St Helens Borough Council: local authority assessment
Overall summary
Local authority rating and score
Quality statement scores
Summary of people's experiences
In 2024 St Helens developed a new Adult Social Care Strategy – Enabling People to Live Healthier, Happier Lives (2024-2027), coproduced with people who had lived experience of using services.
People told us they felt their voices were heard as part of the Care Act 2014 assessment process. People didn’t feel rushed when making important decisions about care and support and were provided with choices and access to advocacy to help them make informed decisions. People felt frontline staff worked positively with them to achieve agreed outcomes, and support plans reflected agreed actions which had meaningful impacts on their lives.
Unpaid carers told us assessments were person-centred, strengths-based, and focused on promoting independence and giving people control over their daily lives. Unpaid carers valued the support they received, including respite options, peer support from other people with lived experience of caring, and signposting to advice, information and social contact opportunities. All unpaid carer assessments included information on direct payments and support in how to use them effectively, however this was not always the case for people using services.
People said the Contact Cares service (the front-door function for access to all St Helens Adult Social Care services) was easy to access and provided information and advice as well as urgent support when needed. This service was also used to allocate more complex work to frontline social work teams, and people told us waiting times were reasonable, with contact made to ensure they were safe whilst waiting. People told us hospital discharges were supported by local authority staff, with a ‘Home First’ approach to discharge promoting independence, including using mobility aids, adaptations and assistive technologies.
In addition to the Contact Cares service, people told us information and advice focused on people’s rights and ways to meet their care and support needs, including for unpaid carers and self-funders was available via local community centres and via the local authority’s website. However, feedback was mixed in how accessible information was to those with protected characteristics such as people with sensory impairments and those who faced barriers to accessing technologies such as older people and people struggling with the cost of living.
People told us the local authority understood the care and support needs of the local communities and worked closely with partners to provide services to meet those needs. Whilst people felt there was good access to homecare services and residential care, more complex support services, around mental health and complex dementia needs, were less accessible. People said this led to delayed hospital discharges and reduced choice in service provision.
Partnership working between integrated health and adult social care services was seen by people using services as well developed, with St Helens working hard to bring people back locally from out-of-borough placements if it was what they wanted. People gave us mixed feedback about their experience of transitioning from Children’s to Adult services.
People told us there were effective safeguarding processes in place to keep vulnerable people safe when concerns were raised, however not everyone who used adult social care services felt safe. Wider community issues around mental health, self-harm, domestic abuse, and suicide rates remained the main area of people’s concerns, with the cost-of-living crisis leading to increased unemployment, homelessness, and drug and alcohol abuse in the Borough.
People said they appreciated the local authority’s work towards coproduction and improved engagement with communities and people with lived experience. There was positive response around the supported employment scheme, and a recognition the new Partnership Boards had the potential to put people at the heart of the local authority’s strategic decision making. Frontline staff were seen as competent, well-trained, compassionate and caring, whilst senior leaders were felt to be accessible and open to challenge.
Summary of strengths, areas for development and next steps
Senior leaders in St Helens were committed to supporting adult social care, in recognition of the wider determinants leading to the need for interventions, services and support. In response to an understanding of people’s complex lives, stemming from deprivation and cost of living concerns, Council leaders and the wider Cabinet agreed several strategies across directorates in 2024 to focus on preventative strategies to tackle the longer-term impact of inequalities within the Borough.
The local authority worked closely with Cheshire and Mersey ICS to support a place-based approach to integrated commissioning across health and social care. The Executive Director for People (Adults, Children’s, and Public Health) was also the NHS Place Director which enabled integration, governance, and commissioning arrangements, as well as integrated decision making. The Place Leadership Team (PLT), Executive Management Board (EMB), and the People’s Board (Health and Wellbeing Board) all supported a collective ambition to encourage people to live healthier lives through commissioning preventative services to meet the needs of the population. Strategic decisions were made collectively through weekly meetings of the integrated senior leadership team.
There was a clear strategy on integrated Contact Cares services as the focal point for all health and adult social care integration, offering a broad range of services focused on prevention and integrated activity, managed by St Helens Integrated Place and Social Care Directorate in partnership with Mersey and West Lancashire Hospital Trust and Merseycare.
Care Act 2014 assessments were underpinned by the St Helens Practice Model, a bespoke, strengths-based approach to assessments launched in March 2024 and influenced by trauma-informed practice and locality-working. This approach also incorporated an ‘ABC Discussion Model’ designed to guide staff as either a prevention discussion, looking at alternatives, a crisis discussion looking to restore balance, or a discussion about longer-term services intended to establish and maintain connection to the locality.
The St Helens Practice Model, combined with a Home First approach to hospital discharge and an integrated Urgent Community Response (UCR) and Emergency Duty Team allowed Contact Cares to respond to risk within 2 hours, with complex care referred on to frontline teams following triage.
St Helens supported approximately 15,000 unpaid carers via the voluntary and community sector, completing statutory carers assessments on behalf of the Council as well as providing advice, information, and support for carers alongside respite services to reduce carer stress. National data provided by the Survey of Adult Carers in England (SACE) in 2024 showed 72.80% of unpaid carers in St Helens found it easy to access information and advice. This was a positive variation from the average for England of 59.06%.
In addition to the changes in front line practice, senior leaders and partners told us of several key areas of development aimed at improving outcomes for people receiving care and support. As part of a ‘Healthier, Happier Lives’ commissioning strategy within adult social care, coproductive Partnership Boards had been re-established to ensure community involvement in decision making and strategic planning. Each board had several people with lived experience in particular areas of adult social care as well as links to senior managers and the Transforming Care Board. Partners told us co-production was in its early stages in St Helens and needed time to embed.
The move towards locality working was similarly in the early stages of development. Locality working was a joint initiative with the NHS to improve joint working and community engagement across 7 localities, combining resources across Children’s services, Housing, Public Health, the ICB and adult social care. Senior leaders told us of plans to establish 4 Care Communities across North St Helens, Central St Helens, Newton and Haydock, and South St Helens. Care Communities aimed to build on locality working in response to increasing demand for adult health and social care whilst targeting the needs of local communities and build on the focus on early intervention and prevention strategies. However, many staff and leaders were unclear about the locality and care community working vision, or how it impacted on their role.
Direct payments were seen as another area of development within St Helens. Whilst unpaid carers in the Borough had embraced the benefits of direct payments, a 2024 review identified uptake by people 65+ receiving adult social care support services was less effective. This led to a promotion drive both in advertising the benefits of personal budgets, and to improve the understanding of the direct payment function within frontline teams.
People and partners told us the local authority needed to do more to engage with seldom heard groups within local communities as well as improving access to advice and information for those who were digitally excluded, including older people and people with sensory impairments. Senior leaders shared plans to improve frontline approaches to cultural and diversity needs, as well as working on its advice and information offer by embedding the Council’s ‘Live Well Directory’ within community systems and practices. This included local libraries, faith centres, and voluntary and community sector groups.
Partners told us of a lack of nursing care, complex dementia placements and services providing support for people with mental health needs, leading to delayed hospital discharges and an increased use of out-of-borough placements to meet people’s care and support needs. Senior leaders shared plans to work closely with support providers and other partners to improve the capacity of services within the Borough to meet the needs of people with complex lives. A new Market Position Statement had been approved, focusing on locality-based support and an improved Home First offer to ease pressures on more complex services, ensuring people were supported by the most appropriate services to meet their needs.