St Helens Borough Council: local authority assessment

St Helens understood the health needs of the local population and worked closely with internal and external partners to understand current and future service demand in the area. However, whilst the local authority had a good understanding of health inequalities and deprivation in the borough there was less focused engagement and understanding of the social care needs of culturally diverse communities or people with protected characteristics within the borough.

Partners told us the local authority’s approach to prevention and early intervention focused on health inequalities leading from high levels of deprivation. For example, St Helens had key challenges around mental health issues, including social isolation, self-harm, and suicide rates. However, engagement with seldom heard groups and people in the community with protected characteristics was less robust.

Senior leaders told us they took a whole-Council approach to tackling inequalities, using their links to the independent, multi-agency Inequalities Commission to oversee the delivery of commissioned activities and to identify the key changes, interventions, and actions which had the greatest impact on reducing health inequalities. The commission had recently been successful in a bid for support from the Connecting Health Communities programme which was a 24-month facilitation support package to enable cross-sector partnerships to address health inequalities.

Staff and leaders shared the outcomes of the St Helens Annual Inequalities Commission Report (2022-2023) which identified health inequalities between the Wards across the Borough. For example, data for 2016-20 showed there was an 11.8-year difference between the Wards with the highest and lowest male life expectancy (Eccleston at 82.4 years compared to Town Centre at 70.6 years) and an 8.8-year difference in female life expectancy (Billinge and Seneley Green at 84.4 years and Parr at 75.6 years). The ‘Tartan Rug’ was produced to help identify where the need was greatest in the Borough and where interventions could be targeted using a using a colour coding of red, amber and green (RAG) rating of multiple health inequalities identified.

St Helens published 3 individual JSNA reports in 2023 on Mortality, Mental Health and Wellbeing, and Older People. These reports showed the population of St Helens was older than the average for England and Wales. There were fewer young adults in the Borough, while the proportion of 50 to 85-year-olds was slightly higher than the national average. The JSNA data identified 62.7% of the population were of working age, with 20.5% aged 65 or over. Of the 119 neighbourhoods in St Helens, 47 were in the 20% most income deprived neighbourhoods in England. In 2020-2021 hospital admissions due to substance misuse (15–24-year-olds) were the highest in England, and the number of emergency hospital admissions for intentional self-harm were the highest in the North-West.

Staff and leaders told us they proactively engaged with the people and groups where health inequalities had been identified, to understand and address the specific risks and issues experienced by them. In 2021 the Institute for Health Equity were commissioned to identify local priorities and areas of need, with the Institute for Voluntary Action Research supporting 2 community engagement events in 2022.

Partners also shared a number of strategies jointly funded with the local authority to tackle the mental health issues prevalent in St Helens, including a suicide prevention strategy, substance misuse services, and the St Helens Recovery Community which comprised of various organisations offering daily support and multiple initiatives including yoga classes, faith-based programmes and recovery housing.

However, staff and leaders told us the data gathered was not always effectively used to improve the experiences and outcomes for all people who were more likely to receive poor care and support. Engagement around inequalities with seldom-heard groups had been a challenge. Partners felt the data on the demographics of local communities was out-of-date, with the focus being on the health inequalities having most impact on traditional white working-class communities. For example, staff, and leaders told us they were unclear how the local authority engaged with people from LGBTQ+ or trans communities to ensure their voice was heard. There were also small communities of people from Eastern Europe, and a Roma, Gypsy, and Traveller community and refugees, each with their own care and support needs. However, there was little evidence shared with us of how the local authority engaged with these communities under their Care Act 2014 duties. One example showed how a person from the Roma, Gypsy and Traveller community used direct payments to employ a personal assistant.

Senior leaders told us they were working with partners to improve their engagement with seldom heard communities and people with protected characteristics. St Helens had jointly commissioned a Black, Asian, and other Minority Ethnic (BAME) Community Development Group with Halton and Knowsley local authorities. The service provided support to members of BAME communities by raising awareness of information about services and support available in the Borough and signposting people to health and social care services.

Staff and leaders told us the St Helens Transformation Board had recognised the need for changes to future engagement, with the Council providing ‘Embrace’ training for frontline staff. This training supported the recognition of the lived experiences of BAME communities in the region. Senior leaders told us they were looking to develop cultural competency and embed race equality throughout frontline teams by signing up for the Social Care Workforce Equality Standards (WRES). The Director of Adult Social Care (DASS) was also leading on the development of the local authority’s anti-racism strategy with the ambition for St Helens to become an anti-racist borough. The local authority was a member of the Liverpool City Region Race Equality Hub, offering training and employment support to people from BAME communities.

There were appropriate inclusion and accessibility arrangements in place in St Helens so people could engage with the local authority in ways which worked for them. QR codes were used to access videos, British Sign Language (BSL) and easy read versions of information and advice leaflets. However, people with sensory impairments and people who were more digitally excluded, for example older people and those living in more deprived areas, told us they had less access to online information. People and partners told us the local authority needed to do more to engage with seldom heard groups within local communities to ensure people were supported to access advice and support.

Staff and leaders told us they could access translation support through the communications service which provided sign language interpreters, lip-speakers, and deafblind interpreters as well as a range of languages spoken by people whose first language was not English. This service supported Care Act 2014 assessments as well as providing information and advice to people looking for support.

Partners told us the local authority commissioned a provider to support people living with sensory impairments, including a deafness resource centre and a visual impairment team. Technology-enabled care promoted digital inclusion, and people could use direct payments to access communication technology and independence support.

People shared their experience of accessing adult social care services as generally positive. People with lived experiences were able to access co-production forums to ensure their accessibility needs were heard. For example, the supported employment scheme, championed by the Disability Partnership Board, enabled people living with disabilities to return to education, employment, and training.