing a specific brokerage team. The local authority had invested in training for staff with the aim of having CHC Champions in social work and occupational therapist teams. Staff felt confident in their decisions and ability to professionally challenge. For example, they told us of a person who was rejected for CHC funding, but the team were confident the circumstances met eligibility, they took the case to the CHC disputes panel, and the person was accepted for health funding. However, the speed of response in decision making varied, where there were delays, we heard, these could be escalated, and adult social care would ensure the funding was in place until decisions were complete. There had been an improvement after CHC processes had been brought in-house under adult social care leadership.

Examples of cross-partnership working and multi-disciplinary working were shared, for example, the mental health recovery service, close working between health, adult social care and housing for transforming care in funding and discharge processes.

There was a shared approach to provider quality across the system with joined up working informing safeguarding concerns and regulatory compliance, with regular information sharing between health and regulation partners. Providers told us they were able to raise issues and jointly identify solutions.

Staff spoke positively about the good sharing of information and intelligence to ensure where people were funded by health, staff had access to information about the quality of provision to make informed decisions. Staff from housing told us they worked strategically to meet the needs of people discharged from acute settings and had regular multi-disciplinary meetings, focused on outcomes to meet people’s choice and needs. A Commissioning Housing Partnership Board had been developed to bring together housing, communities, children’s services and adult social care, this gave better strategic oversight which had not been present previously.

The local authority was an active partner in the Integrated Care System especially in promoting and encouraging integration of the prevention agenda. Partners highlighted more needed to be done in system thinking to promote further integration from both health and social care. The local authority acknowledged there was always room for improvement, particularly while the transformation programmes were in their early stages to improve outcomes and experiences for people.

The local authority worked collaboratively with voluntary and community groups in Sefton. Leaders, partners, people and staff told us relationships between the voluntary and community sector and adult social care were strong, and they worked together to co-produce services and delivery to meet the prevent, reduce, delay agenda.

The local authority commissioned and grant funded services in the sector. Leaders told us they were held to account by the voluntary and community sector. The voluntary sector had representation on boards and partnerships and within policy groups informing and shaping local decision making. For example, the Sefton Partnership Board which provided strategic oversight of Sefton’s place partnership delivery model, to transform health and social care services and how they are integrated.

The New Realties agreement clearly set out the principals of the relationship between the local authority and the voluntary and community sector, for example, mutual respect, a common purpose, solution focused, inclusive and risk aware. There were clear measures of success for the Sefton economy, improved health and wellbeing for people and an engaged community working in partnership. Joint working included the development of welcome spaces, the living well health improvement service, community connectors (who offer short term support to increase independence and confidence for people experiencing isolation), commissioned assessment and support for unpaid carers and the voluntary sector trusted assessors working with adult social care and health.

Staff and people knew about New Realities and how co-production and collaboration was embedded in service design and delivery. Staff told us they had good relationships with community services and worked closely with the sector. There was a Co-production Guide, Working Stronger Together, to support staff plan and deliver co-production activities.