London Borough of Southwark: local authority assessment

The local authority’s approach to assessment and care planning was person-centred and strength based. It reflected people's right to choice, built on their strengths and assets and reflected what they want to achieve and how they wish to live their lives. 

We received somewhat mixed feedback from people and unpaid carers about the quality of their care. Most people and their carers told us their assessments were positive interactions by caring and efficient staff. They felt involved, listened to and could express their wishes. Staff demonstrated a person-centred, empathetic approach to help them get the support they needed. They promoted choice and offered people a range of options to meet their needs, for example with a home first approach to maintain their independence for as long as possible. Some people told us they had consistency from the local authority in terms of the people who supported them, from assessment to ongoing contact. This helped them build rapport and understanding with staff and supported staff to develop a good understanding of any progress or deterioration. However, this was not universal, and some people and unpaid carers reported poor communication and delays, difficulties contacting the local authority, difficulties accessing information, and a feeling of being overlooked and unsupported. This highlighted inconsistencies in people’s experiences.

Most of the local authority’s national data indicators were in line with the England average. A 2024-25 Adult Social Care Survey (ASCS, October 2025) showed 61.93% of people in Southwark were satisfied with their care and support, similar to the England average of 65.39%. But 69.03% of people felt they had control of their daily lives, worse than the England average of 77.31%. This indicated people’s assessments did not always result in what people wanted to achieve from their support and how they wished to live their lives.

Assessments and reviews were carried out in different ways to meet people’s needs, including face-to-face, video call and telephone assessments, joint assessments with partner agencies, or combined assessments for an unpaid carer and person with care and support needs. People’s records showed staff tailored assessments to the individual and considered the most appropriate assessment environment. They recognised the different ways people understood, retained and weighed up information and communicated their needs and wishes. There was consideration of people’s mental capacity and use of advocates, translators and other support to enable people’s active participation.

People could access the local authority’s care and support services through multiple channels, including online, telephone and in-person. In 2024 the local authority redeveloped its telephony system which had reduced wait times for callers. The local authority also introduced an online assessment form which had reduced wait times and automatically recorded information on the electronic record system.

All incoming referrals were initially processed and triaged by the front door contact team. Approximately 70% of contacts were resolved by the front door or duty team, usually with information, advice and guidance, or provision of low-level equipment following a light touch assessment by a trusted assessor. People’s immediate support needs were dealt with by the contact team or urgent response team. The urgent response team was a jointly managed health and social care team providing medical, functional and social care assessments. People requiring a Care Act assessment were referred to the relevant team.

We reviewed a sample of people’s records which showed consideration of people’s holistic needs, for example, physical and mental health, communication, mental capacity and support needs. Assessments were generally recorded thoroughly. We saw positive practical examples of strength-based practice. Most assessments focused on people’s right to choose, their aspirations and abilities and ensured the least restrictive support options to promote independence. Care and support planning focused on what people could do and positive risk taking, in line with recognised good practice. There was a clear sense of people’s wishes, interests and aspirations, and their cultural and religious needs. This showed staff considered core parts of a person's identity and what was important to them. There was evidence of direct conversations with people and their support networks, and multidisciplinary collaboration with relevant professionals.

Providers told us people’s care plans were detailed and included relevant documentation such as risk assessments and background information. Staff prepared a ‘pen picture’ of the person which was securely shared with providers to identify if they could meet that person’s needs. This supported person-centred care and enabled providers to prepare resources effectively from the outset.

Frontline teams were competent to carry out assessments, including specialist assessments. There was a comprehensive staff induction and training programme. This included strength-based practice and its application in practice. Senior leaders articulated a renewed focus on professional curiosity and executive function because more people in Southwark were presenting with increased complexity and life challenges.

Assessments and care planning arrangements were mostly completed in a timely way. Some progress was being made to reducing the backlog of people waiting for assessments, but many people were still waiting too long, which presented risks to their safety and wellbeing. Some waiting lists were negligible, such as for the learning disability team, however there were longer waits for occupational therapy (OT) assessments.

Local authority data at the time of our assessment showed there were no waits for Care Act assessments in the mental health team and only 1 person waiting for an assessment by the learning disability team. 387 people were waiting for an assessment by the older people and people with physical disability (OPPD) team. The OPPD median waiting time was 89 days, and the maximum wait was 157 days, beyond the internal target of 28 days. The longest wait was at the request of a resident who was abroad for a prolonged period but remained on the waiting list as they expected to return to the UK. Wait times had reduced in the 6 months up to our assessment.

At the time of our assessment 321 people were waiting for an OT assessment, with a median wait time of 49 days and a maximum wait of 154 days. 27 people were waiting for a sensory assessment, with a median wait of 64 days and maximum of 189 days. Senior leaders attributed this to increased OT caseload complexity, vacant posts (which were recently filled) and the local authority’s’ transformational change taking place simultaneously (improvements at front door had resulted in faster passage of cases). Wait times reduced in both teams in the 6 months up to our assessment.

For people receiving long-term care, the local authority applied a proportionate approach with established support plans reviewed annually. If a person’s circumstances changed, or an early review was required, this was prioritised and allocated to a social worker to reassess. Local authority data showed 74% of people receiving long-term support were reviewed in 2024. At the time of our assessment 965 people were awaiting a review, 84% of which were in the OPPD team. There was a median wait of 135 days and maximum wait of 524 days. The longest wait was at the request of the person receiving care, whose needs were reported as unchanged. National Adult Social Care Finance Report (ASCFR) data for 2024-25 showed the local authority had reviewed (planned or unplanned) 58.96% of long-term support clients, similar to the England average of 59.13% (Short and Long-Term Support, October 2025).

Providers told us the local authority was responsive to requests for reviews and reassessments and ASC staff acted promptly to implement changes and update people’s care plans and assessments. Staff proactively liaised with providers and undertook joint reviews. Providers appreciated the flexibility of ASC staff in scheduling reviews and assessments to ensure all relevant individuals could be present.

The local authority took action to reduce waiting times for assessments and reduce risks to people's wellbeing while they waited for an assessment. Senior leaders recognised wait times as an area for improvement. Waiting lists were regularly reviewed to ensure routine oversight and work allocation. The increasing complexity of need and volume of referrals was being mitigated by the local authority’s ‘front door transformation plan’ with revised initial screening and referral forms to improve triage and management of risk. Data dashboards evidenced improvements in the previous 6 months with a reduction in the number of people waiting for assessments and reviews.

There was a risk-based approach to screening incoming referrals and consideration of people’s immediate support needs to manage risk at initial contact. Priority was indicated through a risk matrix system used to escalate cases according to perceived level of risk and urgency. The local authority had systems to mitigate risks while people waited for assessments. All referrals were triaged, risk assessed and prioritised. Staff applied a risk-based approach to caseload management to ensure people with urgent needs were responded to promptly and interventions were put in place to keep them safe. The local authority supported people to wait safely with ‘waiting well’ initiatives such as active provision of advice, guidance about who to contact should their needs change. Staff regularly re-assessed people’s risks while they waited, to check if their needs had changed. This provided opportunities for signposting to other services, prevention and enablement support. The front door team also provided low level equipment and aids, which in some cases removed the need for further assessment or intervention.

The local authority recognised the needs of unpaid carers as distinct from the person they cared for. Assessments, support plans and reviews for unpaid carers were undertaken separately, but many unpaid carers reported mixed experiences. The 2021 Census showed approximately 18,000 Southwark residents (6% of the population) provided some form of unpaid care, of which 25% provided more than 50 hours of care per week. In 2025 approximately 2,300 adult carers were registered with the local authority’s commissioned carer service.

The local authority had mixed performance in carer support indicators from the Survey of Adult Carers (SACE) 2023-24, with some positive and negative outliers to the England averages. For example, 10.47% of carers accessed support to keep them in employment, which was significantly better than the England average of 2.79% and the highest reported performance nationally. But 41.07% of carers were not in paid employment because of caring responsibilities, significantly worse than the England average of 26.70%. 56.18% of carers experienced financial difficulties because of caring responsibilities, worse than the England average of 46.55%. 33.33% of carers with satisfied with social services, similar to the England average. This indicated not all carers were well supported in their care responsibilities, although variation to national averages reflected the deep inequalities in the local authority’s central London location. The local authority stated 36.30% of unpaid carers were retired, which accounted for higher levels of unpaid carers not in paid employment. Additionally, Southwark was in the 98% percentile nationally for income deprivation affecting older people, and Southwark residents experienced disproportionate costs of living in inner London.

In April 2025 2 people were waiting for a carer assessment, with a median wait time of 25 days and maximum wait of 38 days. At the time of our assessment there were no people waiting for a carer assessment. However, some unpaid carers we spoke with said they had not received a carer assessment despite some providing unpaid care for a long time. Unpaid carers also reported mixed experiences about understanding carer assessments and accessing available support such as respite care, direct payments and short breaks. Some unpaid carers also highlighted concerns with delays to carer assessments, for which they had to submit follow-up applications. This indicated divergent unpaid carer experiences compared to the local authority’s wait time data.

There were multiple access points for unpaid carers to seek support, including an online referral form, telephone and email to different teams. Carer assessments were completed by local authority staff, not the commissioned provider. The local authority’s website published the referral routes to different teams, but this was potentially confusing as the carer would need to know which service was responsible for the person they cared for.

Staff told us unpaid carers’ needs were assessed in a way that ensured a person-centred and supportive process. Carer assessments were completed according to people’s needs, by telephone or in-person. There was an option to complete it separately to the cared for person’s assessment. The local authority funded and supported local organisations to provide support to unpaid carers and offered equipment and training to help them carry out their caring roles safely and effectively.

Some unpaid carers told us staff were kind and empathetic towards them, although some unpaid carers told us they often felt unheard, the local authority did not sufficiently understand their caring role and support needs, and it was difficult to reach the right team. Many were unaware what services were available to them, and some did not know how to access support. However, local authority data showed since July 2024 its approach to improving awareness of carer support and information advice and guidance (IAG) reached 22,766 residents with caring responsibilities through targeted advertising campaigns. This exceeded the 2021 census data which showed approximately 18,000 residents provided some form of care. Local authority data also showed 977 unpaid carers received weekly online support including e-courses and the peer online community hub through a mobile app and website. The targeted advertising resulted in an 119% over achievement of the expected rate of unique new users accessing IAG online pages and an estimated 2555 new users as of July 2025. There was a 28% overachievement of expected targets for residents accessing full support, such as coaching programmes and e-learning modules.

The local authority had an unpaid carers policy and a dedicated joint strategic needs assessment (JSNA) for unpaid carers which documented current and future demand for unpaid carers including unmet needs. These were co-produced with local unpaid carers and representative organisations. The local authority acknowledged the need to increase the volume of carer assessments, improve mental wellbeing of carers, integrated support plans between NHS and ASC for the cared-for person, and publish an inventory of local carer support. The local authority worked with health partners to develop a carers’ charter and carer passport to improve the pathways and experiences of unpaid carers navigation the healthcare system. The local authority had also worked with partners and to develop a more inclusive and accessible preventative offer for families to avoid the need for statutory intervention and more specialist services. The local authority’s targeted short break offer increased significantly from 2021-2024 with a 300% increase in the number of individuals accessing targeted short breaks support. This demonstrated the local authority was aware of challenges carers faced and had strategic plans and actions to address them.

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. The local authority identified people with care and support needs that were not being met. As part of the assessment process, people whose needs did not meet eligibility criteria for formal support were signposted to information and advice to support their needs and prevent, reduce, or delay the risk of requiring further specialised support.

The local authority signposted people to non-statutory services for help with their non-eligible care and support needs, including commissioned VCSE organisations which bridged the gap for people who were not eligible for a funded package of care. They provided low level support such as information, advice and guidance, befriending and companionship, warmer homes support and income maximisation advice. Staff were confident in their knowledge of available services in Southwark, which enabled them to signpost people to appropriate support. Staff accessed a shared document which contained an up-to-date list of local services and contact details.

The local authority published an online advice booklet for people about cost-of-living support. This included information about a wide range of local financial support and advice organisations and grants to help people struggling financially. It included money advice, local food and clothes banks, community warm spaces, and help with energy bills and household costs, and links for support with mental health and finding employment. It also included eligibility criteria information for accessing support. These services were offered in partnership with voluntary and community organisations.

The local authority applied documented eligibility criteria to decide whether people and unpaid carers were eligible for care and support. Eligibility criteria were in line with national legislation and guidance and accounted for people’s fluctuating needs. Eligibility did not require formal diagnosis. People with urgent needs prior to assessment were referred to preventative interventions such as universal services, reablement, equipment or minor adaptations, which did not require eligibility decisions until the outcome of the intervention.

The local authority had a right of appeal process for people who wished to challenge eligibility decisions, aligned with its complaints procedure. In the year up to August 2025 the local authority received 14 appeals relating to a range of concerns including charging disputes, eligibility decisions, and dissatisfaction with the services provided. Of these appeals, 5 were not upheld, 3 were partially upheld, 2 were withdrawn, and 1 was fully upheld. The remaining 3 cases were still under review at the time of our assessment.

National data from the Adult Social Care Survey June 2024 indicated 69.34% of people did not buy any additional care or support privately or pay more to 'top up' their care and support, slightly better than the England average of 64.39%.

Frontline staff told us they always provided people with an explanation of eligibility decisions and referred people to community resources such as wellbeing and disability hubs if they were not eligible for local authority support.

The local authority’s framework for assessing and charging adults for care and support was clear, transparent and consistently applied. Decisions and outcomes were transparent and most financial assessments were completed in a timely way.

The local authority charging policy was in line with relevant legislation and financial regulations. It included definitions, charging principles and an online care charge calculator to help people understand their potential contributions. It included clear information about the financial assessment process, thresholds for financial assistance, and contact details for external organisations to direct people to financial support and advice. The local authority also provided an easy-read leaflet to support people’s understanding.

The local authority’s financial assessment team visited people in their homes and held drop-in clinics to explain the assessment process and answer questions about charges and contributions towards care and support. Staff applied the local authority’s ‘rightfully yours’ approach to support people to maximise their eligible welfare benefits. The local authority provided people with a copy of their financial assessment within 10 working days of completion. The local authority also conducted annual financial assessment reviews to ensure people paid the correct contributions. People gave positive feedback that the financial assessment team was understanding, helpful and acted with kindness.

 At the time of our assessment 16 people were waiting for a financial assessment, with a median wait time 84 days and a maximum of 134 days, against a local target of 28 days. Senior leaders attributed the longest delays to people not engaging in the financial assessment process, as was the case with the longest wait.

The local authority's fairer contributions policy recognised its responsibility to support vulnerable people and assess how much they could afford to contribute towards the costs of their care and support needs. Where a financial assessment was not possible or disproportionate, staff completed a ‘light touch’ financial assessment. Staff worked with advocates and individuals with legal authority to make financial decisions on behalf of people without capacity to make an informed decision.

The local authority's personal budget policy provided comprehensive guidance to meet people’s eligible Care Act needs. It outlined what people can expect after they have been assessed as eligible for care and/or support, the different ways they can choose to organise their care, an overview of financial contributions, and a list of related local documents and national policies that a person, carer, or practitioner might also find helpful. The local authority had a right of appeal process for people who wished to challenge the amount they were expected to contribute.

An advocate can help a person express their needs and wishes and weigh up and make decisions about the options available to them. They can help them find services, make sure correct procedures are followed and challenge decisions made by local authorities or other organisations. The local authority had a commissioned advocacy provider in place which supported people to access statutory and non-statutory advocacy and independent advice and guidance. Statutory advocacy covered Care Act assessments, Independent Mental Capacity (IMCA), Independent Mental Health and NHS/social care complaints to support people to be as fully involved as possible in decisions about their care.

Timely, independent advocacy support was available to help people participate fully in care assessments and care planning processes. Staff reported good access to advocacy which they used as and when people needed this. They told us the advocacy service was accessible and responsive and there were no challenges ensuring advocates were available when needed. Staff had a good understanding of the importance of advocacy services and told us having an advocate present ensured assessments were person-centred and the views and wishes of the person were heard. For example, staff involved advocates to support best interest decisions for people with cognitive decline.

People’s records showed advocates involved in care planning and best interest decisions. There was evidence of good partnership working between adult social care, health, support workers and advocates to achieve the best outcomes for the person. Advocates supported people to express their needs and wants and what they would like their care and support to look like. Feedback was sought from people, their families and carers about whether the advocacy service was appropriate and achieved the desired outcomes.

The commissioned advocacy provider described a good working relationship with the local authority which had led to increased referrals for support. The provider shared that local authority staff understanding of advocacy was variable but improving. For example, there were instances of confusion between Care Act advocacy and IMCA referrals. There was improvement in timeliness of referrals and there were no delays for Care Act or IMCA advocacy. The advocacy provider held awareness raising sessions with local teams to improve staff understanding of advocacy processes and responsibilities.