Sefton Council: local authority assessment

Leaders and staff recognised the safety and risks people could face along their care and support journey. The local authority considered safety a priority for everyone and had a proactive and effective approach to managing and identifying risk. The local authority had strengthened oversight and governance in operational and professional practice and senior leadership capacity, with an Associate Director of Quality and Safeguarding within Sefton Place ICB working alongside a Senior Manager for Assurance and Safeguarding Adults within the local authority to develop strong and safe systems.

Staff had access to shared systems with partners and could respond quickly to concerns and risks. The local authority had implemented a Sefton Inter-board protocol to strengthen cooperation across; safeguarding children and safeguarding adult's boards, the Health and Wellbeing Board, children and young people partnership board and community safety and domestic abuse partnership board.

There was access to support out of hours for people in Sefton (24 hours a day, 365 days a year) and staff had processes in place, including the ability to make urgent decisions on eligibility and understand routes to escalate or self-authorise where appropriate. Staff and first contact officers understood risk; first contact officers were supported by a daily duty manager to discuss crisis situations. Social workers were enabled to undertake immediate welfare checks and assess people. People who were waiting for a Care Act assessment or care plan review were monitored and prioritised using RAG ratings alongside use of a waiting well model. Staff could assess for and authorise basic equipment and utilised team huddles to discuss and plan actions and responses for people they could also refer cases to a Complex Need Panel.

Partners acknowledged there were issues with the Transfer of Care hubs and these could be more effective, with better partnership planning on managing capacity for assessments and response to discharge. Adult social care staff who worked with hospital discharge and reablement told us they took part in partnership panel meetings with health partners about people who frequently attended accident and emergency services to discuss wider partnership support and alternative interventions to reduce hospital readmissions.

A voluntary sector partner told us they worked with adult social care on discharge pathways, they told us people and unpaid carers did not always know where to go after a person has been discharged. There was a community scheme in place where volunteers contact people after discharge to check whether required support is in place.

Following recommendations of a LGA peer review in 2022, adult social care implemented a new team specifically for autistic people and people with a learning disability. The development of the team was co-produced with people with lived experienced and whilst operational, with cases transferred across to the new team, at the time of the assessment it was relatively new and not fully staffed, the local authority understood this meant there were people waiting and there were areas for improvement in hospital discharge and services for autistic people and people with a learning disability.

At the time of transition through care journeys, including from children to adult services, gaps and differences between services and support can be particularly problematic and adversely affect people’s experiences. The local authority had processes in place to support pathways when people moved between services and providers which included hospital discharge, moving to another local authority and transition to adulthood.

The local authority was aware of areas for improvement in transitions and told us they listened to people and planned with partners and communities' ways to improve safety across care journeys. For example, in 2022 there was a Special Educational Needs and Disabilities (SEND) public consultation with parents and parent carers, the findings showed there were delays in reviews, lack of engagement with transition teams and people were not listened to. In response, the local authority, in co-production with the Sefton Parent and Carer forum, developed a Preparation for Adulthood Guide, which included information on social care, direct payments and transition. A multi-agency transition group was also established.

Staff told us the Transitions Team worked with children’s services to identify young people approaching adulthood and had weekly meetings with the experienced care team and the children with higher (complex) needs team. The team screened the waiting list using RAG ratings for prioritising, which included consideration of the person’s age and how soon they would turn 18.

We heard mixed views about how people experienced transition, particularly around timeliness in preparation, we heard planning could wait until people reached 17 years or who had been asked to contact adult social care at the end of their education. We also heard from unpaid carers supporting young people into adulthood who told us the transition was seamless and supported by a social worker.

The local authority acknowledged there were further areas for development for transitions including; building on the referral pathways, strengthening information sharing between Adults and Children's services and ensuring the voice of people using the service in assessment and support planning. They had a Transitions Action Plan in place to 2026 and had completed an option appraisal for a 0-25 service and planned to implement a digital solution to integrate adult and children's electronic care systems and an ongoing training and development programme.

Senior leaders told us the implementation of the Care Transfer Hubs had seen an improvement in movement to a home first pathway for people and frontline staff described how they used strength-based approaches to consider people’s potential to improve their reablement by being at home. For example, advocating for people who had delirium to return home for assessment and to support recovery, and for those people being discharged from mental health settings.

Staff told us they worked with unpaid carers to access their own support or to arrange for a personal health budget to enable a person to be discharged to their home. Transitional beds were used for people who required rehabilitation before returning home and they worked with housing when unsuitable accommodation was identified, for example, if the accommodation was cluttered or there was a risk of homelessness.

Staff told us referrals to the Transfer of Care Hubs were screened twice daily, and the multi-disciplinary team agreed a case manager lead for each referral. Local authority staff would consider a home first approach unless there were concerns over mental health capacity. The social worker would then complete a face-to-face assessment and would always consider their best interests.

Providers were mostly positive about how the local authority worked with them to ensure people received coordinated support when moving between services and the process was usually seamless and co-ordinated well. Some providers told us communication could sometimes be through the family, rather than the local authority. Staff told us, they completed post hospital discharge reviews, including those from out of borough hospitals.

The local authority undertook contingency planning to ensure preparedness for possible interruptions in the provision of care and support. The local authority had an integrated approach with health and community partners for services closures and disruptions.

The local authority had an Adult Social Care and Strategic Commissioning Business Continuity Plan and a Provider Failure and Closure Policy in place. The Provider Failure and Closure policy ensured closures and failures were managed effectively and ensured people using services had their health and wellbeing maintained and their needs and welfare safeguarded. Information sharing was in place across partners and system failures and enforcement managed effectively. An example of the implementation of the policy was shared along with the integrated approach to shared learning across the system. We heard from staff about a service closure with 48 hours' notice and how teams from safeguarding, health and adult social care worked together to identify alternative accommodation, ensuring friendship groups of people who used the service were kept together for a better experience of the transition and how the clear framework had achieved good outcomes for the people using services.

We heard from leaders the integration of health and adult social care with senior leaders responsible for Sefton ICB Place, with accountability for funding and budget meant there were no financial delays or disputes in decision making for the provision of care and support.